Contraceptives should be classified as preventative health care for insurance coverage
For the purposes of this debate, a contraceptive is a device or drug serving to prevent pregnancy.
The debate will have 4 rounds:
1 - Acceptance/Intro
2 - Opening Argument
3 - Rebuttal/Continuation/Clarification
4 - Closing Statement
This is my first debate on DDO but I am an experience debator. Thank you and good luck.
Because of the sometimes astronomical cost of health care, the Affordable Care Act includes a new provision that makes many preventive services available patients. These services will not require co-pays or deductibles, and will apply to both self-inusured and fully insured plans.
Among these preventative services are FDA-approved contraceptives for men and women, with some restrictions. This provision was included as a way to drive down costs, to reduce pressure on overburdened systems, and to remove cost barriers - ensuring that more women maintain access to preventative health care. 
Only half of Americans have historically sought health care as a normal preventative measure, and this has driven up medical costs in the US exponentially.  Additionally, women's health care needs in particular can be difficult to meet, especially in relation to reproductive health, where the health of an infant may be necessarily included. 
Hopefully, this debate will help to explain some of the reasons for including preventative health care and reproductive health care in particular, as part of any new health care reform laws. I look forward to an interesting exchange!
For the record, this is a link to a DDO Opinions section that covers this subject: http://www.debate.org...
Hi Beverlee! Thanks for accepting this debate. I just want to clarify that the scope of this debate is strictly on whether all contraceptives should be classified as preventive care, not preventive care in general nor reproductive health, which has a larger scope than just contraception.
For the purpose of this debate, I am defining preventive care as "a pattern of nursing and medical care that focuses on disease prevention and health maintenance. It includes early diagnosis of disease, discovery and identification of people at risk of development of specific problems, counseling, and other necessary intervention to avert a health problem. Screening tests, health education, and immunization programs are common examples of preventive care."(1)
Preventive care consists of two basic functions:
1. disease prevention
2. health maintenance
Some common methods of attaining said functions are:
1. Screening and early diagnosis/identification
2. Education and counseling
3. Proactive prevention methods such as immunizations
As you can agree, that is a pretty broad definition and there are definitely some aspects of contraception that can fall into preventive care. However, contraceptives as a whole does not meet the definition of preventive care. FDA-approved methods of contraceptives are "hormonal (e.g., birth control pills), barrier (i.e., diaphragms), emergency contraceptives (i.e., "morning after" pills) and select over-the-counter (OTC) contraceptives."(2) "Certain OTC contraceptives for women are covered at 100 percent including female condoms, emergency contraceptives (Next Choice", Next Choice One-Dose", Plan B One-Step"), and contraceptive film, foam and gel."(3) I will structure my argument around the function of preventive health care and relate it to the 3 FDA-approved functions of contraceptives (as OTC contraceptives fall into one of those three categories).
A. Disease Prevention
One type of barrier contraceptive (condoms) does assist in preventing the spread of Sexually Transmitted Diseases (STD). However, that is just a secondary function. I will argue that STD prevention is not a critical objective for preventive health care, the primary purpose of contraceptives is not disease prevention, and the decision to have sexual relations is a privilege, not a right.
Point 1: STDs are not considered a critical objective to preventive health care
I would like to highlight some diseases on the CDC website for Preventive Screening recommendations by the U.S. Preventive Services Task Force (USPSTF):(4)
1. Alcohol Misuse
2. Chlamydial Infection
3. Hepatitis B only for pregnant women
4. HIV only for high risk persons
5. Obesity in Adults
6. Tobacco Use
Hep B and C are on the list but the USPSTF only recommends Hep B screen for pregnant women and does not recommend or is neither for nor against screening for Hep C. Also, there is a distinct absence of other STDs, such as gonorrhea, meaning that STDs, in general, are not considered part of the preventive care regimen.
