“Mr. Trump’s Attack on Birth Control” (nytimes) is interesting on a few levels.
The context:
the Trump administration is making it harder for women to get access to birth control. On Friday, it rolled back an Obama-era rule requiring most employers to provide their employees with birth control coverage without co-payments.
So the debate concerns only women with jobs who get health insurance as part of their compensation. An employer that doesn’t mind being picketed by an angry Facebook mob can now tweak its health insurance plan so that birth control pills are either not covered or require a co-payment.
The first interesting idea is that insurance is an appropriate vehicle for funding expenses that can be predicted in advance. I.e., an Obamacare policy should provide “health assurance” in addition to what would traditionally have been regarded as “health insurance” (paying for unexpected costs):
These regulatory rollbacks will almost surely reverse years of progress. The percentage of reproductive-age women who faced out-of-pocket costs for oral contraceptives, for example, fell to less than 4 percent by 2014 from more than 20 percent just two years earlier, according to the Kaiser Family Foundation. One study estimates that women are saving about $1.4 billion on the pill.
The second interesting thing is the assumption that if an insurance company is buying something it costs less (maybe it costs nothing because it has become “free”). The assertion highlighted above is that women will be saving money compared to going to Walmart and paying $9 per month (nine different options for pills at that price), perhaps out of a health savings account or flexible spending account to neutralize the pre-tax/post-tax issues (again, remember that this entire debate concerns only those women with jobs). This can be true only if insurance companies have special money trees. If they don’t have money trees then payments come from premiums paid by other members.
Who pays premiums to fund “free” birth control pills plus whatever administrative costs are associated with arranging reimbursements by an insurance company in $9 chunks? To a large extent… other women!
In the hierarchy of American victimhood, lesbian and transgender women are more victimized than cisgender heterosexual women, right? Why would it make sense, then, to transfer money earned by lesbian and transgender women, whose demand for birth control pills is presumably low, to subsidize cisgender heterosexual women? Also, why does it make sense to transfer wealth from older infertile women to younger fertile women? In addition to suffering from any complications of menopause, these older women now have to subsidize the younger women who are often taking their places in society?
[You might argue that some of this wealth transfer does flow in the correct direction with respect to comparative victimhood because premium dollars paid by men are used to fund birth control pills consumed by women. But a lot of women share household expenses with men so taking money from a man within their households reduces their spending power just as much as if the money had been taken from them.]
What does the credentialed American public think? Let’s look at the highest-rated reader comments:
S: I went to medical school for multiple reasons, one of which to make sure abortion services would always be safely available. I was hoping to use that skill as little as possible, but if Trump, Ryan, McConnell, and the Heritage Foundation (holding the marionette strings over all of them) have their way, it looks as though this country is going back to the dark ages.
*** about 10 more top-rated comments that assume that working women will quit using contraception if they have to pay $9 per month. Then they will end up pregnant and will have abortions. But does this make rational economic sense? Can they get an abortion every six months for less than $54? If not, why wouldn’t they choose to pay $54 every six months out of pocket for pills? ***
Laura Haight: Consider a single mom who was finally able to go back to work after her child went to pre school. She can’t afford to take care of another child, so she gets birth control through her company. The cost would be prohibitive otherwise as they are just getting by now. No, she can’t work another job because she needs to be home raising her child. Without birth control, she gets pregnant. She can’t get an abortion. She has the baby. Must quit her job. Cannot work now because she has an infant to care for. She turns to the so-called safety net but it’s not there. And so on. And another well-intentioned, willing to work, American woman begins down a cycle of failure for herself and her kids and their kids. [No explanation for why the “single mom” didn’t learn enough about the U.S. family court system to turn a profit on the second child. Or for why she can’t get an abortion in a country where women are free to sell abortions at a discount to the net present value of the potential child support revenue.]
J.M. Kenney: Not all women are unmarried and poor! Access to effective birth control is crucial to married women and the families who rely on them to earn wages through work. We are now a society where the majority of households rely on two adult wage-earners to survive. Not to afford vacations or other luxuries, but just to keep food on the table and a roof over everyone’s head. [i.e., in a heterosexual couple, with both the man and the woman are paying health insurance premiums, somehow it saves money to pay a higher premium and let the insurance company pay the $9/month… ergo they are being subsidized by people who don’t have sex? Or people who are infertile?]
njglea: Go ahead, Con Don. Try to take away women’s right to choose what they do with their own bodies.
LAllen: This is an attack on many fronts. It’s an attack on women’s health, women’s autonomy, and women’s rights. [Women can be autonomous only when someone else is paying for their pills? But, as noted above, if the payors are lesbian and transgender sisters, isn’t there a zero-sum autonomy game going on?]
