A Philosopher's Blog

“Free” Birth Control

Posted in Law, Politics by Michael LaBossiere on August 2, 2011
Picture Of Ortho Tri-Cyclen oral contraceptive...

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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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19 Responses

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  1. magus71 said, on August 3, 2011 at 7:55 am

    Why not free food for everyone? Isn’t that one of the most fundamenal things to human existance?

    • Michael LaBossiere said, on August 3, 2011 at 1:34 pm

      Free food is not a bad idea-provided that it can be produced at a level that makes it viable as free. Many sci-fi tales of better futures have food as free because the productivity of society is so high there is no need to charge for such a basic necessity.

      • WTP said, on August 4, 2011 at 8:31 am

        So in these Science Fantasy worlds, do they mention how the food gets there? Is all of the food of exactly equal quality? If so, do those who get the poorer quality food complain that they are being treated unfairly? Do the ranks grow of those who do no work yet consume this plethora of food? What kind of “society” are you talking about, one world government? If not, do those governments that give away food for free also give it for free to neighboring governments? Do neighboring governments out perform the free-food governments? These are all viable possiblities, are they not?

        Mike, do you believe that socialism is a better path to prosperity than capitalism? Yes or no. No squirrel-driven weasling.

        • Michael LaBossiere said, on August 4, 2011 at 1:09 pm

          Depends on the world. In some cases, the free food is bland and basic. In others, such as the Star Trek world, the food is really good. In the real world, it does seem possible to have such an efficient food production system that food would be incredibly cheap or even free. Of course, it is also possible that a shortage of usable water and other factors will lead to a future in which food is a precious resource and once again the basis for war.

          Depends on what you mean. Pure capitalism and pure socialism would probably both be failures. We currently operate on a blend of the two.

          • magus71 said, on August 4, 2011 at 5:02 pm

            Yes–Mike envisions Star Trek happening now…

            • Michael LaBossiere said, on August 5, 2011 at 10:48 am

              Not at all. We’d need the sort of technology in Star Trek, such as anti-matter power and replicators. If we had cheap, unlimited power and replicators, then food would be incredibly cheap. People would buy replicators, pay for power and replicate food from cheap raw material. I have no objection to everyone on earth having cheap access to healthy, nutritious food and clean water. I don’t see that as a bad thing at all.

          • WTP said, on August 4, 2011 at 6:13 pm

            And you weasle again. It’s a simple question, Mike. Which one is the BETTER path? I never said anything about purity. If you won’t answer yes or no, tell me where you draw the line? What will socialism provide and what will captialism provide in your perfect world? Or what percentage of each would you prefer (and try not to let your total go over 100%).

            “Depends on the world. In some cases, the free food is bland and basic. In others, such as the Star Trek world, the food is really good.” — What are you, a child? All the food will all be of the exact same quality based on whatever fantasy world they live in. The food in Star Trek is always “good”. Do they have brussel sprouts in Star Trek, I don’t remember…

            And how does the food get from where it’s produced to where it’s consumed? Do people have to travel to get their food or does it magically get delivered to the door like manna from heaven? (raises the question of free shelter…digress, digress) Do the people have to labor at all? Do they have to cook it themselves or would it only be cold food? If they have to cook it, does society pay for the fuel/electricity to do so? Do they even have to put it in their mouths? I take it wiping their chins would not be covered.

            • WTP said, on August 4, 2011 at 6:17 pm

              heh…re-reading this I’m reminded of the Shmoos in L’il Abner:

              “Shmoos are delicious to eat, and are eager to be eaten. If a human looks at one hungrily, it will happily immolate itself, either by jumping into a frying pan, after which they taste like chicken, or into a broiling pan, after which they taste like steak. When roasted they taste like pork, and when baked they taste like catfish. (Raw, they taste like oysters on the half-shell.)”

              http://en.wikipedia.org/wiki/Shmoo

            • Michael LaBossiere said, on August 5, 2011 at 10:56 am

              I really cannot give a simple answer. After all, a great deal depends on the definitions of the terms, the conditions, and so on. It is somewhat like expecting a person to say whether a hammer is better than a screwdriver. It depends on what you are trying to achieve and so on. Or it could be seen as asking whether justice is better than virtue in the sense that these are all complex and controversial concepts.

              Since we are talking science-fiction, the Star Trek method is the replicator and, of course, they have transporters.

              As far as in the real world, there is already work in progress on artificial foods (such as meat, which is currently rather bad) that could be grown cheaply and efficiently. As far as distribution goes, that depends. If the technology enables local production, then the distribution would not be as important as it is today.

              On the basis of human compassion, it seems to make sense to develop ways to lower the cost of nutritious food. On the basis of pure self-interest, as the world population continues to expand we are going to need to address the challenge of how to keep people fed. After all, a lack of food is a major factor in unrest. I could do without more wars and social collapse.

    • D'n said, on August 5, 2011 at 2:46 pm

      Food stamps.

  2. James Claims said, on August 3, 2011 at 11:40 am

    “this would seem to imply that pregnancy is in the same category as diseases and such.”

    This is not necessarily the case. Quality of life does not imply an absence from disease, it’s a maintenance of functionality that is desirable. And pregnancy wouldn’t be considered a disease under a view of drugs that considers them as optimizing desired performance; rather, pregnancy would be considered as an unwanted/undesired health condition by a woman who goes on birth control and not optimal.

    And as for costs associated with birth control, I’d be interested to see how the numbers work out for insurance companies in terms of payments for abortions and also costs associated with prenatal care, delivery of newborns and routine check ups in the first 2 years of life. Given how high these costs can run, the insurance companies might come out ahead in the end in preventing expensive pregnancy costs.

    • Michael LaBossiere said, on August 3, 2011 at 1:37 pm

      James,

      While I would also need to see the numbers, I suspect that you are on to something. By providing “free” birth control, the insurance companies might break even or come out ahead. After all, birth control is cheap relative to the costs of pregnancy.

  3. T. J. Babson said, on August 4, 2011 at 3:29 pm

    Let’s face it–these rules go far beyond free birth control. It basically forces everyone to subsidize the medical care of women of child bearing age.

    There may be legitimate societal reasons for doing this, but we never had the debate. These rules were just handed down to us from on high.

    • Michael LaBossiere said, on August 5, 2011 at 10:46 am

      This could result in an overall savings, though. After all, much of what is now covered can help avoid latter costs that would be covered by insurance as well.

      In any case, we already subsidize the medical care of each other. For example, I’ve used my insurance for one 30 minute surgery, yearly checkups and a few minor things over the years. I’m subsidizing everyone who is less healthy than I. This might also be an injustice.

      • T. J. Babson said, on August 5, 2011 at 11:11 am

        Women use more medical care than men, so their premiums should be higher. However Obamacare has enforced a policy that men and women should pay the same. These new rules go one step further and further subsidize women’s care.

        I suspect that these changes are motivated more by politics than policy.

        • Michael LaBossiere said, on August 8, 2011 at 1:42 pm

          It does make sense to charge based on use, with a safety cap to keep people from being stripped of insurance. In my own case, I use my insurance once a year for my checkup. I did have surgery to repair my tendon and I have had a few minor problems (mostly sinus infections) over the years. But, I have paid in far more than I have gotten out, so I am presumably subsidizing others and also helping the insurance company get some fat profits.

          • T. J. Babson said, on August 8, 2011 at 3:24 pm

            Politics, not policy…

  4. […] no clear explanation to why some people are upset about free birth control. It’s especially mind-boggling when condoms are a form of birth control that have been free […]


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