Point 2: The primary purpose of contraceptives is not disease prevention but pregnancy prevention
See definition of contraceptive. Also, the majority of FDA-approved contraceptives (hormonal, barrier other than condoms, and emergency) do not prevent disease. "The condom is the only form of birth control that also protects against sexually transmitted diseases, including HIV (the virus that causes AIDS)."(5)
Point 3: Sexual activity is a choice, thus the use of condoms is a responsibility, not privilege
The decision to be sexually active is a privilege, not right. In fact, abstinence is the only way to prevent the spread of STDs.(6) Just like purchasing care insurance, the cost of condoms for the purposes of STD prevention is the responsibility of the individual. While I fully agree that counseling for obesity or tobacco use should be included as preventive health care, the cost of tools such as gastro-bypass surgery and Nicotine patches are NOT covered by most preventive health care insurance nor required by ACA as preventative coverage. Review the Cigna Preventive Drug List and there is no category for weight loss or tobacco cessation.(7) Therefore, counseling and education on STDs should be covered by preventive care but not contraceptives such as condoms.
I do not support full coverage of condoms under the guise of preventive health. Like the cost of maintaining a healthy lifestyle (gym membership, more expensive organic foods), using a condom is a personal responsibility.
B. Health Maintenance
This will probably be a greater point of contention in this debate as there are direct health benefits to the use of some contraceptives for specific individuals. I will argue that contraceptives as a whole do not promote health maintenance because only a few hormonal contraceptives help regulate health in specific circumstances and the use of contraceptives may actually be a health detriment.
Point 1. Contraceptives used for health maintenance is limited to specific circumstances and types
Oral birth control pills can help regulate numerous issues such as acne(8), premenstrual dysphoric disorder (PMDD) (a debilitating form of PMS)(9), ease menopausal symptoms/discomfort(10), and even help prevent osteoporosis(11). However, each of these are only representative of a select group of hormonal contraceptives and health situations. Not all hormonal contraceptives are helpful in each of these specific cases. Other contraceptives have no bearing on an individual's health whatsoever. For the sake of clarity, becoming pregnant is not a health maintenance issue for a normal, healthy woman.
Point 2. Use of contraceptives can actually be a health detriment
According to the World Health Organization, "the birth control pill increases a woman's risk for cancers of the breast, cervix and liver, but it decreases risk of endometrial and ovarian cancers."(12) Additionally, hormone imbalance is an issue where women may experience "anxiety, loss of appetite, insomnia and lack of concentration...sudden weight gain, a reduced sex drive, hot flashes and night sweats"(13) While there are several factors that can contribute to hormonal imbalance, "more commonly, medication such as birth control pills can also throw off your body's chemistry."(14) Other potential side effects of oral contraceptives "may include severe abdominal pain, chest pain, unusual headaches, visual disturbances, or severe pain or swelling in the legs"(15) as well as "sexual, metabolic, and mental health consequences."(16)
Contraceptives were never designed to be a health maintenance tool. I would support the limited use of certain oral contraceptives to assist in regulating hormones as a preventive health resource, but not all contraceptives in general.
(2) http://www.uhc.com..., Page 1
(6) http://www.webmd.com...; last bullet: Consider that not having sex is the only sure way to prevent STDs.
Thanks for the debate so far. We will have to stick to the schedule and scope that we agreed to in the first round. That means that CON will "be arguing that contraceptives should NOT be classified as preventative health care for the purpose of insurance coverage," and I will be arguing that "Contraceptives SHOULD be classified as preventative care for the purpose of insurance coverage."
The ACA includes an amendment that seeks to increase access and reduce cost barriers to very basic family planning and women’s health services. These services will be needed by every healthy woman at some point in her life.
Contraception and reproductive health care cannot be removed from the larger topic of women's health care. Every woman will require some form of these services throughout her reproductive life in order to prevent unintended pregnancies and related health care needs.
According to the US Department of Health and Human Services, some 71 million Americans will benefit, or have already benefited, from preventive medical procedures without cost sharing burdens thanks to the Affordable Care Act. Many of these Americans are women, who may now qualify for pregnancy postponement options that might have otherwise been unavailable to them. 
This is important, because unexpected pregnancies are the leading factor in elective abortions, and play an outsized role in the rate of miscarriages that occur each year. Almost half of all pregnancies are unplanned. 
Why should family planning services be classified as Preventive care?
The purpose of contraception is to prevent unwanted and unintended pregnancy, and the related health impact and costs. The preventive nature of contraception makes this area the most common-sense form of classification.