A lot of the comments discuss the fact that Viagra is covered by all health insurance plans, while plans from Catholic employers may no longer cover birth control pills. This is evidence for U.S. society being rigged in favor of men. However, it looks as though the most popular insurance plan for older American men, i.e., those most in need of Viagra (except for some prime-age guys at Burning Man), does not cover Viagra: “Does Medicare Cover Viagra.” And it is unclear that there is any Obamacare mandate requiring insurers to cover Viagra for men under 65. Maybe a social psychologist can do a master’s on how Americans managed to convince themselves of something that can be easily fact-checked with Google.
Readers: What do you think? How is it possible that while other countries keep pulling ahead of us in terms of GDP per capita (list) we have a national debate on the subject of who pays $9/month? And, if we are going to have such a debate, why are newspapers that champion the rights of the lesbian and transgender supporting this subsidization of cisgender heterosexuals?
[Update: Today the Times published “The Economy Can’t Grow Without Birth Control”, which uses a figure of $600 per year for birth control, without explaining the apparent contradiction with the Walmart web site. The article is another great example of the idea that insurance companies have money trees and their spending isn’t taken away from money that we could have spent on something else: “Consumer spending makes up about 70 percent of all economic growth, and women are responsible for an outsize portion of that spending. Billions of dollars less a year in their pockets means billions of dollars less that they could spend on goods other than birth control, dampening their ability to support businesses and the economy.”]
The interest society has in ensuring that all women can effectively manage their own fertility is compelling enough that it justifies removing direct cost to individuals as a barrier to access. If the burden for doing so unfairly falls on lesbian and transgender women then that is merely a problem with the system used to allocate those costs.
That ‘dark age’ business is pretty funny when you compare U.S. abortion laws to those in the Nordic Utopias.
The more realistic barrier to the accessibility of oral contraception is the cost of a doctor’s visit, although that is not an issue for people with health insurance, and probably free through planned parenthood.
The funny thing about planned parenthood, is that if you are actually planning parenthood, they offer you no services. Talk about manipulative name for an organization!
“”The interest society has in ensuring that all women can effectively manage their own fertility is compelling enough that it justifies removing direct cost to individuals as a barrier to access.”
So asserted but why?
“The interest society has in ensuring that all women can effectively manage their own fertility is compelling ”
If society’s interest is the most important factor, it should be society, not individuals, that manages fertility and decides which members are fit to reproduce and when.
I bet many lesbian cisgender women taking birth control pills to suppress menstruation, but I do have to ask, do transmen take birth control to suppress manstruation?
Tom: I think you can answer your own question. First list all of the potential adverse impacts associated with unwanted pregnancy. Then think about all of the ways in which those effects spill over onto society in general. Avoiding those spillover effects is society’s compelling interest.
> “”The interest society has in ensuring that all women can effectively manage their own fertility is compelling enough that it justifies removing direct cost to individuals as a barrier to access.”
> So asserted but why?
Because Bastiat’s broken window aside, the economic cost to society of an unwanted pregnancy, especially in households that cannot properly care for an infant, are huge compared to the marginal cost paid for by society of a monthly stream of free bc pills. It’s also rather inhumane to the unwanted, poorly treated infant and then child. Better to let the woman time her pregancy for when she can best care for her child.
> If society’s interest is the most important factor, it should be society, not individuals, that manages fertility and decides which members are fit to reproduce and when
Yeah, well, that’s taking the logic to an illogical extreme in our society.
Society has an interest in the most efficient allocation of jobs and products and services produced, but society has decided that it doesn’t need a 5 year plan to get us there.
It is in the interest of society to encourage high IQ, healthy women to breed and discourage low IQ, unhealthy women from breeding. There is zero demonstrable interest in “ensuring that all women can effectively manage their own fertility.”
Making implantable birth control or sterilization a precondition for receipt of welfare or subsidized housing would be a reasonable policy.
The only thing Congress can actually do to increase women’s access to birth control and decrease prices is paying to fast-track over-the-counter hormonal birth control through the FDA approval process. Which has been proposed by Republicans and blocked by Democrats with Planned Parenthood joining in on opposition.
The real cost of birth control isn’t the pittance of $9 a month–that anyone with a steady enough job to be on employee based health insurance couldn’t conceivably be rationally concerned about–but the litany of extremely invasive and completely unnecessary tests that doctors regularly submit women to in order to run up the bill.
Obviously the hospitals and the doctors benefit from the current state of things by forcing women to endure invasive and expensive tests, but Planned Parenthood and Democrats do also: if birth control went OTC, the question of insurance for most would become a completely forgettable issue, and their case that there is a “war on women” you have to vote Democrat and donate to PP to prevent would lose a lot of strength.
