“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.