But will Medicare pay for lube?

You might have missed the part about the penis pumps. It was in a New York Times article about Medicare overpaying for things like oxygen tanks. Apparently Medicare, despite its potentially enormous bargaining power, spends more for many items than they would cost in your neighborhood pharmacy or surgical supply store. In the midst of the article is this paragraph:

For example, last year Medicare spent more than $21 million on pumps to help older and disabled men attain erections, paying about $450 for the same device that is available online for as little as $108. Even for a simple walking cane, which can be purchased online for about $11, the government pays $20, according to government data.

The article doesn't comment at all on whether penis pumps are a legitimate Medicare expense, which I think is interesting. Given our government's very conflicted attitudes about sex, I find the news both heartening and irritating. I am glad that Medicare takes the needs of aging men seriously and considers sex a part of healthy living. We were just talking about sex and aging when we were discussing Pepper Schwartz's book Prime. TracyA linked to a great post by Supercrone about sexual desire in her 80s, Mimi of Sexagenarian in the City writes about her own re-entry into dating and sex, and so I'm glad that the US takes the sexual needs of the elderly -- at least eldery men --seriously. I wonder why it denies the sexual needs of so many of the rest of us.

Our own internal contradictions around sexuality are pretty amazing. Medicare, an entitlement program for older folks, will pay for penis pumps. Medicaid, the program that provides health care for poor people, does not cover abortion services (thanks in large part to Henry Hyde, who died the other day) though states are apparently free to provide such coverage. (For example, in New York State residents enrolled in Medicaid are entitled to "Free access" family planning -- including contraception and abortion -- even if their Medicaid Managed Care Provider does not cover those services.) We see inability to have intercourse as an illness for the elderly but don't want to teach young people about safer sex.

We spend our tax dollars foolishly in either case, overpaying for penis pumps or paying at all for abstinence-only education.

But back to the penis pumps again: is this an example of sexism in health care again? I mean, older women are less likely to be in need of contraception or other family planning services, but does Medicare pay for lube? Or are women expected to deal with the changes in their sexual function on their own while men's physical changes get medical attention? (And if Medicare does cover lube, what are they paying for a bottle of Astroglide, do you think?)

And is Medicare paying for condoms to keep these older men from getting and transmitting STIs? Or are we again in a situation where we'll pay to address the disease (inability to maintain erection) but not to prevent disease?

If, like me, you were wondering about the efficacy of penis pumps in the first place, here is a link to Corey Silverberg's piece on them from About.com. He points out that penis pumps are pretty reliable at generating erections but that unless well aroused, or if the man has a problem maintaining erections, that the erection created by the pump might not last. He mentioned that better penis pumps, of the sort sold by medical professionals (which he says run about $200, not the $450 that the US pays) come with "constriction rings" (read: cock rings) that help maintain the erection.

I wonder if Medicare would cover the cost of cock rings alone for men who have no trouble getting erections but do have trouble maintaining them.

And what about sex ed for older folks so that they know that there is plenty of good sex to be had without erections and penis-vagina penetration? What about some workshops on manual sex? Oral sex? Sex with toys? Training in orgasm without intercourse, anyone?

Meanwhile, lets make sure that all government provided health care treats sex as an important component of healthy living. Lets make sure that Medicaid and Medicare cover sexually-related health care costs, whether those be penis pumps or lube, or contraception or abortion. If sex is a party of a healthy life, those things are all important.

Lets make sure that private insurance plans do the same!

And lets pay for smart sex education for sixty-year-olds and for sixteen-year-olds!

Illustration, "Penis Pump," by Derek on Flickr, and used under a Creative Commons Attribution, Noncommercial, Share alike license.

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Elizabeth