Over the last week, we’ve heard a lot from the people who (with a hat tip to one Joker), I now call “contraceptive sponges” — people who want others to pay for their contraception because — well, just because they don’t want to pay for it themselves.
I don’t think we need to take those people seriously. But others have taken the trouble to make actual arguments, both on this blog and elsewhere. Some but not all of those attempts deserve serious attention.
The worst imaginable argument — the one I have difficulty believing was ever intended seriously — is this:
| It is cheaper to foot the bill for contraception than to to foot the bill for childbirth. |
This is probably might be true (though I haven’t seen any actual estimates of the number of childbirths prevented per dollar spent on contraceptive subsidies) but (and I am embarrassed to even have to point this out), so what? If we’re going to start making choices strictly on the basis of what’s cheapest, we should all stop eating.
Here’s a much stronger (but still failed) attempt:
| The externalities from childbirth are, on balance, negative. Therefore childbirth should be discouraged. |
There are two problems here. First, it’s by no means clear that the externalities from childbirth are in fact on balance negative. Second, and more fundamentally, if you’re out to discourage childbirth, the best way to do it is to tax childbirth, not to subsidize contraception.
I for one am reasonably well convinced that the externalities from childbirth are on balance positive, each new child being a fellow citizen, a potential friend, potential lover, potential mate, potential collaborator, potential employer, potential employee, potential customer and potential Steve Jobs. And even if I’m wrong about that — even if the marginal child is, on balance, a drain on the world’s resources — there is still an offsetting benefit to the newborn child him-or-herself, who presumably places considerable value on the gift of life.
To overcome those objections, you’d need a good economic argument that children, at the margin, are less socially valuable than I believe they are, and a good philosophical argument against including “people” who haven’t yet been conceived in our social welfare calculations. (I’m very skeptical that you can provide the first, but more optimistic that you can provide the second.) But even then, what you’ll be left with is an argument for taxing childbirth, not subsidizing contraception.
To discourage childbirth by subsidizing contraception is like discouraging carbon emissions by subsidizing hybrid cars — it misses the point, and thereby gets the incentives wrong at multiple margins. Once people have bought their subsidized Priuses, the subsidy does nothing to discourage overdriving, and it does little to encourage the development of alternatives to fossil fuels. A tax on burning gasoline, by contrast, gets all of those incentives right. Likewise, if you want to discourage childbirth, then a subsidy to contraception encourages people to use birth control pills, but it does nothing to discourage activities that might lead to pregnancy and it does nothing to discourage large families among people for whom the cost of birth control is not an important consideration. A tax on childbirth works at all the relevant margins.
In fact, if the people who make this argument are sincere — if they really believe that the primary goal is to staunch childbirth — then it seems very odd that that they’d ever have focused so narrowly on contraception in the first place.
A more sophisticated version of this argument came up in last week’s comments:
| We might not want to discourage parenthood in general, but surely we want to discourage parenthood by the sort of woman who won’t use contraception unless it’s subsidized. Ideally we’d tax childbirth among that class of women, but since they’re hard to identify, the best available policy is to subsidize contraception. |
This one is harder to refute. The underlying assumption seems to be that these women are either very poor or very dumb and those are exactly the people we don’t want reproducing. I’m not sure I buy that assumption, but it’s not entirely unreasonable. On the other hand, it seems a little out of place in a discussion that started off being about the importance of supplying free contraceptives to third year law students.
A slight variant on the above runs like this:
| We might not want to discourage parenthood in general, but surely we want to discourage unwanted parenthood, because unwanted babies are far less socially valuable than wanted babies. |
This argument has been made with considerable eloquence by (among others) the commenter named “nobody.really” at several points in last week’s thread on this subject. He points, for example, to to the work of John Donohue and Steve Levitt, linking legalized abortion to drops in violent crime sixteen years down the line.
Kudos to nobody.really. This is a good argument, and worth taking seriously.
Here’s an attempt along entirely different lines:
| Female birth control confers a positive externality on heterosexual men and so ought to be subsidized. |
This one makes sense only insofar as the benefit to heterosexual men is truly external. It seems far more likely that, insofar as this argument works at all, birth-controlled women are in an excellent position to reap the benefits of their enhanced attractiveness to men.
If this is the road you want to travel, it makes a lot more sense to subsidize benefits that accrue to casual passersby who are not in a position to internalize the externality by picking up a dinner check. That means subsidizing cosmetics, plastic surgery and revealing clothes. The downside is that the same cosmetics that might confer benefits on passing (straight) men simultaneously confer costs on (straight) women who don’t appreciate the competition. So instead of subsidizing cosmetics, it’s possible we’ll want to tax them.
There’s a lot to sort out here. Anyone who made this argument sincerely will surely want to get right to work on that.
