What If the Government Stops Paying for Sex?

October 25, 2015

Thomas Jefferson had sex with Sally Hemmings. Bill Clinton had sex with Monica Lewinsky. Washington politicians understand sex. So when it comes to healthcare, why do they sometimes seem confused? Why do they not consistently agree to pay for treatments for erectile dysfunction?

Viagra forced the question of whether or not sex is medically necessary. This it did because all of a sudden someone had to write a check to pay for it. Nebraska, for example, found that sex is not medically necessary as it looked at whether or not to pay for Viagra and penile implants

The practical question is what happens as constrained government healthcare budgets lead seemingly inexorably to the contraction of choice and elimination of specific covered benefits. For example, Medicare no longer pays for vacuum erection devices and it seems headed to cutting coverage for prosthetics generally. Put two and two together and it seems very possible that it will one day stops paying for penile prostheses, giving Federal reinforcement to the positions some may want to take at a state level, as in Nebraska. If so, Medicare will be following not only its own momentum and that of states but also of some private payers who do not pay for penile prostheses at all.

What if the government stops paying for patients to be able again to have sex?

The fact is that many services are not covered. Commonly non-covered services include such things as vision correction (LASIK, PRK) and weight loss surgery (gastric sleeve, adjustable gastric band). Penile prosthesis surgery is already largely on this list and may be destined to move from sometimes covered to never covered. So the "what if" is that men who need penile implant will join the ranks of patients who need other non-covered services and be pure healthcare consumers. As such consumers, they will need actionable information about surgeons, services, and cost. 

Our objective is to help patients, payers, and providers navigate the delivery of surgical services. Keeping the patient supreme, the idea is to eliminate waste and start to reframe the healthcare conversation around quality and convenience. In the case of non-covered services, such as is often the case with penile implant, the idea is to develop flat-fee, comprehensive services with clear cost that deliver choices of great surgeons and simple, easy access unfettered by mysterious financial surprises and aggravation.

Why? Because it's not enough to leave patients to fend for themselves. Our task as a civil society is to do everything we can to help the sick, hurting, and dying access high quality care. In future posts, we will detail how patients with penile implant surgery have benefited from practical healthcare reform and how their experience can help to guide patients, surgeons, and payers to a more efficient and harmonious relationship. We will illustrate how the experience with penile implant surgery informs the optimization of care delivery generally.

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