“Free” Birth Control

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Starting in August 2012, most American health insurance will cover birth control and other preventative services for free. This is being required by the United States Department of Health and Human Services. Not surprisingly, this has created some concerns.

One main concern is that this will result in an increase in premiums. After all, health insurance companies are in the business of making money and they will need to increase their income to offset the cost of covering birth control. Those who do not use this sort of birth control (men and some women) might regard this as unfair and wonder why they should have to pay a price for this new coverage. Those who have moral objections to birth control might also take issue with it being covered.

One obvious reply is that insurance already covers many things that many people will not use. One obvious example is Viagra. It is covered by insurance but is obviously not used by women and is also not used by many men who pay for insurance. Other obvious examples would be other sex specific medical procedures such as prostrate surgery and hysterectomies. If coverage of these things is acceptable (especially Viagra), then it would seem that covering birth control would also be acceptable. Of course, this does not address the moral concern.

While most people do regard birth control as morally acceptable, not everyone does and these folks might object to having it covered by insurance. This point has been addressed, at least to a degree:  the law makes an exception for religious organizations, most notable Catholic organizations. Interestingly enough, the majority of Catholic women and Evangelical Christian women claim to use birth control, despite the fact that the official religious dogma is against it. As such, some of these women will need to pay for their birth control (assuming their insurer is among the exempt). But such is the price of dogma.

Those who truly object to birth control and do not use it can, of course, try to acquire insurance through such organizations. That way they will not need to support, however indirectly, birth control. Of course, they will have to be careful to determine if the insurer covers anything else they might regard as morally offensive. For example, some people might find Viagra unacceptable.  If so, the only option might be to find a truly morally pure insurance company or (more likely) simply forgo insurance so as to avoid even the slightest connection with the morally distasteful.

Of course, some folks regard the coverage of birth control as an evil in and of itself and something that should be prevented. For these folks it is not enough to merely not buy insurance from the same company that provides coverage. These folks contend that birth control should not be covered at all.

One argument is the religious argument, or rather a limited religious argument. As noted above, the official Catholic position (which is relentlessly violated by Catholics) is against birth control. However, there is the obvious problem of making the dogma of one sect a deciding factor in the law of the land. As always is the case in such matters, I leave it up to God to show up at set the matter straight. Until then, of course, we’ll have to settle things by other means.

A second argument is that birth control is not a medicine in the sense that it does not treat or prevent a disease or other health threatening condition (with some notable exceptions). It does not, as Viagra proponents point out, restore a normal function of the body. Rather it simply does what the name states: it prevents (most of the time) pregnancy. As such, it can be argued that it should not be covered by insurance.

Viagra is, of course, covered by insurance. This provides a context in which an argument can be made for having insurance cover birth control. So, if Viagra is covered by insurance, then should birth control be covered?

The answer is clearly “yes.” One argument against covering birth control is that birth control is a matter of lifestyle choice and not (in most cases) a matter of health. Of course, this same argument could be applied to Viagra. Both Viagra and birth control seem to be lifestyle drugs. A person takes Viagra to be able to have sex and a person takes birth control to be able to have sex without becoming pregnant. In general, neither is needed for actual health. Unless, of course, one considers having sex to be important for health. If so, they are still on roughly equal footing.

It might be countered that Viagra is different because it simply restores a natural function that is lacking. In this regard it could be seen as analogous to a hearing aid or a pair of glasses. in contrast, birth control does not restore a natural function or correct a problem. It simply prevents a natural function from taking place.

This argument does have some plausibility. Naturally, the argument would justify covering birth control in the case of women who needed it for clear medical purposes rather than simply to avoid pregnancy. However, this would be a very small number of women.

It can be argued that insurance does cover treatments and medicines that are designed to enhance or preserve quality of life and that this would justify coverage of birth control. For example, a person might be on blood pressure medicine to keep her blood pressure from increasing further even though it is not currently high enough to be a significant danger. In the case of birth control, it could be argued that it is a medicine that enables a woman to maintain a desired quality of life. As such, it would be a preventative medicine. Of course, this would seem to imply that pregnancy is in the same category as diseases and such.

Another argument that can be employed is this: if Viagra is covered and it is justified because men should be able to chose to have sex, then birth control should also be covered because it enables women to chose not to become pregnant. If men need to have sex and hence Viagra should be covered, then women can argue that they also need to be able to avoid getting pregnant and hence birth control should be covered. This seems reasonable.

As a final point, it seems sensible and morally correct to have birth control covered. This coverage might help reduce the number of unwanted pregnancies and thus result in less costs (monetary and social). If so, covering birth control could turn out to be financially a good idea-even if premiums are increased, the overall costs might be lower. There is also the moral argument that reducing the number of unwanted pregnancies would create more happiness than unhappiness-and also perhaps reduce the number of abortions. Then again, maybe the coverage will have no impact-it all depends on how many women forgo birth control on the basis of cost.

