By Judy Mann
Washington Post Staff Writer
Friday, May 22, 1998; Page E03

Rarely do you come across a situation involving men and women when the double standard is absolutely clear and incontrovertible. But here it is, live and in pill form, in the social laboratory known as the American health care system.

The insurance industry is covering the cost of Viagra, which helps men maintain an erection, but many insurers are still refusing to cover the cost of the birth control pill or other forms of contraception for women.

Viagra is a wonderful development if it can combine youthful virility with the wisdom and maturity of age. If older men start acting like frat boys again, we may have created another problem: a generation of dirty old men. But so far, all we've been hearing about are reports from couples who have cured impotency problems and are enjoying new and improved sex lives. So we're not knocking Viagra.

Why the wowsers, as H.L. Mencken called them, haven't jumped all over Viagra is a mystery to me. A wowser is a person who is tormented by the fear that someplace, somewhere on earth, someone is having a good time, and with 300,000 or more prescriptions for Viagra filled, it's a safe bet that a lot of people are having a good time. Perhaps the wowsers think older married men are using it only with their wives, but who knows? With newfound vigor may come newfound opportunities. Perhaps the strange silence is due to the fact that some of the wowsers have found Viagra so helpful in their own pursuits that they don't dare make a peep about it.

One thing Viagra has done for me is answer the question about who runs insurance companies: men. Viagra costs $10 a pill, and its sole purpose is to promote male erections. Insurance companies have decided to cover Viagra's cost in less time than it takes most men to get a dinner date. A story in this week's Washington Post reported that for the week ending May 1, 47 percent of the nearly 270,000 Viagra prescriptions sold in the pill's first five weeks were covered by health insurance. Some companies, such as Blue Cross, are paying for six pills a month, thus taking them into the uncharted territory of rationing sex.

Or maybe not. Many insurance companies may have already been in the game of rationing sex, since they have for years refused to cover the cost of birth control pills and many other forms of contraception for women, or do so only if they can charge employers extra for this kind of coverage. Today, slightly more than half of contraceptive pill prescriptions are covered, but most insurers do not cover other forms of birth control. Office visits, lab work and pelvic exams are usually required to obtain birth control, and they jack up the cost.

"Basically, if you are paying for it yourself, it's extremely expensive, and insurance frequently does not cover it," says Eleanor Smeal, head of the Feminist Majority Foundation and a leading advocate of efforts to make contraception more accessible and affordable. "Some birth control pills cost $30 a cycle. It's not just the pill, but for some prescriptions you need to have an ob-gyn or doctor's examination yearly and some every six months. We had estimated it was over $500 a year if you are paying the full cost, and I'm sure it's higher today. For those who don't qualify for low-cost health care or for women without insurance, it puts the pill, which is the most effective form of birth control, beyond their reach. Then we ask why we have so many unwanted pregnancies."

The average annual income of full-time working women was $23,710 in 1996, according to the U.S. Department of Labor. According to the Planned Parenthood Federation of America, women have to have a yearly gynecological visit, pelvic exam, breast exam, Pap smear and blood pressure check, which total $60 to $95, plus $15 for a chlamydia test. Private visits to gynecologists can range from $80 to $220. Norplant costs about $350 for the device and $150 to $650 for counseling and insertion, according to a fact sheet developed by the Feminist Majority Foundation. An intrauterine device costs about $400. For women whose insurance will not cover birth control, these costs are not small change.

To cover Viagra, which is going to cause more pregnancies, and not to cover birth control pills and other contraception is simply foolish. Unwanted pregnancies, whether they end in abortions or live births, produce huge negative social costs to women, children and society. If insurers are refusing to cover birth control because of costs, how can they cover Viagra, which at six pills a month is running twice the cost of the birth control pill? "They are willing to cover the cause, but not the prevention. . . . It really is the double standard laid bare," says Smeal.

Legislation introduced by Sen. Olympia J. Snowe (R-Maine) and Rep. James C. Greenwood (R-Pa.) would require insurers to pay for birth control if they also cover other prescriptions. Smeal would go further, to make birth control pills available over the counter, making them far more accessible to teenagers than they are now. They would not have to go through the ordeal of a doctor's exam, which can be a barrier to young women obtaining the most effective birth control.

Birth control pills are covered by national health insurance in many other countries and are available over the counter in many Northern European countries, where the abortion and unwanted pregnancy rates are much lower than here. An unintended benefit that has come from Viagra is that it has put the spotlight on the hypocrisy of what insurers will cover. Surely, in any sane society, we would put as much emphasis on providing coverage against unintended pregnancies as we do on preventing impotence.