What associated medical conditions can proper contraceptive use prevent?
Postponing pregnancy can benefit public health in important ways. Some of these benefits include creating better opportunities for families to prepare for an ideal pregnancy, helping to prevent fetal and infant illness, and a greatly reduced likelihood of abortion. Women who cannot afford to provide a healthful environment for their offspring benefit the most from low-cost, safe pregnancy prevention.
Proper family planning can help women have healthier babies, healthier pregnancies and improved postpartum health. These provisions can also prevent some very serious medical costs and conditions later. These medical concerns can pose a very serious risk for newborn infants and mothers alike. Although healthy women can benefit greatly from pregnancy postponement and reproductive health care, women who may be unable to deliver a full term baby safely will also benefit from preventing the potential medical consequences of pregnancy.
Preventive reproductive women’s health services can help to reduce the high costs of unintended pregnancy in at-risk populations. Although these costs are economic and social as well as medical, it is the medical toll that is most relevant to this debate. Some of these potential consequences are low birth weight, poor fetal development, exposure to harmful substances (because the mother was unaware that she was pregnant), infant death in the first year after birth and insufficient resources.
According to the Centers for Disease Control, contraceptive availability and other preventive care is essential to women’s health at times when pregnancy would create unaffordable health care costs, improper infant nutrition or exposure to harmful substances, since about half of all pregnancies are unintended.  The CDC goes on to report that contraceptive use helps to prevent 188 million unintended pregnancies and therefore, some 1.2 million newborn deaths, and 230,000 maternal deaths worldwide. 
Although some forms of birth control can be helpful in preventing the spread of STDs, the primary function of contraception is to prevent pregnancy and associated health effects. Preventing the spread of STDs and other communicable diseases, such as the cold and flu, is not directly relevant to a debate on family planning and women’s health care.
Thanks for your well-thought out opening argument. I would like to address some of your points with comments.
"Contraception is not only critical to the health of women, but also crucial for healthy pregnancies and babies. Contraceptives play an important role in helping to ensure that more pregnancies are planned, provided for, and healthy."
It is difficult to have this discussion as it appears we do not have the same definition of preventive care. In my opinion, being pregnant is not a health problem. One can be pregnant and healthy or not pregnant and unhealthy and vice versa. They are independent of each other. Back to the definition I posted in Round 2, I would like to highlight the key is "necessary intervention to avert a health problem." Contraception is critical to women's health, but should not be classified as a preventive health tool. More on that in my rebuttal/continuation.
"What is covered by the Affordable Care Act?"
"Why was pregnancy prevention added to the new health reform laws?"
This is an ignoratio elenchi. We are talking about whether contraceptives should be considered preventive care. The reasons for inclusion in ACA is irrelevant and do not address the issue of contraceptives as preventive care.
"The purpose of contraception is to prevent unwanted and unintended pregnancy, and the related health impact and costs. The preventive nature of contraception makes this area the most common-sense form of classification."
Again, preventive care is not preventing all health conditions. It is specifically focused on disease and detrimental health issues. Being pregnant is not a health problem nor is preventing pregnancy the goal of preventive care.
"Contraceptives and family planning options are a critical component of women's health, and should be included with other preventive health care options available to families."
I completely agree with this statement. However, it is another ignoratio elenchi. Family planning is not a key component of preventive care.
Rebuttal and Continuation
Being pregnant is a not a detrimental health issue and pregnancy prevention is not a goal of preventive care. Being sexually active is a lifestyle choice. Therefore, the onus to do so responsibly falls on the individual. Going to the gym and working out has great benefits to health. In fact, regular exercise helps to control weight (less strain on joints and bones), combats heart disease, high blood pressure, and high cholesterol (actual health problems that preventive care seeks to prevent/mitigate), improves mental health, and provides more energy and better rest.(1) All of these things fall under the tenant of preventive care, yet a gym membership is not covered under preventive care by insurance companies. Why? Because it is a lifestyle choice and personal responsibility.