Finally, here’s a good argument that nobody’s made (at least here on The Big Questions or anyplace else I’ve looked):
| Birth control pills are provided by monopolists, and monopolists should be subsidized. |
This argument will, I trust, be crystal clear to anybody who’s recently completed a Principles of Economics course, but let me fill in the details for those whose freshman years are well behind (or ahead of!) them: First, monopolies are economically inefficient because they underproduce in order to keep prices up; therefore it can be good policy to subsidize increased production. (“Good policy” here means that the benefits to consumers exceed the costs to taxpayers; this is pretty much guaranteed because the benefits of increased production have to go somewhere.) Second, subsidizing the consumer is economically equivalent to subsidizing the producer. So for goodness’s sake, let’s subsidize the consumers of birth control.
Another way to say this: If it costs $1 to make a package of pills that, because of monopoly power, sells for $30, then anyone who’s willing to pay, say, $15, ought to get the pills (because they’re willing to pay far more than the resource cost of producing those pills) but won’t get them unless they’re subsidized.
This is an argument which, if anyone had made it, I’d have applauded — with this caveat: It has nothing to do with birth control. Instead, it’s an argument for subsidizing patented drugs in general (or better yet, for reforming the patent system).
Now you could argue that most prescription drugs are already subsidized under Medicare Part D, but that birth control pills are special because they are used primarily by people who are not yet eligible for Medicare. And you’d be right.
I am, as a general rule, skeptical about using government power to (partially) counteract the harm done by other exercises of government power (in this case, imposing subsidies to counteract the harm done by the patent system). I’d much rather attack the more fundamental problem (in this case, via patent reform). But a perfectly reasonable person could well argue that when the first best solution is not available, the second best is better than none.
Bottom line: There are both good and bad arguments for subsidizing contraception (and good and bad arguments against). From what I’ve seen in the past few days, the bad pro-subsidy arguments have largely crowded out the good ones. But the good ones are worth taking seriously.
Addressing this argument:
“We might not want to discourage parenthood in general, but surely we want to discourage parenthood by the sort of woman who won’t use contraception unless it’s subsidized.”
you wrote:
“The underlying assumption seems to be that these women are either very poor or very dumb and those are exactly the people we don’t want reproducing.”
There’s another group this would affect, which would be: women whose productivity and income will soon go up substantially, but for whom the market has failed to provide an efficient means for them to borrow against their future earnings, and for whom a pregnancy might derail their ability to finish their studies and boost their income. Law students would fall into that category.
That’s more of an argument for setting up a mechanism for those students to borrow against their future earnings, in order to pay for their own birth control. But subsidized contraception is better than nothing.
I disagree with your first point. That is, I think the argument:
“It is cheaper to foot the bill for contraception than to to foot the bill for childbirth.”
is quite reasonable and serious. First two assumptions. 1) All things being equal, people prefer cheaper insurance. 2) All things being equal, people prefer insurance that covers more things. Think of this as a free disposal assumption (and ruling out reasons why people might prefer less, like because of temptation).
Let X be the set of expenses covered by the default insurance, e.g. X={hospital stays, childbirth, certain medications, etc.}. Let Y be the same set of expenses plus contraceptives, i.e. Y=X U {contraceptives}. Then by assumption 2, if the price of X and Y are the same, then everyone prefers Y to X.
I interpret the argument that providing contraceptives is cheaper than paying for childbirth to mean that the price of Y is less than the price of X. This might be because the cost of providing lots of contraceptives is less than the cost of the few childbirths which are prevented from providing contraceptives. I don’t know if this assertion is actually true. Certainly insurance companies know best if this is true or not. But that is what I think this argument is saying.
Hence everyone is better off because they prefer Y to X and Y is cheaper than X.
Now I do NOT think this is an argument for forcing insurance companies to provide contraceptives. I think insurance companies are in a better position than the government to determine whether or not it is cheaper to provide contraceptives. Also, if a company or non-profit wants to compensate its employees with an inferior insurance policy at a higher price tag then that is their prerogative. I would imagine they would have to pay an above average wage to compensate for that fact (either that or they have to attract employees who do not value contraceptives at all).
Finally, I don’t think Steve’s example of giving up food is applicable here. Giving up food has a cost (no food) and a benefit (more disposable income). Providing contraceptives, according to this argument, has only benefits (you get contraceptives AND more disposable income).
What a great post. If only the people debating this topic had just part of the insights described here.
I would hope that one more thing has become clear in the recent discussion, namely:
“It is really, really nasty to call a woman ‘slut’ just because she advocates a policy decision you don’t agree with.”
Isn’t this a debate about forcing your employer to dock your pay to buy a health plan that gives some of that money back to you in the form of birth control? Yet we seem to be discussing subsidies. And in some cases subsidies to people who – at least by implication in some of the arguments – don’t have a job. These seem at best a distraction, and at worst a bait and switch.
The Donohue-Levitt work was based on a data processing error and is contradicted by other work.
