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Coburn's Hard Bargain

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Senator Tom Coburn (R-OK) introduced an amendment to the health care "fixes" bill that would prohibit use of federal funds to purchase erectile dysfunction ("ED") medications for registered sex offenders.

Coburn must have thought he hit a political trifecta with this amendment. It's about sex (allowed only with an opposite-gender spouse in the missionary position with lights off); and sex offenders ("the gift that keeps on giving" for politicians); and restricting access to a drug (the more regulation, the better where drugs are concerned -- because that works so well now).

Right there are three good reasons for all Republicans (plus a few Democrats) to vote for the amendment. I think Republicans liked it for a fourth reason: it would insert politicians between doctors and their patients. (These are the same people who want to keep government out of people's lives.)

Coburn's amendment was a Republican vote-magnet for a fifth reason: if the amendment passed, then the whole "fixes" bill would have to be returned to the House of Representatives for another vote. Coburn could have introduced his proposal as a separate bill but he chose to use it as a way to obstruct passage of the "fixes" bill.

Unfortunately for Coburn, support for the measure was soft. The Senate voted to kill the amendment, by 57 to 42. Those in favor included all 40 voting Republicans, plus Democrats Evan Bayh and Ben Nelson.

Just as second marriage often represents the triumph of hope over experience; I keep taking these Republican legislative proposals seriously. So I wondered how many people actually would have been affected by Coburn's amendment.

The answer: not many. Here's the math. All that follows will probably come out in committee hearings if Coburn introduces his proposal as a stand-alone bill in the Senate.

There are about 705,000 registered sex offenders in the United States and its territories (Source: National Center for Missing and Exploited Children reported 704,777 on December 8, 2009). Fewer than 10% of these people are female (Center for Sex Offender Management). So let's assume 95% of sex offenders are male -- 669,000 people.

About half of those people committed non-contact sex offenses like as exhibitionism, voyeurism, mooning, streaking, solicitation of a minor, downloading child pornography, etc. The ability to achieve erection had nothing to do with their crimes so they should not be included in the pool of people who would be affected by Coburn's amendment. That would reduce the size of the affected pool to 334,500 people.

But most of those people would not commit another sex crime anyway, whether they have erectile dysfunction or not. Recidivism is lower for sex offenders than for any other class of criminals except murderers about 5.3% (Center for Sex Offender Management, May 2001). We should therefore also exclude the 94.7% of the pool who pose little or no risk of committing another sex crime. That would further reduce the pool to about 17,700 offenders.

But the number of men who suffer from chronic erectile dysfunction is small -- about 2.6% (National Kidney and Urologic Diseases Information Clearinghouse, 2002. Many more people experience occasional ED). So that reduces the pool of people affected by Coburn's proposal to about 446 people.

Yet rape and child molestation are rarely about sexual gratification alone. Thus, denying violent sex offenders the means to achieve physical gratification will have little effect on whether or not most of them commit another violent sex crime. They can do that without sustaining erection. If we assume that just 20% of violent sex crimes are committed solely to achieve sexual gratification (I have no source for that number and think it is probably high), then the pool that Coburn wishes to control shrinks to just 92 people.

If those 92 people cannot obtain ED medication through traditional means, then they can probably get it through non-traditional sources -- through a friend or from on-line, cross-border, or black market sources. If we assume that 90% of the 92 people would get their ED meds in one of these ways, then the number of people who would be denied ED meds by Coburn's amendment is down to a mere 11 people countrywide.

However, Coburn's proposal would extend only to people who buy their health insurance with federal assistance or through insurance exchanges. Eighty-five percent of the population is already insured so the pool would be further reduced to just 15% of the 11 people left.

Thus, by the time it emerges from committee, Coburn's bill will probably affect only those male violent sex offenders who are likely to reoffend mainly to achieve sexual gratification but who can't get it up, and who can't buy ED meds through non-traditional sources, and who need federal assistance to buy any insurance at all.

That would be just one person, somewhere in the whole of these United States. And that guy is probably still in jail.


Rick Wise is an industrial psychologist and retired management consultant. For 15 years, he was managing director of ValueNet International, Inc. Before starting ValueNet, Rick was director, corporate training and, later, director, corporate (more...)

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Whether Coburn's measure would apply to one or a h... by Richard Wise on Thursday, Mar 25, 2010 at 6:06:35 PM
"The state must declare the child to be the most p... by Joni Greever on Friday, Mar 26, 2010 at 7:34:19 AM
You may be right, Joni. But what is the relevance... by Richard Wise on Friday, Mar 26, 2010 at 8:51:31 AM
I'm an activist to reform the SO laws and I put th... by Joni Greever on Friday, Mar 26, 2010 at 12:42:08 PM
I see ... thank you!... by Richard Wise on Friday, Mar 26, 2010 at 3:59:23 PM