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May 24, 2005

Viagra for sex offenders

I'm getting sick of the manufactured outrage over the fact that New York's Medicaid program pays for Viagra for sex offenders. People are talking about the Viagra for sex offenders "scandal" as if  felons were exploiting some kind of loophole. In fact, they're just using the same medical services that everyone is entitled to.

Medicaid covers Viagra for anyone for whom it is medically indicated. You don't have to undergo a criminal record check to get any other kind of medical treatment. Pickpockets can be treated for carpal tunnel, peeping toms for ADD, and embezzelers for dyslexia--and that's exactly how it should be.

It's unnerving to see moral busybodies demanding a closer mesh between health care and the law. Medicaid is not an arm of the parole system. Prescriptions shouldn't be rationed in the name of social engineering. It sounds as if Health and Human Services might even revoke Viagra coverage for sex offenders who have already served their time. This is unconscionable. It's not up to HHS to heap extrajudicial punishments on people who've already paid their debt to society. 

I agree that our insurance priorities are skewed when it comes to Viagra and other impotence remedies. Big pharma has spent a lot of money convincing us that there is a disease state known as Erectile Dysfunction that requires medical treatment. It should be controversial that public and private insurers are spending millions of dollars to treat a non-life threatening, non-disease.

I'm not saying that sexual dysfunction is trivial. But most erectile dysfunction is the result of normal aging, stress, and other non-pathological factors. Meds like Viagra and Cialis enhance quality of life, but they aren't themselves lifesaving. They don't even correct the underlying disorders that cause impotence, like atherosclerosis, diabetes, depression, etc.

I'm not a pharmaco-economist, but I doubt the true cost benefit ratio for impotence drugs justifies their inclusion in the Medicaid formulary--especially if the same program can't afford treatments for female sexual dysfunction or contraception. (Maybe someone knows whether the NY Medicaid formulary is as solicitous of female sexual health is it is of men's quality of life.)

We can debate whether Viagra and other ED meds should be on a public insurance formulary, but the sex offender issue is a total red herring. The unsubstantiated implication is that Viagra is facilitating rapes. That might be true, but then again, so might angina medication, antibiotics, or any other medical treatment for a sex offender who would otherwise be out of commission.

Ironically, as Njorl suggests in the comments, some sex offenders might have a stronger medical claim to Viagra than many healthy men.

Developing a healthy normal sex life might be an integral part of a sex offender's rehabilitation. I have no idea if it is ever true, but it is certainly conceivable that sex crimes are the result of abnormal development. If a rapist is incapable of erection in consensual circumstances, it could easily result in frustration, violence and recidivism. While viagra wouldn't fix the problem, it would enable therapy to be more effective. Of course, this assumes that paroled criminals are receiving real therapy, which might be a stretch.

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Listed below are links to weblogs that reference Viagra for sex offenders:

» Viagra For Sex Offenders from Unpartisan.com Political News and Blog Aggregator
New York Senators Hillary Clinton and Chuck Schumer are objecting to Medicaid payment of prescriptio [Read More]

» Viagra! from Political Animal
VIAGRA!....Should Medicaid pay for Viagra prescriptions? Eh, probably not. But if it does, is it outrageous that convicted sex offenders who have done their time are eligible along with everyone else? Lindsay Beyerstein says no:Medicaid covers Viagra f... [Read More]

» I must beg to differ from dadahead
There's nothing to be gained from coming out against a ban on giving Viagra to sex offenders. It will only serve to make the Left look like it is taking the side of sick perverts. Plus, I don't really care whether the rights of these 'people' are be... [Read More]

» Give the man his Viagra from Pandagon
A lot of people have been upset about this issue of Medicaid covering Viagra even for sex offenders, which I have to admit made me uneasy, but so did people decrying the right of people who draw Medicaid to get... [Read More]

» more to say on the viagra issue from fidlet.com
We ought not to trivialize the horror of sex offenses, but if Medicaid (or any other) government agency is going to pay for medications like Viagra, I think we must question the reasons why we would want to deny them to sex offendors, and ask ourselves... [Read More]

Comments

Public tax dollar support for this is rediculous for anyone, support for sex offenders though... is more than insane... it goes into the Twilight Zone!

First, I agree with your point wholeheartedly.

