BOSTON -- Bless your heart, Neil.
Here we are in a sexual frenzy about the drug that is raising male spirits. On the joke circuit, Viagra has replaced Monica. On the cover of Time, the little blue pill has become the Man of the Year. In the newspaper, the word erection is now part of the hard news vocabulary. And double entendres about this growth stock are spilling over the airwaves like water over Niagara.
Land office business
Today, men who never talked about fear of failure are sharing. Phone lines to urologists are jammed by rising expectations. There are 150,000 prescriptions already written, the price of Pfizer stock is soaring higher than its product, and on the ever-tasteful Don Imus show, the host is passing out purloined pills to his pals in exchange for performance reports.
Meanwhile, we have a hallelujah chorus singing praises to the restoration project and a patient telling "Nightline," "The skies opened, a bolt of lightning came down and God said, 'I love you.' " In short, the earth has moved.
But from deep in the heart of New York state comes our guy Neil Levin to remind us of our puritanical roots. In the midst of all the hype, the state insurance superintendent has announced that his department doesn't want to support the use of Viagra by anyone who wants to "just take it for fun."
Sex for the fun of it? Nooooooo.
Neil is not entirely alone in his anxiety. The man who headed the British studies of this drug also wants men to take Viagra seriously. Dr. Ian Osterlow has been everywhere telling folks that the pill that brings blood rushing to the rescue is not a "superstud" drug to be used by "regular guys" who want "a little extra performance."
Nevertheless, I am not surprised that the real cold shower on Viagra would come from folks in the health insurance industry. After all, Pfizer's magic little pills cost about $7 apiece, or $10 retail.
Insurance companies are not part of the sex industry. They are in the business of cost control. So they ask, in the charming words of Leslie Fish of Fallon Healthcare Systems: "How many erections does a health plan owe a patient?"
The fundamental question is the one posed so many years ago by James Thurber: "Is Sex Necessary?" Is a sex pill like thyroid medication or plastic surgery? Where's the line between a cure for impotence and a prescription for whoopee?
Insurance companies are deciding whether a man must prove he has a pre-existing condition like diabetes to get free Viagra and whether, say, old age is or isn't a medical problem. They are calibrating how much sex is good for your health and how much is just for fun.
So far, in this fairly bizarre conversation, at least one major insurer has decided to pay for six sex acts a month. There you have it. Insurers now control how often clients will have sex. This is truly managed care.
The pope's blessing
Now I confess to being fascinated with this conversation piece. I can't help wondering why we got a pill to help men with performance instead of communication. Moreover, how is it possible that we came up with a male impotence pill before we got a male birth-control pill? The Vatican, you will note, has approved Viagra, while still condemning condoms.
It also seems that in some places, we'll get health insurance coverage for male potency before we get it for female contraceptives. Hasn't anybody noticed that the chief sexual turnoff for women is fear of pregnancy? It's all enough to give a gal Viagra envy.
But at the risk of taking sex too seriously, may I offer a footnote about a nation of have and have-nots. We already have a two-tier health plan. From now on, it will also determine whether men have or have not sex.
Boston urologist Michael O'Leary says, "I'm not convinced it's a God-given right to have an excellent erection." Maybe not. But for some it's going to be an insurance-given right.
The wealthy man from L.A. who told a reporter that Viagra would be a trophy for his young trophy wife can buy all he wants. The un- or underinsured man without $10 to spare will get six tries and on the seventh day, he'll rest.
Who knows whether Viagra will yet sprout physical side effects. But we are already seeing some bizarre social side effects. As the beat goes on, listen for the strange sound of men trying to convince their insurers that sex is not for fun.
Ellen Goodman is a syndicated columnist.
Pub Date: 5/05/98