Most contraceptive pills are out of patent, so the discussion of patent monopolies is irrelevant.
No one called anyone ’slut’ just because of disagreement with a policy decision. She was called a slut because she wants someone else to pay for her sexual relations.
No one called anyone ’slut’ just because of disagreement with a policy decision. She was called a slut because she wants someone else to pay for her sexual relations.
—–
She is evidently a policy advocate, whether or not her contraceptive use (IF ANY, you don’t know about that) is of little personal importance to her. Most likely, it IS covered through whatever health plan she is on.
And even if she personally benefited from such coverage, it would STILL be nasty to call her a slut.
It is no more appropriate to call her a slut than anyone who would be advocating, for example, covering erectile dysfunction treatments.
Advo, you keep misstating the facts. Fluke testified about her personal contraceptive needs, and how she wanted Georgetown to pay for them.
If a male Georgetown law student complained to Congress about his Viagra expenses, then he would be ridiculed also.
First point – Lets assume total cost of contraception is cheaper than childbirth. An economic argument suggests that insurance companies and employers would pay for this anyway. There would be no need for compulsion or subsidy. However, we have an irrational belief which prevents some employers taking advantage of these economic benefits. Doesn’t this result in insurance that is is more expensive for everyone?
I am having trouble with the “unwanted preganancy” bit. The assertion should be “we want to discourage unwanted parenthood, because unwanted babies AND their parents are less socially valuable than wanted babies and their parents.
The value added to society by individuals through their working lives will be reduced if they curtail their education. This is in addition to their personal financial loss.
Children produce externalities, some positive and some negative. It seems pretty clear to me that unwanted children will have fewer positive and more negative externalities. Even though we may not have all the data, it seems that a good policy would be one that encouraged wanted, and discouraged unwanted pregnancy. Taxing childbirth is therefore out. In fact, subsidising both childbirth and contraception may be the way forward.
We do not need to try to identify a “class” of women who would only use contraception if subsidised. There is no such class – the same woman may move from one to the other and back. We just need to know if a policy actually does reduce unwanted pregnancy.
I think that most people who have an unwanted pregnancy view it – at least in the short term – as a bit of a disaster. Taxing childbirth will be a adding a teeny tiny amount to the perceived negative impact, and therefore will have almost no effect on unwanted pregnancy rates.
SL has posted a link to an article that showed subsidising contraception increases its use. Since birth control is effective, we can conclude that subsidising contraception does reduce unwanted pregnancy. We do not need to know the ins-and-outs of why.
Subsidising childbirth acts in another way. Since unwanted pregnancy is by definition unwanted, and contraception is fairly easily available, the pregnancy is likely to be a surprise. Therefore any incentive for or against pregnancy will have little encouraging or detrimental effect. Wanted pregnancy is very different. Significant planning will occur, and subsidy here will encourage more planned births.
So subsidising birth would encourage planned births much, much more than unwanted ones. Subsidising birth control encourages fewer unwanted births, and has little effect on planned birth. Conversely, taxing childbirth discourages planned birth, and has little effect on unwanted birth.
I also think Ken B has a point – if it was made OTC it would remove a lot of the “medical” arguments. I do not know all the medical reasons for keeping it on prescription, but clearly there are side effects.
As I see it, contraception is like a flu shot. It is a product to prevent an unwanted condition. If my employer-paid COMPENSATION covers flue shots why not contraception?
Some posters seem to think there is a distinction between a want and a need. I challenge anyone to find a meaningful distinction. The man who “needs” a heart bypass wants one, plain and simple. Someone who wants contraception needs it.
@Neil: No reason at all why not, if that is what you agreed with your employer. But why should I have to pay for it through taxes, and why should I be asked to compel your employer to pay for something she stipulated she wouldn’t.
One of the amusing things on this thread is seeing how many people argue that the pill benefits only women and viagara benefits only men.
@Roger: I have just re-read the transcript, and she did not specifically mention her own sexual relations beyond a generic “we” to describe the female students. She may be celibate, but could still promote a policy of subsidised contraception.
Even if she had said that she wanted to subsidise her own sex life, that would not justify describing her as a “slut”. SL may define it as someone who has a joyous enthusiasm for sex, but that is not the whole story. It only applies to women, and is very clearly demeaning. If someone uses this term without intending to insult, then they have as poor command of the English language. It implies that women are wrong to want to have sex, although it is fine for men.
At least half the people in the USA want the Govt to subsidise something they do or use. This sort of language is only used where women’s sexuality that is affected.
I note that SL did not call anyone a slut, but it would have been better not to repeat the name calling of others.
John Stovall:
Finally, I don’t think Steve’s example of giving up food is applicable here. Giving up food has a cost (no food) and a benefit (more disposable income). Providing contraceptives, according to this argument, has only benefits (you get contraceptives AND more disposable income).