Second, I find it disturbing that this is being treated as a New York-specific issue. Granted, it was discovered in New York state, because we have an active (Democratic) State Comptroller who believes in doing his job... but the unstated fact is that this is undoubtedly occurring in other states too.

I see two possible caveats.

First, chemical castration is sometimes a provision of parole. Obtaining a medication to counteract it would probably be a parole violation. That would not be Medicaid's problem though, it would be the bureau of correction's problem. Medical records are confidential though. It would be correction's responsibility to notify medicaid not to correct impotence in the specified parolees.

The second caveat is trickier. Developing a healthy normal sex life might be an integral part of a sex offender's rehabilitation. I have no idea if it is ever true, but it is certainly conceivable that sex crimes are the result of abnormal development. If a rapist is incapable of erection in consensual circumstances, it could easily result in frustration, violence and recidivism. While viagra wouldn't fix the problem, it would enable therapy to be more effective. Of course, this assumes that paroled criminals are receiving real therapy, which might be a stretch.

No, I don't buy it. The other examples you cite involve disabilities which hamper essential life-functions. Screwing well into old age isn't an essential life-function! It's gravy.

And Medicaid should'nt be paying for Viagra for anybody, IMHO. Medicaid pays out of tax money, meaning every tax payer is being forced to subsidize some old fogey's sexual pleasure. Screw that! If we (the left) are going make asinine arguments like that, it's enough to make even me read a conservative blog or two!

Excellent. Thanks for this very helpful perspective, and for injecting a clear-sighted sense of the politicization of healthcare that this represents. Good post.

Njorl: How often is chemical castration a term of parole? What jurisdictions? I'm really curious, I don't know the answer. I don't necessarily think Viagra would be counteracting Depro-Provera really, would it? It's not like chemical castration is just making people impotent...I'm not even sure it does that.

On the general post: Thank you a million times for saying this. I got so sick of the news crying about "How did this happen?" It happened because no one thought to spend the administrative/legislative costs necessarily to deny these specific drugs to sex offenders - no big scandal there. It never occurred to me either, and it's not necessarily a convincing policy anyway.

Finally: I endorse the post's reservations about judging the state's spending policies until there's some perspective, but in response to the comments: I don't see why we should even consider limiting Medicaid to "essential life-functions." The vast, vast majority of medical care most people will want in their lifetimes isn't about saving their lives, it's about improving the quality. It'd make more sense to cover contraceptive drugs than ED drugs, but I don't see why ED drugs are necessarily something to be disparaged or written off. I always thought pretending sex wasn't a big, rewarding part of life was for squares.

On Viagra for sex offenders:

You're both legalistic and missing the point. Legalistic, because having a right to something doesn't mean that one should exercise that right. I, for example, have the right to drive a car in Maryland. You, perhaps, should be very happy that I don't exercise this right, as I have epilepsy and could have a seizure, cause an accident, and kill someone. The sex offender who wants his Viagra is like the person with poorly controlled epilepsy who insists on driving. Both lack common sense.

Which brings me to point two - your framing of the issue in moral terms. I am not as ignorant as your dear reader who opines that perhaps Viagra would be good for some sex offenders. Then again, I know survivors of incest. To me, sex offenders suffer from a disease. We can't punish them pre-emptively for acts they have not yet committed. But society has no reason to *enable* these individuals to repeat their offenses. Giving sex offenders Viagra is enabling them.

SFM: How bad is your epilepsy? Do you really have the right to drive on MD highways? I always thought most states had pretty routine restrictions against issuing/maintaining drivers' licenses for people with disabilities that make them unusually dangerous drivers unless those people met some specific restrictions.

It sounds as if Health and Human Services might even revoke Viagra coverage for sex offenders who have already served their time. This is unconscionable. It's not up to HHS to heap extrajudicial punishments on people who've already paid their debt to society.

Shouldn't the larger point encompass case review of individual disorders and the appropriateness of treatment prescribed? Sex offenses are both crime and disease; serving time only compensates the crime while the disease demands diligent management.