Additionally, Pro's argument is specifically focused on women's health, which is understandable as only women can become pregnant. But that effectively ignores half of the population. If contraceptives are classified as preventive health, which would be fully covered without copay, then half of the population is paying for a service (through either taxes or premiums) to which they have no access. Don't get me wrong. Pregnancy prevention is a shared responsibility of both people involved. But because it ignores half of the population is another reason why it should not be classified as preventive health care.
What concerns me about this mindset is that it promotes a culture of a lack of responsibility. Individuals who choose to be sexually active want others to pay for them to be responsible in their lifestyle choice. If I choose to drive without insurance, should others pay for my car to be fixed if I get in an accident? Should I expect others to pay for my toothbrush, toothpaste, and dental floss to ensure that I responsibly maintain the health of my teeth and gums? Better yet, in my example in paragraph one, should I have other people pay for my gym membership so I can work out and improve my health? Where do we draw the line as to what are preventive health issues and problems?
Again, I would like to reiterate that my position is not that contraceptives should not be covered by insurance. It is only that it should not be classified as preventive health care, meaning zero out of pocket expenses. There should be plans that include contraception, just like there are plans that include family planning or dental. But it should be the responsibility of the individual to pay for those additional, and sometimes necessary, services.
Pro cannot redefine the meaning of preventive care or she needs to clarify how she defines preventive care. As is currently presented, in my opinion, she has not adequately addressed why contraceptives should be classified as preventive health care.
Thanks to CON for clarifying the scope of the debate.
So far in this debate, the following areas of agreement have been reached:
CON agrees that insurance companies should cover contraceptives, just not all contraceptives in all circumstances. This is hyperbolic, and is not being argued in this debate.
CON has dropped the contention that contraceptives and family planning should be categorized as part of the preventive care amendment in the Affordable Care Act, saying that he does not feel that it is a relevant point.
"Preventive Care" can be defined as "a pattern of nursing and medical care that focuses on disease prevention and health maintenance. It includes early diagnosis of disease, discovery and identification of people at risk of development of specific problems, counseling, and other necessary intervention to avert a health problem. Screening tests, health education, and immunization programs are common examples of preventive care."
These concessions are important to this debate, because we have settled the issue of whether or not contraceptives are key to women’s health care, are correctly categorized legislatively as “Preventive Care” in the Affordable Care Act, and that insurance companies are justified in providing contraception to their policy holders. I feel that these concessions fulfill my requirements in upholding the resolution.
The fact is, that women must be mature and informed about the decision to become pregnant. Pregnancy is a wonderful part of womanhood, and is a major life goal for most women. However, in order for it to be the safe and healthful event that it should be, it must be adequately prepared for. Otherwise, the consequences can be severe, and can include death for the mother and the baby. According to the World Health Organization, the main causes of maternal death are:
Usafe Abortions (13%)
Obstructed labor (8%)
Other direct causes (8%)
Indirect causes (20%)
Indirect causes, such as anemia, HIV/AIDS and other ailments. all of which may complicate pregnancy or be aggravated by it." 
Considering the potential health risks that can accompany pregnancy, especially unmanaged pregnancies, no argument that suggests that Pregnancy is not a "disease or detrimental health condition and therefore never requires medical care, prevention or postponement" can be credible. The fact is that contraception is critical to controlling the timing of pregnancies, allowing for higher levels of preparation for this important life event. Contraception is critical in averting the serious health problems that can be associated with uncontrolled pregnancy.
As I showed in the previous round, most women who are at risk for unplanned pregnancy are married, since more married women have more frequent sexual encounters than their single counterparts. Attempting to punish these women for having sex with their spouses is a gross violation of the intimate lives of these partners. An inability to control the frequency of pregnancy can cause resources, nutrition and proper care to be divided up among too many children, which can negatively impact the health of the family.
Pregnancy and the related health impacts are prevented by contraceptives, in exactly the same way that flu shots prevent influenza.
The extreme costs of health care make preventive options impossible for almost all Americans without insurance.
Many preventive medical procedures are unaffordable without insurance. For example, mamograms can cost up to $600 ; a colonoscopy can cost as much as $8,500 ; and a pap smear can range up to $200 . To regularly conduct all of these preventive health care measures would be cost prohibitive... which is why the concept of health insurance was created.