Providing contraceptives also has a cost: You lose the positive externalities from the children whose births are prevented.
Such a nice, sweet-toned, irenic post. But Steve forgot Fluke’s most inflammatory argument, the one most clearly a form of emotional blackmail and extortion:
On this board too we have seen attempts, and it is hard to think some were not deliberate, to cast concerns about paying for the pill as part of a more general assault on women’s health.
@Steve
I guess I was making three assumptions then. The third was that there are no externalities.
Roger Schlafly:”She was called a slut because she wants someone else to pay for her sexual relations.”
That’s twaddle Roger. She wants no such thing. It’s bad enough dealing with inflammatory nonsense with people I disagree with about the mandate.
JohnE:
I guess I was making three assumptions then. The third was that there are no externalities.
In the absence of externalities, you are of course correct, but that seems to me to be a pretty much indefensible assumption here. Some people think they’re very large and positive; others think they’re very large and negative; it seems extremely unlikely that they’d happen to be exactly zero.
That’s quite gracious; thank you.
But also a little stigmatizing. “[T]he commentor named ‘nobody.really’”? It’s like being called “the Ukraine.”
Besides, it ruins the fun of the name. People say, “nobody.really argues X.” And others respond “Oh yes someone does; didn’t you read the comments?” I love that.
I mean, Odysseus is able to escape the Cyclops Polyphemus only because Odysseus claimed his name was “Nobody.” So when Polyphemus cries out in pain, shrieking “Nobody’s hurting me!,” the other Cyclopes figure that he was just acting crazy as usual and ignored him. If Polyphemus had yelled, “A commentor named ‘Nobody’ is hurting me!,” all would have been lost.
Think about it. Epics hang on such seeming trivialities.
“Is life a boon?
If so, it must befall
That Death, whene’er he call,
Must call too soon.
Though fourscore years he give,
Yet one would pray to live
Another moon!
What kind of ‘plaint have I,
Who perish in July?
I might have had to die,
Perchance, in June!
Is life a thorn?
Then count it not a whit!
Man is well done with it;
Soon as he’s born
He should all means essay
To put the plague away;
And I, war-worn,
Poor captured fugitive,
My life most gladly give—
I might have had to live
Another morn!”
William Schwenck Gilbert (of Gilbert & Sullivan)
“Consider how lucky you are that life has been good to you so far. Alternatively, if life hasn’t been good to you so far — which given your current circumstances seems more likely — consider how lucky you are that it won’t be troubling you much longer.”
Douglas Adams, The Original Hitchhiker Radio Scripts
Indeed. Nobody really believes Steve Landsburg is gracious!
Dunno; seems self-evident to me.
Oh, wait, I get it: Perhaps we can promote the social welfare by having more people stay home and raise kids. But we can certainly promote the social welfare by getting lawyers to stay home and raise kids. Damn, economists are insightful….
By the way:
http://onlinelibrary.wiley.com/doi/10.1111/j.1465-7295.2011.00377.x/abstract
or
http://www.princeton.edu/~dixitak/home/Elaine-Final-Web.pdf
As a healthy and fit male, why then should I have to subsidize healthcare for those who drink, smoke, eat too much, are old, etc? What Ms Fluke argued for is the benefit be added to medical insurance she is already paying for. Would you say that a bi-polar person advocating mental care as part of an insurance package is unreasonable? As a young female, isn’t it likely Ms Fluke is subsidizing others with their ailments which a good many are a result of bad habits, as I think some are labeling consensual, recreational sex?
Public choice Theory thoughts http://www.thedailybeast.com/articles/2012/03/02/peter-schweizer-big-pharma-s-role-in-the-contraception-debate.html
Shane:
As a healthy and fit male, why then should I have to subsidize healthcare for those who drink, smoke, eat too much, are old, etc?
Who said you should?
More seriously:
By my assessment, this issue becomes relevant to public policy only to the extent that the benefit to society (potentially including the interest of the potential newborn) exceeds the detriment to society. If we’re facing negative and declining marginal benefits, at some point we’d expect to cross that threshold where the benefit to the potential newborn is swamped by the detriment to society at large. In short, taking account of the interests of the newborn does not resolve the question of the merits of subsidizing birth control; it merely kicks the can down the road.
(Here the discussion goes a little Rawlian: At this stage of a policy discussion I’d usually add that, while encouraging more births may not make sense from a public perspective, any private party should of course remain be free to pursue his own objectives employing his private resources – or borrowed resources. But the private party under discussion here is a not-yet-born person. We all know credit markets are imperfect, but I’d never really thought about this kind of imperfection in the market….)
I don’t agree that birth control should be mandated to be fully covered. One argument I’ve heard elsewhere is that birth control medication helps other ovarian health issues. If this is the case, and the medicine is not covered by insurance as medicine to treat an ovarian health problem, then I’m surprised that drug manufacturers don’t just bottle the same stuff and give it a different name with an explicit purpose of treating such issues. Seems like insurance companies would be more likely to cover such a drug.