For example, if after comprehensive diagnosis erectile dysfunction is determined to be an essential component of a certain psychosexual disorder, then treatment with Viagra would seem perfectly appropriate -- likewise Medicaid disbursements to cover it. However if, absent comprehensive workups, physicians are instead hastily (due to caseload or other constraints) prescribing medication in response to symptomatic patient complaints rather than confirmed symptomatic manifestations of the disease, then there is indeed a problem.

The unsubstantiated implication is that Viagra is facilitating rapes. That might be true, but then again, so might angina medication, antibiotics, or any other medical treatment for a sex offender who would otherwise be out of commission.

But the sex offender's continued existence isn't in itself a problem for society. It's the possibility that the sex offender might offend sexually again. If a convicted rapist rapes again, this time while on government-sponsored Viagra - and yes, it COULD happen - there's not a politician alive who is going to want it known they didn't fight against Viagra for sex offenders.

I'm sorry, but I can't work up much outrage over the prospect of sex offenders having to pay for their own Viagra. In fact, I say make that part of the punishment for sexual offenses - jail time AND you have to pay for your own Viagra the rest of your life.

Developing a healthy normal sex life might be an integral part of a sex offender's rehabilitation.

Is using Viagra now considered part of a normal sex life?

I don't think Viagra will make much of a difference to hardcore sexual predators. If they can't get an erection, they'll find some other way to sexually exploit their prey. Penetration is just part of sexual abuse, after all.

It's not such a stretch to think that psychosexual performance issues can causally contribute to rapes. Imagine a guy who's terrified of having a normal relationship with another adult because he can't get it up. So, he fondles kids. That's NO EXCUSE at all, OF COURSE. But seriously, wouldn't it be better for someone like that to have consensual Viagra-assisted sex with someone is own age?

Lindsay, thanks for making that point in the last comment. ED medications don't alter libido; they make it possible to sustain erections. There may be some sex offenders who won't offend because of erectile dysfunction, but, as you point out, there are many, many kinds of sexual abuse that don't require erections.

Is using Viagra now considered part of a normal sex life?

Is that question supposed to be rhetorical?

If you have certain medical conditions, than of course it is! Paxil also might be part of a normal mental life. Various other drugs are, when indicated, part of a normal respiratory life. etc.

It's not such a stretch to think that psychosexual performance issues can causally contribute to rapes. Imagine a guy who's terrified of having a normal relationship with another adult because he can't get it up. So, he fondles kids. That's NO EXCUSE at all, OF COURSE. But seriously, wouldn't it be better for someone like that to have consensual Viagra-assisted sex with someone is own age?

It's no stretch for me to imagine any number of things - I have a good imagination. But my imagination is not the issue.

It's my understanding of pedophilia that pedophiles don't focus on children because they can't have sexual relations with adults. They focus on children because children turn them on.

It seems to me you're beyond objecting to the government refusing to pay for Viagra for sex offenders. You seem to feel that Viagra should be used as therapy for sexual offenders - because if they could get reliable stiffies they wouldn't feel the need to work out their frustration by assaulting people.

Is using Viagra now considered part of a normal sex life?

Is that question supposed to be rhetorical?

If you have certain medical conditions, than of course it is! Paxil also might be part of a normal mental life. Various other drugs are, when indicated, part of a normal respiratory life. etc.

No, it wasn't rhetorical. I was asking for a clearer definition of terms.

So my understanding is that you feel that drug-assisted biological functioning is defined as normal. Does that mean that somebody who doesn't treat erectile problems with Viagra has an abnormal sex life?

Or is the term normal being equated with satisfactory?

I think that it's worth pointing out that "sex offender" and "pedophile" aren't synonyms. When people pass blanket policies punishing "sex offenders" they generally capture a number of other groups, including statutory rapists (many of whom likely committed a considerable moral wrong and many of whom likely didn't) or perpetrators of the ever-vague "lewd conduct." I don't see why a 55-year-old man undergoing chemo should have narrower Medicaid coverage because his girlfriend was 16 when he was 19 or 20.

You seem to feel that Viagra should be used as therapy for sexual offenders - because if they could get reliable stiffies they wouldn't feel the need to work out their frustration by assaulting people.

I'm not a doctor. I have no idea how sex offenders should be treated. Viagra may be contraindicated in some cases and appropriate in others. I certainly wouldn't want a law or a health insurance bureaucracy to make a blanket ruling. It should be a medical decision between a patient, his doctor, and (possibly)his sentencing judge or parole officer.