Con argues that it is a matter of personal responsibility to pay for one's own preventive health care, and that other people should not pay for your personal upkeep. However, with any insurance plan, other policy holders will "pay" for your claims. In the case of health care, other people will pay for your hospital visits, Doctor's Office visits, and preventive care. And they, in turn, will pay for yours. This is just how all insurance policies work.
"CON agrees that insurance companies should cover contraceptives,..."
It's not hyperbolic as Pro's arguments in Rounds 1 and 2 focused on reproductive and women's health, which has a much larger scope than preventive care. I merely wished to emphasize that I am only speaking in respect to preventive care, not all insurance plans/programs. Given Pro's statements in Round 3, I would have to conclude that she still confuses the two.
"..matter of personal responsibility to pay for one's own preventive health care."
Never said that. This would only be true if you assume that pregnancy is a health problem and should be prevented under preventive care. If that were the case, we would not be having this debate.
"Pregnancy and the related health impacts...in exactly the same way that flu shots prevent influenza."
Are you comparing pregnancy to a disease?
There are many more falsehoods in Pro's Round 3 but I will address them as a group at the end of the Rebuttal section.
Contention 1: Pregnancy may be a health issue (meaning neither good nor bad), but it is not a disease, so it doesn't meet the criteria of disease prevention, nor is it a part of health maintenance, as a pregnant woman can still be healthy. Again, Pro represented the Fallacy of Irrelevant Conclusion. She is confusing potential complications that may arise due to pregnancy with the condition of being pregnant, which, in and of itself, is not a health problem for most women.
Contention 2: Another Ignoratio Elenchi. Whether or not contraceptives allow women a choice is irrelevant to this discussion of preventive care. Let us not confuse things we want to prevent with health problems that preventive care seeks to prevent. Also, I am offended that you think I believe "pregnancy makes women undeserving of medical care." I have said no such thing nor do I even believe that. Then Pro continues to distort my argument with "...it should not be prevented by insurance." I never said contraceptives should not be covered by insurance. Pro even acknowledged that I believe there should be plans that include contraceptives. This contention is an outright lie and personal attack.
All her other arguments stem from the mistaken belief that being pregnant is a health problem and should be covered by preventive care. However, I must object to the tone and implications she made about my personal beliefs. The last half of Pro's Round 3 stems from the Fallacy of False Dilemma. She can only conclude that I want to enforce female chastity or punish sexual activity if the only two options were between full coverage of contraceptives under preventive care or abstinence. Fortunately for all of us, there are other options including buying your own condoms, having your partner purchase the contraceptives, or finding an insurance plan that includes contraceptives. Most States enacted laws requiring contraceptive coverage prior to ACA so they are already available.(1)
Pro's sub-contention addressing health care costs is also irrelevant to this debate. Preventive care does not take fiscal matters into account when determining what should be covered.
a) Pregnancy can have harmful side effects
b) Choice to prevent pregnancy should be available
c) So contraceptives must be covered under preventive care
a) Preventive care seeks to prevent/manage health problems
b) Being pregnant is not a health problem
c) So pregnancy prevention should not be covered under preventive care
Pro's argument is based on the Fallacy of False Dilemma. There are more options than full coverage under preventive care or abstinence. Her a) and b) do not logically conclude c). Her point of view is that there should be cost effective options of pregnancy prevention available for all women. I am in complete agreement with that. However, shoving it into the classification of preventive care is not the answer. Pregnancy prevention does not fit into the description of what preventive care is supposed to do.
Finally, I would like to thank my opponent for a spirited debate, though I object to her distortion of my views and character. I will forgive those transgressions due to her obvious emotional attachment to the very important issues of women's health, reproductive health, and pregnancy prevention. Believe me, I fully support your cause. But it has to be done honestly and morally. Personal responsibility is still important. Thanks for reading and I look forward to any comments from the DDO community.
Contraceptives as Preventive Care
Health care providers, women and insurers all have every reason to prefer contraception over the costs and health impact of unintended pregnancy. Perhaps more importantly, women have every right to ask for the ability to control the timing, spacing and frequency at which pregnancy occurs.