Even if we put aside concerns about externalities, there’s one more argument Landsburg has not addressed: I like insurance. Even more than Friedrich Hayek, I support socializing costs to the extent that doing so does not create a moral hazard. If someone, through no fault of their own, has a disability – autism, or female genitals, or an inability to defend autonomy rights against a mob – I want to socialize the cost of mitigating that disability.
I don’t see how the magnitude of the cost is relevant to this analysis (ok, except to the extent that the administrative burdens of socializing the cost exceed the benefits).
Landsburg and others argue that it’s inappropriate to buy insurance for known expenditures. Fine: so tell me, if you know, how much will my next child spend on birth control? Under the status quo, the answer to that question depends in part on the kid’s gender – which I don’t know. But under ObamaCare the answer does not depend on the kid’s gender; ObamaCare lets me (and my unborn kid) defray that risk in a manner that creates little moral hazard.
That said, Landburg and others note that ObamaCare does not merely socialize the risk of incurring costs for birth control; it subsidizes birth control, with all the distortions that entails. Arguably a better policy would be to provide good ol’ fashioned insurance: if you’re a female between the ages of 12 and 42(?), you get a check from government to cover the cost of birth control. You could then use those funds for any purpose you like.
Nobody.really: “I like insurance … I don’t see how the magnitude of the cost is relevant to this analysis (ok, except to the extent that the administrative burdens of socializing the cost exceed the benefits).”
If you look at it abtractly enough insurance provides social value because the convexity of an individual’s marginal utility curve is greater than that of a larger collective. This means that when a large cost must be paid it is paid with low-utility dollars not high utility ones. The felt cost is lower. People will voluntarily participate. That effect DOES depend on the size of the benefits and costs. However the perverse incentives as well as administrative costs do not, or at least not nearly so much.
JohnE,
All things being equal, people prefer insurance that covers more things.
If this were true, then a law wouldn’t be needed to make this happen. The market would take care of it.
Advo,
It is really, really nasty to call a woman ’slut’ just because she advocates a policy decision you don’t agree with.
Let me know when you are going to get worked up about the left calling a woman a “cunt”. This yammering really is just the double standard playing out: it’s an outrage for a conservative to use harsh language to describe a liberal woman, but it’s not just okay, but standard, for a lefty to use harsh language to describe a conservative woman.
Robin Hanson discussed whether we’d be willing to pay for Rawls-esque inequality insurance for our kids. Would parents choose differently for “autism, or female genitals, or an inability to defend autonomy rights against a mob”?
it’s by no means clear that the externalities from childbirth are in fact on balance negative
I find it odd that this isn’t obvious to everyone. Those who argue that childbirth is cheaper than contraception must ignore the entire life of people and focus on the first nine months of life (in the womb). It is clear that on average that a childbirth is on balance positive, otherwise the average wealth per person in the world would be declining as the population goes up; however, the average wealth has increased, pretty dramatically, as the population has increased.
To focus on childbirth, while ignoring the totality of the average life is pretty myopic.
So under the current system, she has just as much right to advocate for contraceptive services as someone who does so for alcohol/drug rehab, allergy medications, fertility treatments, etc. Now, one can argue the current system is flawed and folks should only pay for services used, but that’s not realistic at the moment and should be excluded from the discussion; that is a separate discussion altogether. I don’t believe anyone would have come down this hard on someone who advocated for the things like in the above examples. Do you?
Shane: You seem not to be making the distinction between what is covered by insurance and what is *mandated* to be covered by insurance.
Had the argument been about mandating coverage for many of the other things you mention, I can assure you I’d have made the same blog post.
Fluke testified, “I attend a Jesuit law school that does not provide contraception coverage … We are all grateful for the new regulation”. So yes, she does want contraception coverage for herself, and she wants someone else to pay for it.
Maybe that does not justify calling her a slut, as that is name-calling. I am just pointing out why Rush used the term. Now Fluks says about Rush’s apology, “I don’t think that a statement like this, issued saying that his choice of words was not the best, changes anything.” So I guess her real complaint is that Rush disagrees with her.
“Senators, I come before you to plead for the thousands of soon-to-be CEOs at the business schools of the land who cannot afford to buy anti-histamines. I beseech you, think of the blighted lives …”
No Shane, no-one would mock that.
@Ken: Most of us have been preached at for decades that population growth is an evil, and must wreck the planet and impoverish us. That is why many simply assume the externalities must be negative.
@Roger Schlafly:
Dismissing Levitt’s work as a “data processing error” is misleading. A lot of work and peer review has gone into his thesis. Here is a response to some of the critique (including lots of links): http://www.freakonomics.com/2005/05/15/abortion-and-crime-who-should-you-believe/
@Henri: The above 2001 Donohue-Levitt article is wrong. Yes, Levitt claims to have found other data supporting his conclusion. Others say that is wrong also. For more details, see The Impact of Legalized Abortion on Crime.