Medicaid shouldn't be using drug coverage as a tool for social engineering.

I don't see why a 55-year-old man undergoing chemo should have narrower Medicaid coverage because his girlfriend was 16 when he was 19 or 20.

That would be a shame, but your quarrel is with the definition of sex offender - you don't consider statutory rape a true sex offense.

------------------------------
A follow-up to my previous post - I found this definition of "normal" at dictionary.com. Please note the second usage, pertaining to biology.


nor·mal ( P ) Pronunciation Key (nôrml)
adj.

Conforming with, adhering to, or constituting a norm, standard, pattern, level, or type; typical: normal room temperature; one's normal weight; normal diplomatic relations.

Biology. Functioning or occurring in a natural way; lacking observable abnormalities or deficiencies.

Abbr. n or N Chemistry.
Designating a solution having one gram equivalent weight of solute per liter of solution.

Designating an aliphatic hydrocarbon having a straight and unbranched chain of carbon atoms.
Mathematics.

Being at right angles; perpendicular.
Perpendicular to the direction of a tangent line to a curve or a tangent plane to a surface.

Relating to or characterized by average intelligence or development.
Free from mental illness; sane.

n.
Something normal; the standard: scored close to the normal.
The usual or expected state, form, amount, or degree.

Correspondence to a norm.
An average.
Mathematics. A perpendicular, especially a perpendicular to a line tangent to a plane curve or to a plane tangent to a space curve.

[Middle English, from Late Latin normlis, from Latin, made according to the square, from norma, carpenter's square. See gn- in Indo-European Roots.]
--------------------------------------------------------------------------------
normal·ly adv.

Good point, Eli. According to the local throw away paper, the comptroller was specifically upset about Viagra going to a class of offenders designated Level 3. I'm not sure what that category encompasses.

Now that the story has hit the national media, people are upset about any "sex offenders" getting full Medicaid coverage.

I didn't even know there were levels of sex offenders. So clearly it is already legally feasible to distinguish a statutory rapist from other sex offenders.

I found a handy guide to sex offense levels here: http://criminaljustice.state.ny.us/nsor/risk_levels.htm

Level 1 (low risk of repeat offense), or
Level 2 (moderate risk of repeat offense), or
Level 3 (high risk of repeat offense and a threat to public safety exists).

Medicaid shouldn't be using drug coverage as a tool for social engineering.

Why not? And what tools are allowable for Medicaid to use for social engineering, if any?

According to the local throw away paper, the comptroller was specifically upset about Viagra going to a class of offenders designated Level 3. I'm not sure what that category encompasses.

New York Annotated Correction Law | Chapter 43, Article 6-C: Sex Offender Registration Act (Current as of April 27, 2005)

[Level 3 references are highlighted through Google's search cache]

Also FYI: Beyond the Registry by Rick Marshall; Metroland Online; Vol 28., No. 19.

Nancy, the point isn't that it's logically impossible to distinguish between statutory rapists and honest-to-God pedophiles - of course it is. The point is that, politically, it almost never happens, especially when the public is out for blood. It looks like there may be some restraint where actions are being taken by an administrative agency and not voters, but how many of the furious outcries over this case have you heard regularly and clearly making the distinction? The overinclusiveness has already worked its way into sex offender registries, I don't see why the angry mobs won't be equally overinclusive about this on the legislative level.

...and, actually, I do think statutory rape is a sex offense - of course it is. There's absolutely no conduct element other than sex.

"Medicaid covers Viagra for anyone for whom it is medically indicated."

Is there an implication that Medicaid does _not_ cover Viagra when it's not medically indicated? OK, that's a rhetorical question, but with a point -- medical indications are relevant to the medical justification for an intervention, and not just to determine whether it should be covered by health insurance. But if medical indications are relevant in this way, isn't there a problem with the claim made in yesterday's piece on parental notification? To wit: "Abortion is a medical procedure." Well, when an abortion is medically indicated I think that's beyond dispute that it's a medical procedure. But what about non-medically indicated abortions? True, what the provider does is identical to what is done when the procedure is medically indicated. But if there's not a medical indication, doesn't that make the claim that abortion is a medical procedure at least questionable?

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