Sungold of Kittywampus has an interesting post up about reconstructive surgery after breast cancer vs. prostate cancer. I’d like to excerpt the whole thing but I’ll pull out the relevant bits as best I can.
According to Nate Jenkins at the AP, the state of Nebraska has decided that there’s no need to help men who are struggling with erectile dysfunction. It already stopped Medicaid payments for Viagra and related drugs when the federal government did the same in 2006. Now it’s excluding penile implants from Medicaid coverage as well.
From patient accounts that I’ve read, the erection resulting from the implant feels natural and pleasurable to both partners. Most of the men who have an implant wonder why they didn’t get the surgery sooner.
...
[A]part from the cringe factor, this is what they’re up against:
State Medicaid director Vivianne Chaumont said the change is consistent with a federal rule, approved in 2006, that barred the federal government from spending Medicaid dollars on erectile dysfunction drugs including Viagra. Nebraska followed suit a few months later and changed its rules to keep state Medicaid money from being spent on the drugs.
The federal government will still help pay for penile implants in states that choose to continue covering the procedure under their Medicaid plans.
Medicaid is meant to pay for the medical necessities of needy people and “sex is not medically necessary,” she said.
Do I even need to enumerate what’s wrong with this? ...
The ruling is also blatantly sexist. The state Medicaid program covers breast reconstruction, as most private insurers are required to do in accordance with federal law. Where’s the difference? Again, from the AP:
Chaumont, who moved to Nebraska about a year ago to take her current position, said she didn’t know why the decision was made to cover breast reconstruction under Nebraska Medicaid but added that it didn’t strike her as unreasonable.
“I don’t think breast cancer has anything to do with sexual dysfunction or sexual impotence,” she said.
I’m always uncomfortable when breast cancer and prostate cancer get pitted against each other. Both deserve adequate – no, generous – funding. It should never be a zero-sum game. And in this case, there’s no conceivable reason to cover one but not the other. Breast cancer has effective advocates. Prostate cancer remains largely in the shadows. That’s the only real difference.
...At bottom, Chaumont is enforcing the idea that sex is optional and probably downright icky or evil. That sex is not for people who are aging or ill (even if an increasing number of prostate cancer patients are in their 40s and 50s). That sex is not a part of mental health. She doesn’t give a shit that their partners suffer nearly as much from the loss of marital “delight.” But what gave her the right to impose her own anti-sex views on Nebraskans who’ve had the double bad luck to be both poor and seriously ill?
What’s next? Will the state of Nebraska refuse to subsidize walkers or canes on the theory that walking is not a medical necessity? You can stay alive without walking, chewing, seeing, or fucking. And you can survive for decades without using your higher brain functions, including logic and empathy, as Chaumont’s decision proves. It seems that even thinking is not a medical necessity.
I’ve been interested in medical side effects that inhibit libido or sexual function, especially in men, for quite a while. Our narratives of men as the “sex class” are so pronounced that, as Sungold says, men who suffer such calamities often vanish from sight. (By some accounts the Bible forbids them going to church!) There’s even a pretty strong tradition, thoroughly embedded in the “no-sex” class by the way, that Viagra and penile implants are of interest only to men and that their partners have no, zero, none investment in their partner’s sexual functionality. And as I’ve mentioned elsewhere several times recently the issues is further complicated by sexist/ageist bias: menopausal women who are still interested in sex have been standing objects of derisive humor for generations.
Anyway, great post by Sungold about a topic we really should be having a lot more conversations about.
Submitted by 2247 (not verified) on Thu, 2008-06-19 21:18.
You're not too far off base with your canes and walkers concern. Medicaid has already decided that work is not a medical necessity and participation in life activities outside the home is not a medical necessity, so wheelchairs for use outside the home are not a medical necessity. Private insurers have followed their lead. This means most of us cannot get equipment we need at all or must get very substandard equipment at personal cost.
There's legislation in the distance to change this, but it's at a very great distance. In the meantime, even many quads are being turned down for wheelchairs. But yes, women can get breast reconstruction. (Steaming.)
I'm not so sure it's so much sexism as government and insurance unwillingness to help anyone without a strong enough lobby or perhaps a greater willingness to screw over the people who most need help.
[Yikes, B! It's pretty grim when tongue-in-cheek bitterness becomes public policy! --fl]
Submitted by 2247 (not verified) on Fri, 2008-06-20 09:56.
Thanks, figleaf. I was steaming about this too, so I'm grateful for your spreading the word.
b - I'm shocked but not surprised that Medicaid is sees mobility as unnecessary. If you define "medical necessity" as "that which is required to prevent imminent death," then you really can save a bundle on your budget. The human costs and the greater long-term financial costs to society don't enter into that calculation. The implant example is overdetermined, I think, because this sort of cost-cutting rationale intersects with an anti-sex mindset.