Ken: I totally agree that attacking Sarah Palin that way was equally base, sexist, and despicable. Lots of people do bad things, and advocate bad policies. And lots of other people indulge in cheap emotionalisms, stereotypes, and smears in attacking them: which is generally a waste of everyone’s time. Women in particular are far more likely to be slurred in ways that basically focus on their gender. And that sucks.
In general though, I find it hard to take seriously arguments that demand that one side or another of a partisan to get upset fairly and equally, as if they were applying some sort of broad principle. Even if we pretended that every instance is of the same weight and impact, objectively demanding the exact same response, political people talking politics simply do not and will not act as if there were general, non-partisan moral principles governing their expressions of outrage. Certainly they’ll claim that there are, but almost nobody believes it, and almost everybody is guilty of making the same false claim about themselves, even when they know it cannot possibly be true.
The vast majority of partisan rhetoric is basically an exercise in arguing the generally unstated thesis that the folks on the other side are specially, deeply, morally, & psychologically deficient. It’s usually left unstated because it is in most cases some collection of absurd, embarrassingly narcissistic, and/or laughably supported (here, I’ve cherry-picked a few things that _I_ am outraged about, which is surely all any social-scientist would require as solid grounds to generalize broadly about a group of people!). But these sorts of tribal triggers are easy to pull and immensely gratifying. Indeed, you’re doing it (“it’s not just okay, but standard”) even as you seem to be condemning it.
But I’m not outraged, nor do I think it’s a symptom of you being… whatever your political allegiance is. Nor do I think less of you for it, or at least, any less than I think of us all.
But the questions of incentives, how to measure costs and benefits, how insurance is best structured to achieve what ends, and so on are surely a lot more _interesting_, no?
@Drew: I think Ken is highlighting, rather effectively, that the outrage we see over this incident is almost all in bad faith. It is strategic.
H.R. 3590 [ObamaCare], Section 1302(b) ESSENTIAL HEALTH BENEFITS.—
(1) IN GENERAL.—Subject to paragraph (2), the Secretary [of Health and Human Services] shall define the essential health benefits [that insurance providers must provide in order to avoid paying a fee], except that such benefits shall include at least the following general categories and the items and services covered within the categories:
(A) Ambulatory patient services.
(B) Emergency services.
(C) Hospitalization.
(D) Maternity and newborn care.
(E) Mental health and substance use disorder services, including behavioral health treatment.
(F) Prescription drugs.
(G) Rehabilitative and habilitative services and devices.
(H) Laboratory services.
(I) Preventive and wellness services and chronic disease management.
(J) Pediatric services, including oral and vision care.
@nobody.really: Fluke was not advocating those things. Nothing in that section of some proposed legislation you like to trot out suggests that had she demanded someone else pay for her allergy meds that Steve would not have mocked her.
here’s my two cents
The Vagina and Uterus are part of a woman’s body, therefore it is part of her healthcare.
Regardless of the fact that a Penis goes into the vagina during coitus, the Vagina is still in fact in the womans body. You cannot disconnect a womans Vagina from her body and say I wont cover that because that part is used for sex.
Secondly, the pill has HUNDREDS of other medical uses besides family planning. It is used to treat many conditions and many symptoms that have nothing to do with a penis being inserted into a vagina. Why should that not be covered. Why do so many of you insist on ignoring that entire aspect?? Every women knows a friend or two that is on the pill for reasons other than birth control, it’s not a rare occurance.
And Finally the #1 reason why both Rush and you are full of it:
MY PRIVATE MEDICAL NEEDS ARE NONE OF YOUR BUSINESS. WHAT HAPPENS BETWEEN MY DOCTOR AND I IS NOT A POLITICAL ISSUE. WHAT HAPPENS IN MY VAGINA IN NOT UP FOR DEBATE. IT IS NOT FOR THE GOVERNMENT, NOR MY EMPLOYER, NOR MY FRIENDS AND FAMILY TO DECIDE. NO ONE, ABSOLUTELY NO ONE, HAS A SAY IN MY MEDICAL HEALTH BESIDES MY DOCTOR.
Before you come back at me with a no doubt “creative” response, remember that the logic you will try and use to rebut my statement will negate the need of the entire health insurance system. So be careful their with your logic.
I wish nobody really had reminded me that “the Secretary shall define the essential health benefits that insurance providers must provide in order to avoid paying a fee.”
But the questions of incentives, how to measure costs and benefits, how insurance is best structured to achieve what ends, and so on are surely a lot more _interesting_, no?
