The commentator Bill O’Reilly weighed in on the Sandra Fluke/contraception controversy by saying that Fluke, while sincere, represented the growing “entitlement” culture in the United States, those people who believe that they should receive “free contraception” through their insurance. Like O’Reilly, I’ve expressed concern about the “entitlement generation,” but unlike him, I don’t see contraception as anywhere central to the issue, except as a way for O’Reilly to come out against it without directly taking on a lot of very angry women.
I’d be the first to admit that I’m concerned about a generation that feels “entitled,” but, unfortunately, entitlement feelings aren’t limited to one generation, although I’ve observed that those feelings appear to be more widespread in younger generations. I can still remember the anger of an older American some thirty years ago when I tried to point out that he received more in Social Security benefits in one year than he’d paid for in his entire working life [this was generally true of all recipients prior to the mid-1960s, and has become less and less so with each passing decade]. He was furious, because he’d paid Social Security taxes his entire working life and was “entitled” to those benefits. We see this today with Tea Partiers, who insist that Social Security and Medicare are not government programs or pay-as-we-go tax transfers only partly backed up by a “trust fund,” and who claim they’re entitled not to have their benefits reduced. And there are more than a few documented and recorded cases of food stamp recipients claiming food stamps as an entitlement.
But to claim that insisting that birth control medications [which are also used to treat a number of other health conditions having nothing to do with contraception] is an untoward manifestation of “entitlement” either goes too far or not far enough. Viagra and Cialis and other erectile dysfunction drugs are covered. Which is a greater manifestation of entitlement, birth control and prevention of unwanted pregnancies or male pleasure? [After all, most of the men who need those medications aren’t in the child-rearing age brackets, anyway]. And what about the “entitlement” of smokers to cancer, respiratory, and heart care treatments and surgeries? These are people who have chosen to indulge in a habit that is proven to create huge long-range health care problems. Why are they, in O’Reilly’s calculus, any less members of the “entitlement” generation, claiming they’re entitled to insured health care when they’ve spent a lifetime knowingly destroying their health? And what about extreme sports enthusiasts who knowingly endanger their lives every time they indulge their pastimes… and in several cases have caused the deaths of would-be rescuers? Are they entitled to rescue that can endanger their rescuers?
All of this debate also obscures the entire basis of insurance, which is the pooling of risk by including a broad range of individuals and covering them over time. Some people have almost no claims, excepting routine check-ups or minimal procedures, over their entire lifetimes. Others, with exactly the same backgrounds and habit patterns, may have huge ones. The wife of a relative suffered a brutal and expensive and eventually fatal form of lung cancer, although she’d never smoked, never been exposed to second-hand smoke, was in perfect health, and a trained athlete. That’s one reason why we have insurance, to deal with the unexpected. And there is a good reason why insurance covers check-ups and diagnostics – and that’s to prevent worse and more expensive treatments. Unwanted children are a huge burden on society, and no matter what any of the pro-life people say, they and the private sector aren’t the ones picking up those very real costs, not only in terms of straight medical costs, but also in life-long social costs. Government at all levels bears those costs, and isn’t that a form of “entitlement”?
What O’Reilly appears to be saying is that only some entitlements are justified, and in that case, I have a huge problem with his choice of what’s “entitled,” because it’s just another instance of declaring that government regulations should only support “my” beliefs under the guise of a semi-rational argument.