Get Ready to Pay for Domestic Violence Screening and Breast Pumps as Part of Your Mandated Health Insurance Premium

The term “preventive services” has become so elastic that ObamaCare bureaucrats want domestic violence screening and breast feeding counseling and supplies to be added to the list of free services that must be covered by health insurance, thus enriching those who credential the counselors and supply the supplies.

Domestic violence “screening,” consists of having total strangers ask every women whether her husband or significant other threatens or strikes her, whether there is a weapon in the home, whether there is a gun in the home, and whether her significant other is a drunk or uses illegal. The answers will be recorded in the woman’s medical record which will, in due course, be entered into a searchable, centralized database controlled by the federal government.

Health and Human Services points to the National Consensus Guidelines on domestic violence in support of its inclusion on the list of preventive care mandates. The document is cloaked in the usual academic trappings and lists numerous references. Unfortunately, 8 of the 80 references have “screening” in their title. Of them, one is an introductory epidemiology textbook on screening for disease in general, two talk about the prevalence of abuse detected in response to screening questions, one reports that the county hospital in Atlanta, Georgia, appears to be promising as a site for public-health screening for “intimate assaults,” and one is a how-to on screening in pediatric practice which begins  by asserting that “every patient represents an opportunity for the physician to explore the effect of hidden attitudes on the health of the family.”

The general impression is that these particular National Consensus Guidelines reflect a limited consensus of the sort likely to arise a group of advocacy groups with “coalition” in their names are asked what they would like buyers of health insurance to be required to pay for.

Though one wouldn’t know it from the National Consensus Guidelines, the academic evidence seems to suggest that such screenings are a waste of time and money.

Even before ObamaCare was passed, critics argued that it would politicize medical care. This didn’t take any particular forecasting ability. Evidence from around the world shows that when political systems control health care, politicians and bureaucrats divert spending from ameliorating disease, pain, and suffering towards trendy, ill considered, programs that appeal to the worried well. After all, relatively few people in advanced economies are seriously ill and in need of advanced treatment at any one time.

Politicians and bureaucrats also divert funds to special interest groups. These groups often represent people who provide services that they consider of vital importance but are unable to attract much funding when private interests control how money for health care will be allocated. These groups are quick to improve their fortunes by lobbying regulators to pass rules ensuring that they will get their share of the money flowing through the government trough.

Evidence from the latest round of ObamaCare diktats suggests that the process of redirecting health care spending from the sick to the politically well-connected is well underway in the United States. On August 3, the Department of Health and Human Services, the IRS, and the Department of Labor issued an interim final rule, specifying the laundry list of preventive care services that U.S. citizens must purchase when they comply with the ObamaCare individual insurance mandate. The rule is expected to be finalized next spring.

The National Consensus Guidelines on domestic violence screening may have relied on relatively unimpressive advocacy references because a number of people have tried, and failed, to find published results showing that domestic violence screening improves health outcomes:

• In 2004, the U.S. Preventive Services Task Force found “no direct evidence that screening for family and intimate partner violence leads to decreased disability or death” and “no existing studies that determine the accuracy of screening tools for identifying family and intimate partner violence among children, women, or older adults in the general population.”
• A 2010 Cochrane review by Coulthard et al. found no evidence from controlled studies to support or refute the proposition that screening tools to detect domestic violence are effective in patients with facial or dental injuries.
•  Feder et al. had conducted a similar review in Britain in 2009. They found “insufficient evidence to implement a screening programme for partner violence against women either in health services generally or in specific clinical settings.”
• Wathen and MacMillan, in a 2003 JAMA article, noted that in all the literature, just 22 studies existed on the effectiveness of interventions for domestic violence. They concluded that evidence on how to prevent intimate partner violence in a primary care setting was “seriously lacking.”
• In New Zealand, a randomized study of two groups of almost 200 women found that screening, information, and referral to a counselor did not reduce short-term violence.

Though the new preventive care regulations do not yet decree that people have to pay insurers to purchase infant formula in order to prevent infant starvation and the emotional distress that goes with it, the new rules would require that they pay insurers to offer breastfeeding counseling and to purchase or rent breast pumps. Cash breast pump prices range from about $20, for a manual one at Amazon.com, to about $300 for a fancy electric one with all the bells and whistles.

As was the case with domestic violence counseling, the Department of Health and Human Services supports its free breastfeeding supplies requirement by directing readers to a report, in this case one from the Institute of Medicine Committee on Preventive Services for Women. Deep within it one can read the claim that “Buying or renting a pump without insurance coverage is out of the economic reach of many low income women, leaving them with few options for maintaining breastfeeding.”

Given that every woman in the United States will be required to pay higher insurance premiums in order to provide insurer-supplied breast pumps, one would expect that there is clear, incontrovertible, evidence that women and their babies cannot thrive unless they have health insurance coverage for breast pumps.

Unfortunately, the sole reference given for the assertion that women and babies suffer if breast pumps are not given away is a descriptive article in the Journal of Human Lactation (Chamberlain et al, 2006). It documents the experience Boston Medical Center had when it organized a charitable effort to provide access to breast pumps. A table shows substantial increases in in-hospital breastfeeding from the 1995 baseline to 1999, the year the charitable effort commenced.

The charitable activity is assumed to be responsible for the increase in breastfeeding even though all of the health plans mentioned in it supplied breast pumps when they were medically necessary, and even though advocacy, education, and support campaigns were actively trying to increase breastfeeding during the time period under review. These campaigns were so successful that a number of states passed laws protecting breastfeeding in the 1990s.

Given that there are no documented health benefits from either of these two new requirements, and that the people writing the guidelines would have known this when they did their scholarly homework, it seems that the main effect of these two requirements will be to create new streams of revenues for interest groups seeking to enrich their members at the expense of the average citizen.

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