That’s part of the point of my post – the incentives. What incentives are put in place on the left to make it perfectly acceptable to be overtly racist (e.g., Biden saying “the first mainstream African-American presidential candidate who is articulate and bright and clean-cut and a nice-looking guy” and misogynists (e.g., the left supporting the sexual predator Bill Clinton and even got the endorsement of NOW), while a conservative, just by opposing lefties, are labeled racists (e.g., declaring the entire Tea Party movement to be race based) and misogynists (e.g., anyone who opposes insurance companies being forced to provide contraception)?
@KenB. I beg to differ. My outrage at this issue is far from strategic. I am a male student at Georgetown Law and, though I have never met Sandra Fluke, I feel very personally insulted on her behalf as a colleague and I know for a fact that many of my fellow students, including many of a very conservative political bent, feel likewise. I cannot speak for anyone outside of the Georgetown community who has weighed in on the issue, but I assure you that my disgust with Rush Limbaugh is not manufactured. And I would be equally offended if Bill Maher had spoken so viciously of one of our conservative students.
But back to the underlying discussion. I get the sense from the terms of the discussion that very few of us (including Steve) have actually scrutinized Ms Fluke’s testimony to Congress. Those of us who have should have perceived that her plea did not focus solely on hormonal birth control exclusively as a contraceptive device. It is also a medication with significant therapeutic effects quite separate from preventing pregnancy (it treats seizures and ovarian cysts, to name just two examples from her testimony). To say that Ms Fluke is asking to be paid to have sex mischaracterizes and trivializes the issue. She is simply asking that her insurer treat her birth control no differently than any other essential medication. We don’t need to have a conversation over the marginal value of an additional human life; we should be talking about the marginal value of a young woman’s ovary.
Also (and I cannot believe that so many have missed this), Ms Fluke never asked for a taxpayer subsidy for her and her fellow students’ birth control. (I would be all for this myself, but she never said it). The question all along has been whether her private insurer should be forced to accurately classify a category of medication that it has arbitrarily exempted from coverage. She pays premiums to Georgetown just like I do, and we’ll both be paying back those premiums, along with all the rest of the costs we’ve incurred in law school, for years to come. An unwanted pregnancy at this point in her legal career could seriously hamper her earning power and, thus, her ability to repay that debt, a pretty self-evident social loss, especially when placed next to the great social benefit of her starting a family after she has established herself professionally. As a similarly situated male, I shudder to think of the repercussions a major health event like a pregnancy or an ovarian cyst would have on my life and career, and I’m damn glad to have insurance that covers similarly catastrophic contingencies.
Let it also not be forgotten that market forces are not what brought about this lack of coverage in the Georgetown health plan in the first place. It was a religiously motivated decision by the Georgetown board, who probably considered the cost savings only in passing. Given that, I think it makes entirely good sense that the government should disallow institutions like law schools from arbitrarily discriminating against about half of their staff and students with regards to an issue as personally and socially vital as health coverage.
Griffith:
Ms Fluke never asked for a taxpayer subsidy for her and her fellow students’ birth control. (I would be all for this myself, but she never said it). The question all along has been whether her private insurer should be forced….
This is why people don’t like lawyers. A mandate is, of course, the equivalent of a subsidy. It doesn’t make a bit of difference whether I’m forced to send money to the government or forced to send money to my insurance company. To pretend otherwise strikes me (and I daresay most economists) as the sort of deliberate obfuscation that suggests a complete indifference to honest discussion.
Candice:
WHAT HAPPENS BETWEEN MY DOCTOR AND I IS NOT A POLITICAL ISSUE.
Thanks for putting this in capital letters. It is exactly the point I am trying to make.
I fear I’ve been unclear.
The “section of some proposed legislation you like to trot out” is from the Patient Protection and Affordable Care Act a/k/a ObamaCare. It’s not proposed legislation; it’s the law of the land.
Shane questioned why people responded so negatively to Fluke’s advocating for contraceptive coverage, but people didn’t respond so negatively when people advocated for other types of coverage such as alcohol/drug rehab. Landsburg responded with –
I simply observe that under ObamaCare, coverage for substance abuse disorder services and rehabilitative services ARE mandated to be covered by insurance.
Candice:
Welcome, Candice! I find the discussions here quite stimulating, and I hope you do, too.
But, meaning no disrespect, I humbly suggest that the reason you identify for why Rush and Landsburg are full of it — while clearly heartfelt — probably wouldn’t rank in the top ten. This is a hotly contested category, with new entries almost daily. The longer I participate here, the more discerning I become in these matters.
Steve:
I resent the implication that I’m not interested in having an honest discussion, but moving on.