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  1. I would add the far more pertinent issue that birth control is not ‘insurance’. It is something that people know they will need as opposed to e.g., viagra which is a future risk with variance among the population.
    Hence it is more of the nature of a transfer payment with all of the relevant issues.

  2. I think much of this post misses an important point. If Viagra IS covered by insurance, it does not necessarily follow that the pill SHOULD BE covered by insurance. Mr. LaBossiere does not seem to take this into account until the penultimate paragraph when he adds to the antecedent that it is justified that Viagra is covered because men should be able to choose to have sex.

    But, as far as I can tell, he considers no objections to the claim that Viagra should be covered.

    And I think it can be objected that Viagra should not be covered. I think an objection could be something like this: When so many are dying of starvation, we should not be paying for rich people’s erections.

    But, if this is true, then should blood pressure medicine be covered for someone whose blood pressure is not high enough to be a significant danger? Maybe it shouldn’t, and maybe this is inconsistent with some of our intuitions. But the world is a messed up place. So I would not be surprised if many of our intuitions are messed up too.

  3. In the above comment, I said “the pill” where I should have instead said “birth control” or “contraceptives”.

  4. It also has a public good. Working women can control when they want to have children, so out of this we also get a workforce that controls when they work. This does double time in economic effectiveness of the worker by preventing maternity leave that is undesired and giving reprieve to employers. Also by giving impoverished individuals more family planning capabilities, this will ease the cost burdens of economically necessary abortions on the lower class who may not have cost effective access to birth control but are still covered by insurance that does not cover abortions.

    There may also be an independent feminist argument in here apart from simply comparing it to viagra. This plan increasing a woman’s freedom by allowing her to control her body more effectively without having to balance unwanted pregnancy against the costs of birth control (which adds up over time, even student discount prices can add up to $120 a year). This, in effect, equalizes men and women by making unwanted pregnancy something that both have control over for minimal costs that are shared equally by the population.

    Just some thoughts about other reasons why this is both economically interesting and morally interesting.

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  6. The basis of Insurance is that all risks shall be shared. I do not need Insulin but I cannot therefore ask for a reduction in Premiums because I do not need it. In point of fact I may do at some time for all I know. So far as birth control is concerned could we not regard it as preventative medicine. There are no doubt many whose lives would be adversely affected by the birth of a child. Health insurance must surely include all medication and whatever attention is applicable from the medical profession. Once you start letting people pick and choose the requirement of risk sharing is severely affected. It may be possible to find an insurer who will agree to certain exclusions, I am not familiar with the whole position in USA. I have met several people who will not insure their lives on account that it is not theirs to insure, it belongs to God. When such people die I don’t think God shells out for funeral expenses and or other financial benefits which insurance of the deceased, would have benefited those bereaved.

  7. I think it’s a bad idea, to have Viagra and birth control pills covered by insurance, by law. Why should individuals be obliged to pay for somebody else’s drugs, especially when they are not ‘essential’ to life?

    I am thinking, no wonder we have ‘tea partiers’ when people are constantly obliged to fork over money for things that seem nonsensical. When do we stop trying to be just and merciful about everything? Also, a sense of self-reliance and responsibility go out the window when such things are mandated and made universal.

    One of the reasons why nature societies like ours have incurred such massive debts is because our governments are trying to be all things to all people. If we carry on like this, insuring and protecting everybody, we surely will bankrupt ourselves.

  8. @Philofra “Why should individuals be obliged to pay for somebody else’s drugs” and “no wonder we have ‘tea partiers’ when people are constantly obliged to fork over money for things that seem nonsensical”

    The problem with the teabaggers is they would have you believe that ANY government intervention is anathema to freedom. Sense or nonsense.

    So do you really need that cancer treatment, just for an extra six months of life? Why not take the excruciating cost of cancer research and drugs which are mostly concerned with end of life, and put that into prenatal care.

    The cost of health in the US is astronomical because it is supplier orientated instead of consumer. Just look at the better care offered in a myriad of other countries with substantially lower per capita GDP than the US. The US population pays the least tax of any country, but expects the most and best care – it just doesn’t make any kind of logical economic sense.

    > One of the reasons why nature societies like ours have incurred such massive debts is because our governments are trying to be all things to all people.

    Go tell that to the one in six Americans living in hunger. [feedingamerica.org]

    That there is even ONE child in this country in need of basic human sustenance is a tragic crime against democracy and freedom.

    We should be fighting the war on our own doorstep before telling other people how they should live.

    We don’t care enough about ourselves to help our fellow Americans. If you don’t respect yourself you’re never going to respect someone else, especially if they are imposing something on you.

    If all the obese people in this country took any control over there own eating habits, and those of us with a modicum of restraint could eat what we buy and not throw 60% of it away, everyone in this country would be well nourished and able to contribute to a better life for themselves and their neighbours.

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