When a woman goes to get another pack of birth control pills, how many people have been involved in the process? She had to request a prescription from her doctor, who was reimbursed by her health insurance company. If she’s like most people, her employer paid for some of her health insurance premium, and the insurance company also paid the drug maker and pharmacist.
So a woman, doctor, pharmacist, drug maker, health insurance worker and the woman’s boss all played a role in putting that new pack of pills in her hand.
This is preposterous. It sounds like a bad joke about screwing in a light bulb.
Most people don’t bother thinking about this bizarre process because it is the status quo. But it is exactly this status quo that has created such inefficiency in our health care system and driven up our costs. And recently, due to government mandates, this multi-party payment pipeline has also resulted in culture clashes and multiple lawsuits.
For example, right now the Little Sisters of the Poor, a group of nuns who care for elderly and dying patients, is petitioning the Supreme Court to exempt them from the Affordable Care Act’s requirement that employers provide first-dollar insurance coverage for all FDA-approved contraceptives. Naturally, nuns don’t want to help provide birth control, which they find morally objectionable.
Constitutional and religious freedom concerns aside, this legal conflict exposes the folly of an employer-centric health insurance system. Why should anyone’s boss have to be involved with his or her health care choices? In addition to potential moral problems, like the one facing the Little Sisters of the Poor, our system poses practical problems, as people have different budget-related and coverage preferences. There’s no reason why a group of people who share an office should have to share the same insurance plan.
The reason why so many get health insurance (but not other insurance, like car or home) at work is because of our tax code, which rewards people for obtaining insurance through their employers. On-the-job health benefits are excluded from taxation, saving employees thousands of dollars each year in taxes. Unfairly, people who buy their own coverage directly from an insurance company don’t get this tax break.
This distortion has been in the tax code for decades. But recently, the Affordable Care Act made matters even worse, by requiring that all employers of 50 or more workers provide health insurance or pay steep fines.
Employers shouldn’t be forced to be the arbiters of health insurance in this way. We should get rid of this mandate on employers and equalize the tax treatment of all insurance plans. Employers should still be free to provide health insurance coverage – for birth control or anything else – but they shouldn’t be forced to be party to this payment system.
Actually, we should cut out several parties that right now are part of the process women have to use to obtain birth control.
There’s no good reason that insurance companies should be required to cover birth control. Insurance is supposed to be a backstop against unexpected costs. Paying for contraception via health insurance is the equivalent of using auto insurance to pay for routine oil changes. It’s inefficient, and results in a lack of price transparency and price competition. In other words, because the consumer isn’t going to pay for her own pills, drug makers don’t feel pressure to make their product less expensive. So they charge more, and insurance companies build those hidden costs into higher premiums for everyone. We’d be better off without a government mandate requiring insurance coverage for these routine and inexpensive drugs.
Furthermore, today’s most common forms of birth control are very safe. Women shouldn’t have to obtain a prescription from their doctors to access birth control. The FDA should move all common contraceptives to over-the-counter status, as they have already done with Plan B, or the morning-after pill.
Doing so would reduce the cost of the drugs (as we’ve seen with Claritin and other drugs when they move to over-the-counter status) and remove the hurdle of obtaining a doctor’s prescription. Over-the-counter birth control would reduce unexpected pregnancy by as much as 25 percent, according to one estimate from the University of California–San Francisco.
Bottom line: Women should just be free to go to the store and buy birth control drugs, as we do with most other consumer goods, all on our own. There’s no reason that birth control should be anyone’s boss’s business – nun or not.