This debate has focused primarily on the potential negative health impacts of mistimed pregnancy, in order to support the view that contraception presents a less expensive treatment option for insurers when compared to managing crises that often result from unhealthy pregnancies. Many other areas of focus had to be ignored, such as the fairness of allowing men to enjoy erectile-dysfunction medication while denying contraception coverage to women, and the very basic right of women to control their reproductive fate. For the record, I personally regret not having had the opportunity to elaborate on this basic human right.
Covered in This Debate
Perhaps surprisingly, considering the potential ranges of topics associated with this subject, this debate has centered on the question of whether or not pregnancy qualifies as a medical condition that might incur costs, and potentially cause negative health effects that should be avoided. For this reason, I will focus on underscoring the arguments made on this aspect of the debate in the final round.
Is Pregnancy a Medical Condition that Might Reasonably Require Medical Care?
Repeatedly, Con has stated that pregnancy is not a problem for women. The truth is far different. In fact, pregnancy is very often lethal for women without medical treatment. Women require competent medical care in order to enjoy a healthful and safe pregnancy. The unacceptably high number of maternity related deaths among women who are unable to obtain such care proves this fact. Con says that pregnancy is not a disease, or a harmful health condition that needs to be managed. However, in order for this to be true, pregnant women require medical attention.
Maternity related death is a major problem for women and newborn infants in regions that lack adequate health care.
http://www.childinfo.org...; /> http://www.debate.org...;
Additionally, even developed nations such as the United States often struggle to control the number of deaths associated with pregnancy.
http://www.cdc.gov...; /> http://www.debate.org...
And the causes of death among pregnant women help to underscore the unavoidable conclusion that pregnancy can cause very severe health consequences that are very likely to require medical care.
http://www.cdc.gov...; />  http://www.debate.org...;
Con repeatedly argues that pregnancy is not a health problem that should be managed or in some cases prevented. However, becoming pregnant is always a serious medical event, and is often fatal. Without modern medical techniques, childbirth would be one of the leading causes of mortality among women. 
Even healthy pregnancies require assistance and incur costs that can be offset by insurance. However, there are many types of pregnancy, and many associated health conditions. Con has never argued that these adverse health conditions should not be prevented.
The Benefits of Preventing Unwanted Pregnancy
Spacing and Timing of Pregnancies
Women must provide adequate intervals between pregnancies in order to prevent a wide range of health problems that can result from spacing pregnancies too close together. Some of the negative health effects of rapidly sequenced pregnancies can include:
Besides pregnancy spacing, contraceptives also allow for controlled pregnancies. A woman who was not intending to become pregnant may not quickly detect her pregnancy, and therefore not provide important health care and nutrition to her gestating baby.
Becoming pregnant is a key life event for most women. Unwanted pregnancies can cause severe depression, triggering inadequate maternal care.
Paternal and Familial Involvement
A critical component of a healthy birth outcome is the involvement level of the child's father and other family members. This involvement provides healthful assistance to the mother (both before and after delivery) as well as the infant.
Benefits to Insurance Providers
In addition to the obvious health benefits of controlled pregnancies, there are numerous cost savings to insurance providers. Despite the fact that comprehensive family planning services such as implants, surgical procedures, self-administered and hormonal contraception may be unaffordable for many individual women, family planning is inexpensive for insurers. This is especially true when we consider that insurance companies will pay explosive costs associated with mistimed, unprepared for, and nonviable pregnancies - many of which can present lifetimes of expensive treatments.
Contraceptives are very effective in preventing these accidental pregnancies, when used correctly.
http://www.guttmacher.org... Source Ref: http://www.guttmacher.org...; /> http://www.debate.org...
Additionally, insurance plan providers have a powerful interest in preventing unwanted pregnancies.The costs of health maintenance during and after a pregnancy are explosive, especially if there are complications associated with that pregnancy. Since half of all pregnancies are unplanned, the cost saving to insurers that might be expected to result from prevention practices offers an overwhelming argument in favor of contraception.
http://www.childinfo.org... Source link: http://www.guttmacher.org...; />http://www.debate.org... 
A Clear Decision
Contraception helps to protect the health of women and babies, as well as serving the best financial interests of insurers and overburdened health care providers.
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