I’m thankful that my recent post on Forbes gave Planned Parenthood the opportunity to clarify their position on over-the-counter birth control. It now appears their stance is not against over-the-counter birth control, but over-the-counter birth control coupled with repeal of the ObamaCare mandate that insurers must offer first-dollar prescription contraceptive coverage.
As I wrote previously, these two policy issues need not be coupled. And it’s refreshing to find common ground: All sides of the health care debate can encourage drug makers and the FDA to take the steps necessary to make oral contraception available over-the-counter.
Debate comes down to the anti-choice, anti-competition mandate
The remaining debate therefore centers not on birth control, or even insurance coverage for birth control, but on whether the government should mandate that all health insurance plans must include this specific coverage package. It is strange that such a proudly pro-choice organization wouldn’t recognize the irony in such efforts to limit consumers’ choices and force all women to pay for contraceptives (inefficiently) through insurance coverage.
Their stance appears to rest on some flawed logic and a failure to appreciate how the cost of such mandates manifests. First, Planned Parenthood asserts that proposals that would move to a direct-pay model for birth control are harmful because they do not include “cost reduction” for women. This ignores how market competition naturally works to control prices. Obviously, other consumer goods do not have infinitely high prices in the absence of mandates because producers have to compete for customers.
Planned Parenthood laments the high costs of many brands of oral contraception, but doesn’t consider the rationale for those high prices and how greater accessibility would bring costs down. The “Pill” was introduced more than 50 years ago, and today it is cheap and easy to manufacture. Various pharmaceutical brands produce oral contraceptives, and in an over-the-counter model, these companies would be forced to compete on price. This means that neither women nor insurance policy holders in general would have to pay thousands of dollars each year for what should be an inexpensive product. In fact, already some consumers have found that for certain health services or medications, they can find lower prices when they offer to pay cash instead of invoking their insurance.
The truly costly and noncompetitive model is the birth control mandate itself, where there is no price competition. Under the mandate, drug makers can charge unnecessarily high prices since those costs aren’t borne directly by their costumers, but are passed on to a third party (the insurance company) who is now required by law to pick up the tab.
Have ObamaCare’s mandates saved money?
Planned Parenthood says American women have saved $483 million as a result of the birth control mandate. But this faulty math ignores one side of the equation: How coverage mandates drive up the cost of health insurance premiums so that everyone pays more. Women still pay for birth control, through higher premiums. (And the time costs involved in obtaining prescriptions.)
The birth control mandate is just one of ObamaCare’s many mandated coverage pieces. Together, these required benefits increase premiums greatly: Even former HHS Secretary Nancy Pelosi admitted that ObamaCare plans cost morebecause they offer more mandatory benefits–like it or not. And the Congressional Budget Office estimated that these new required benefits would raise premiums 27 to 30 percent.
(This is not to mention the unfairness of such increased bills for insured women who do not use these new benefits. And there are plenty of reasons why women wouldn’t use contraception: Maybe they are celibate, too young, too old, already sterilized, in same-sex relationships, or actively trying to get pregnant.)
And what about the uninsured? After all, the Congressional Budget Office predicts that 31 million Americans will remain uninsured in 2024. Presuming about half of the uninsured are women, that’s over 15 million women who would be far better served by over-the-counter options than the insurance mandate.
Women know best: birth control is a personal choice and responsibility
Planned Parenthood criticizes over-the-counter birth control proposals for “narrowly” focusing on oral contraceptives…the most commonly used form. They argue that women should use more effective forms of birth control–specifically intrauterine devices or IUDs–instead of birth control pills, and they worry that making oral contraceptives available over-the-counter will discourage women from using IUDs. “Women will end up paying more for less-effective birth control,” they write. “They will be left worse off.”
Why not allow individual women to decide what makes them better or worse off? Currently, only 0.3 percent of women aged 15 to 44 use IUDs. First of all, covering these devices from the first-dollar forever (and never exposing them to price competition) is a great way to keep them expensive.
And secondly, while certainly some women may have avoided this method because of the upfront cost, others may not like the invasive or semi-permanent nature of such devices. Other women may prefer options that also protect against sexually transmitted diseases, a benefit that both IUDs and oral contraceptives lack. As Planned Parenthood can surely understand, choices about a woman’s body are very personal. It follows that the responsibility (and cost) of these decisions should be left to individuals.
Does insurance coverage for preventive care make economic sense?
Planned Parenthood also claims that insurance programs and companies can save money by offering comprehensive first-dollar contraceptive coverage. But if that were so, insurers would all do so without a government mandate. The mandate could be repealed, and insurance companies (and programs like Medicaid) could still offer the coverage out of their own self-interest.
And more broadly speaking, research in the New England Journal of Medicine suggests Americans should be careful before accepting arguments about the cost-saving potential of preventive care:
Sweeping statements about the cost-saving potential of prevention…are overreaching. Studies have concluded that preventing illness can in some cases save money but in other cases can add to health care costs…Although some preventive measures do save money, the vast majority reviewed in the health economics literature do not. Careful analysis of the costs and benefits of specific interventions, rather than broad generalizations, is critical.
No other type of insurance covers routine and expected costs: Car insurance doesn’t cover oil changes or gasoline, no matter how important to a functioning car. My health insurance does not cover the cost of my fresh produce or water, although surely a healthy diet and drinkable water are essential to health. Where does such logic stop? At some point, individuals have to be responsible for what they consume.
But it’s really not my place to say what each person’s insurance should or should not cover. That should be a decision left to each man, woman, or family. Sadly, Planned Parenthood doesn’t share this view, taking a “government-knows-best” approach to what should be deeply personal health care decisions. In doing so, the nation’s largest abortion provider is ironically showing a deep disdain for personal “choice.”