The pill? Yes. New Nikes? No

If her birth control pills are covered, why aren’t my vitamins?

That’s the point reader Robert Filacchione of Fullerton raised in objection to The Times’ editorial Sunday supporting President Obama’s proposal that all healthcare plans, including those affiliated with religious organizations, provide access to contraception with no co-payment or deductible. Filacchione wrote:

“You say this latest act will preempt potentially serious medical problems. I am a fit, healthy man. I work at it by eating right and running 35 to 40 miles each week. Shall the government cover the expense of new running shoes and an Omega-3 supplement since I too am helping to prevent a serious medical problem? Surely this effort is more worthy than popping a birth control pill.

“This rule does not put decisions into the hands of patients, as you state. Rather, it is another step away from social responsibility and a step toward increased reliance on the state.”

Editorial writer Karin Klein responds:

It’s conceivable that at some point government would offer some sort of incentive, perhaps a tax deduction, for healthy living — perhaps not at the point of running apparel but possibly for, say, gym memberships. However, this is a different arena from the issue of family planning.

The latter involves medical products and services, as approved and regulated by theU.S. Food and Drug Administration. Health insurance covers medical products and services; right now, most health plans offer at least some level of coverage for at least some family planning care. I don’t know of any private health insurance that covers running shoes. Similarly, people who eat healthfully enjoy better health, but we don’t expect health insurance to pay for their salmon and steamed broccoli.

The Obama administration calls for placing the medical products and services involved in family planning at the same level of other preventive medical products and services — which is to say, no deductible or co-payment. The Times’ editorial board finds this a reasonable stance.

Preventive care might take the form of FDA-approved vaccines to prevent disease. Or it might take the form of FDA-approved contraception to avoid unwanted pregnancies. In both cases, an unwanted and more expensive medical situation is avoided, which is the purpose of preventive medicine.

People make many choices about their health, both medically and in terms of the way they live each day. Healthcare reform addresses medical choices.