Yes, “insurance” is a misnomer, strictly speaking. For example, most health insurance plans pay for routine checkups, routine pregnancy care, arguably non-essential treatments such as Viagra, and arguably statistically predicable injuries such as broken legs from skiing or for that matter cirrhotic livers from presumably voluntary over-drinking and overdoses from opiates. All of this was true long before Obamacare. You could argue that people should pay for routine checkups out of pocket, as being totally predicable, that they shouldn’t plan children until they have saved up for routine pregnancy, delivery, and pediatric costs, that Viagra is a luxury, and that skiers, motorcyclists, etc., should pay a supplement for undertaking risky activities. Maybe heroin should be taxed, too.
You could argue all that, but you would be describing a very different system from what we have today, where (among other things) if you try to pay for hospital treatment out-of-pocket, you are charged much more than an insurance company is charged. The case you bring up is utterly trivial compared to these bigger issues.
As for the employer-provided health care, I certainly agree that it is perverse that employed people pay for health “insurance” with pre-tax money, which benefits those in higher tax brackets more than those in lower. Linking employment to health coverage is a bad idea.
But at this point, given the institutional and political realities, it seems unlikely that our healthcare “system” will be reformed in a rational way.
No woman is free unless someone else is paying for her birth control
I am confused by this discussion of “wanted” versus “unwanted” child in the context of modern American society.
Let’s start by looking at the wage slave who goes to work 50 hours per week in a tire shop. The income he earns pays for his house, health care, food, and mobile phone service. Does he “want” to work in a tire shop? How could we tell?
Slide over to the American who can get a taxpayer-funded house, health care, food, and Obamaphone ONLY IF he or she can produce or get hold of a child. Is the child inherently “wanted,” independent of these financial incentives? How would anyone ever be able to tease this apart?
Now let’s go to Park City, Utah. A Utah resident has sex with a visiting married radiologist. The resulting pregnancy is continued and $72,000 per year in tax-free child support is collected for the next 18 years. Was that child “wanted” or was it the $72,000 per year that was “wanted”? (see http://www.realworlddivorce.com/Utah for the formula)
Even children born to married couples may not necessarily be “wanted” purely for their own sake. Maybe one partner thinks that having a child will keep the marriage together for an adult benefit or, at least, provide for a free house and larger cashflow in the event of a divorce lawsuit being filed.
So… once you’ve got a society where a child can yield either cash or a raft of free government-provided services (such as housing), I don’t see how it makes sense to talk about children being inherently “wanted” or “unwanted.”
fenn: Thanks for the interesting note about the over-the-counter controversy. You inspired me to search and I quickly found
http://www.cnn.com/2012/11/20/health/birth-control-over-the-counter/index.html
where it says that “the American College of Obstetricians and Gynecologists … is recommending that oral contraceptives be sold over the counter”.
I wonder which politician or bureaucrat was credibly able to say “I know more about this issue than a bunch of ob/gyns”!
[Separately, this is interesting because it is a counterexample to the homo economicus postulate. It would seem that the doctors who made this recommendation would experience a reduced income if the recommendation were to be adopted. So unless they had some assurance that their recommendation would be ignored it was not consistent with their economic interest.]
fenn: Making some methods OTC is only a partial solution because some birth control methods are simply not OTC easy, and because of side effects there are some women for whom there are no OTC easy methods. It is probably true that pharmacists could act as gatekeepers and manage some solutions without the involvement of a physician. There are countries where the system works this way, but it is not a feature of the US healthcare system.
“I am confused by this discussion of “wanted” versus “unwanted” child in the context of modern American society.”
For the purpose of understanding my point in this discussion, please substitute the word “intended” for “wanted” and the word “unintended” for the word “unwanted”. I apologize for causing the confusion.
The interest society has in ensuring that all women can effectively manage their own fertility is compelling…
Does society have a compelling interest in women HAVING children? Many European countries now have total fertility way below replacement, which will have a profound impact on society – not enough money to fund pensions, the creation of demand for immigrant laborers who bring costs to society, etc. If society has a “compelling” interest in reducing fertility then it might also have a “compelling” interest in increasing it, for example by forbidding all contraception.
OR you could say that this is a personal decision and none of “society’s” (AKA the government’s) goddam business. The problem with a lot of extremists, both left and right, is that they want the government to interfere like hell when it suits them and to stay the hell away when it doesn’t and they are left without any consistent framework for saying when interference is “compelling” and when it should be “verboten” except their own ideological preferences.