(By Mark Bridger, cross-posted at ThatMansScope)
The 7 – 2 Supreme Court decision Griswold vs. Connecticut (1965) established the right of married people to purchase and use birth control devices. Six years later, Eisenstadt vs. Baird extended this to unmarried couples as well. (I was living in Massachusetts when that happened and remember Bill Baird’s courage and dedication in risking his freedom to make this test case.)
Given the virtually total acceptance of birth control by Americans — even, or especially among Catholics — it is highly unlikely that this right can be denied. I would venture to say it is less likely than the re-imposition of Prohibition — in spite of ravings from lunatics like Rick Santorum and the hierarchy of the Catholic Church.
So, despite a lot of hyperbole, the issue these days is mostly: Who pays for it?
As it stands now, it is the issuers of health insurance, under the Affordable Health Care Act (popularly called “ObamaCare”), that are required to foot the bill. It is important to note, in this context, that it is not the “American Taxpayer” who pays for anyone’s contraception: that’s simply not the way it works, Rush Limbaugh to the contrary (except possibly in the case of Medicaid, which is barely in the controversy here anyway).
Arguments pro and con involve the following:
1. The Viagra argument
2. The Mental Health argument
3. The Running Shoes argument
4. The Prescription Drug argument.
1. Currently, both Viagra and The Pill are covered by ObamaCare, and neither is restricted by marital status or even one’s sex. It is possible to make distinctions, however. Some (mostly men) might claim that sex — for procreation or otherwise — is possible without The Pill, but in many cases is not without Viagra (or its equivalents). If you take the narrow and exceedingly unpopular view that sex is only for procreation, then this argument might have some force, however, medically, one can obtain semen without erection or ejaculation, so the argument from this perspective is not accurate. The many women who are on The Pill would claim that without it sex would be much more encumbered and far less enjoyable (hence less likely to happen). Furthermore, sex without The Pill would almost surely result in more dependence on condoms and other physical contraceptives, hence result in more unintended and unwanted pregnancies. This in turn would result in higher healthcare costs and/or more abortions. Thus, it is hard to make a realistic distinction between coverage of Viagra and coverage of The Pill, and from an economic perspective, paying for The Pill will, statistically, save money in insurance premiums.
2. The effectiveness of The Pill has enabled several generations of women to feel “in control” of their bodies with respect to sex and reproduction. Supposedly this has lead to an increase in overall mental health, though that is difficult to quantify; nevertheless, this has led to the argument that paying for The Pill is appropriate because its use is a women’s health issue — sort of like regular gynecological checkups. Of course there are other contraceptives available. Some are simply variations on the The Pill such as various “patches” or timed-release doses; others are doctor-based such as diaphragms and IUDs. Then there are condoms which, though not always under a woman’s control and subject to failure, do prevent sexually transmitted diseases. Whatever the validity of the argument for The Pill as important for women’s health, it is safe to say that the vast majority of women support this argument and hence are in favor of coverage under medical insurance; probably the opinion of men on this issue — though pretty nearly in agreement — is irrelevant.
3. Limbaugh et. al. have suggested that arguing the health benefits of contraceptives is similar to arguing the health benefits of running shoes; since the shoes are not covered under healthcare policies, neither should the contraceptives be. In point of fact, even though running shoes themselves may not be covered, many health insurance plans (including my own) regularly cover gym and fitness club memberships. The reason is that insurers know that having members physically fit — especially non-obese — actually decreases their chances for contracting chronic debilitating diseases such at diabetes and heart conditions. This in turn reduces insurance payments for treating these diseases. This is sound economics and makes health care less expensive for all (since the reduced risks are spread around). By the same token, reducing the risk of unwanted pregnancy reduces the costs of pregnancies and instances of abortions. Once again, paying for contraceptives is good competitive economics for insurers. The particular example of (the cost of) running shoes is probably too trivial, but the argument for covering preventative fitness programs is a good one and is already being widely implemented. The analogy with contraception reverses the argument (if there was a serious one) of Limbaugh and others who had hoped to mock it.
4. It has been traditional for health insurance to cover medicines and treatments that are prescribed by doctors. The physician-patient bond has long been recognized legally in many forms. The specter of the old HMO plans standing between a patient and doctor is still a source of discomfort, so modern plans attempt to give at least the appearance of granting the doctor the final say in treatment. Since The Pill, IUD and diaphragm are always doctor-prescribed, they tend to be covered by health insurance. That’s why condoms are not covered even though they could be even more expensive than other birth control methods — they are bought over-the-counter without doctor intervention.
In short, then, there is no one overwhelming and unanswerable argument that “proves” birth-control pills should be covered under “ObamaCare”. Probably the best talking points are that they promote women’s psychological health, and that they actually reduce the cost of health insurance premiums for all by largely eliminating the expenses of unwanted pregnancies; they also avoid many abortions. In any case, claims that tax-payers are financing anyone’s sex is total nonsense.