All Health Care Costs Are Not Created Equal

The mandate that health insurance begin covering birth control has been one of the more controversial aspects of the Affordable Care Act.  Aside from religious objections, cost was cited as the major concern.  There were complaints from individuals and employers who didn’t want their premiums increasing as a result of the expanded coverage.  News articles and opinion pieces on the birth control mandate were everywhere for months.

Now, there’s a new coverage mandate coming out of the Affordable Care Act for 2015.  It’s getting comparatively little press, but in general, the reaction has been positive.  I’m speaking of the requirement that private insurers must cover annual chest CT scans for smokers (and high risk former smokers) to screen for lung cancer.  Medicare was not required to provide coverage in 2015, but recently elected to do so.

I want to make it clear that I support this coverage.  I’ve lost three family members to lung cancer, and have another currently in treatment.  It’s a horrible disease, and the prognosis is grim unless it is discovered early… typically before symptoms would become evident.    I’m not writing this to disparage the policy, but to point out the discrepancy in people’s reactions to the cost.

Insurers will pay about $240-$750 annually per patient for lung cancer screening.  That’s only for the scan itself, not any resulting additional studies such as biopsies or follow up scans for ambiguous findings.   Yet the voices that so stringently cried out against the costs of the contraception mandate are quiet now.  This despite the fact that the IUD placement decried as “too expensive” has a similar per patient cost, but lasts 5-10 years.

When it comes to lung cancer screening, the financial focus is primarily on the benefit.  The overall cost of healthcare will be reduced because of earlier treatment and diagnosis.  That is, indeed, positive…but the exact same logic applies to birth control and unintended pregnancies. While the annual cost of lung cancer treatment (about $60,000) is greater than the cost of prenatal/maternity care ($18,000-$27,000 by this estimate), the population affected unintended pregnancy is significantly larger.  There are roughly 200,000 cases of lung cancer diagnosed each year, compared to over 3 million unplanned pregnancies.  The reduction in health care costs from contraception coverage is potentially far larger than lung cancer screening.

The difference in tone also strikes me as ironic, since sex has health benefits (along with some risks) and smoking is generally recognized to be an unhealthy choice.  But there’s no outrage here, no conservative shock jocks lashing out at the smokers who will benefit from this service.  No one is questioning the choices those people made in an attempt to deny them care.  In general, people are responding rationally, logically and calmly to a policy change that will ultimately save money and improve lives.  I can only hope that someday, people will be able to see contraception coverage in the same light.


  • dizzygirl
    January 5, 2015

    It’s obvious that the debate over coverage of birth control isn’t about cost, no what what they say. It’s about control. Great article.

  • Frank
    January 17, 2015

    My partner, who has never smoked in her life, was just diagnosed with stage IV lung cancer. So we are paying for screenings for smokers but doing nothing for the non-smokers who get this cancer? Half or more of lung cancer cases are in non-smokers and they are often only detected when they have metastasized.

    Sorry if you mainly are interested in BC but the horrible effects of lung cancer and underinvestment in earlier detection in non-smokers has hit me personally.

    • Lunabelle
      January 21, 2015

      It’s an awful disease, truly. I am so sorry that you and your partner are dealing with this, and I hope that there are more advances in early detection for non-smokers.

  • RynJ21
    February 8, 2015

    Excellent point!

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