My cards on the table: I agree with nobody.really that socializing the cost of healthcare is a net positive. It provides much needed security to students and workers, security that enables them to take greater risks and move themselves into the most economically productive position that their skills allow. My simple contention, and Ms Fluke’s if I understand her correctly, is that a system of socialized cost like health insurance must be applied rationally to all participants. Therapeutic medication is therapeutic medication, whether it treats asthma, ovarian cysts or unwanted pregnancies. They’re all medical conditions and they should be covered equally. And if the net effect is the same as a subsidy, so be it. A mandate that vital and effective preventative healthcare like hormonal birth control be free from arbitrary exclusion is a mandate I can live with. If the result is that a little bit of my money flows to cover her birth control, I’m just fine with that, because the alternative is that fewer superlative students like Ms Fluke would attend my law school, which would be a real loss for Georgetown.
I’d also like to address what seems to be an unspoken assumption throughout this thread, which is that sexual activity is somehow suspect behavior and should be treated differently from any other class of activities that are central to a normal, adult life. True, it’s a “choice,” inasmuch as walking down the street to attend class is a choice. Of course, walking down the street is risky behavior, especially in my section of DC. All sorts of things could happen to me, but thankfully my insurance covers most of those events, and my choice to take that walk is funded jointly by me and my fellow students, including those who don’t live on my block but instead pay far more in rent to live in high rises with doormen. My point is that I’m far more likely to move to a safer part of town and pay the higher rents than I am to voluntarily abstain from sex. That’s a legitimate choice for some, but I contend that, in this century, choosing to give up sex is about as realistic for the vast majority as choosing to no longer walk down the street. So yes, maybe I am paying Ms Fluke to have sex, and with someone who isn’t me, no less. But by the same logic, she’s paying me to assume the risk of walking down the street, and I’m pretty grateful for that.
I share this view.
I often think people’s description of ObamaCare’s framework is needlessly complex. Here’s my understanding of the law: People (or sometimes people’s employers) are required to pay a tax, and government will provide them with health insurance. Now, people can opt out of paying the tax if they can secure their own insurance that meets certain minimum standards. But that’s optional. The basic framework is a taxation framework.
(Why don’t the Obama people simply say that? Because taxation has become so stigmatized. Consequently policy makers have to do all manner of goofy, sub-optimal things – such as subidizing Priuses (Priusi?) rather than increasing the gas tax. It’s a second-best world….)
May I also observe in passing that there’s a distinct, if difficult to quantify, social cost to Limbaugh’s words? Rep. Carolyn Maloney (D-N.Y.) put it best:
“If the far right can attack people like Sandra Fluke, women are going to be afraid to speak because they’re going to be called terrible words,” she said. “It’s an attempt to silence people that are speaking out for women.”
Now, I don’t care what side of the particular issue you’re on, there can be no question that we all lose out when public speech and advocacy are disincentivized. Certainly Limbaugh’s tirade has brought Ms Fluke some uninvited notoriety, and she’s using her slightly-more-than-fifteen-minutes to advocate her policy position to the hilt. But a single exception doesn’t negate the fact that the scope and influence of Limbaugh’s audience give endow his vitriol with a particularly chilling effect. For a more fleshed-out argument to that effect, follow this link: http://www.cnn.com/2012/03/05/opinion/frum-rush-limbaugh-fairness/index.html. Silencing Ms Fluke and others like her, as the Republicans attempted to do, results in a deficit of highly pertinent information available to policymakers and voters. Less efficient policies are the inevitable result.
I don’t know how to put a dollar value on the right to free speech (though I daresay someone’s probably given it a try), but may I suggest that it might be commensurate to the advertising revenue he’s losing his parent company right now?
Griffith:
A mandate that vital and effective preventative healthcare like hormonal birth control be free from arbitrary exclusion is a mandate I can live with. If the result is that a little bit of my money flows to cover her birth control, I’m just fine with that
What you can live with, and what you’re fine with, are actually not terribly interesting to anyone but you and maybe a small circle of your friends. The questions of broader interest are things like: Does such-and-such policy address a clearly identifiable market failure? If so, what is that market failure? Is there an alternative policy that would address it more effectively? Does the policy introudce new market failures in the process of addressing old ones? Et cetera. These are questions that are amenable to analysis, and where we have a chance of learning something from each other. Cataloguing our personal preferences is mostly a distraction from that task.
@nobody.really: I agree the essence of “insurance reform” is fairly straightforward: it’s about converting insurance into a more redistributive tool (e.g. broadening the pool). I too wish we could have an open, honest debate about how we can and should fund a moral obligation to those who truly need help.
I’d add that this is not your best case for a Rawlsian world, a 50/50 bet that 15 years out or so you may feel a need for something that you as a parent could likely afford in any event. (Insurable risks are typically (supposed to be) things that one *might not be able to afford* if they occurred.)
@Steve:
The immediate question is whether Georgetown University should be subject to this particular mandate. As a student who voluntarily pays into the Georgetown health plan I am, to my knowledge, the only contributor to this forum who is subject to the ramifications of that decision, so my preference actually does hold a little weight. Of course, being the lone stakeholder in the issue does not automatically make my reasoning stronger. But I believe I have identified elsewhere in my posts several distinct market failures that the mandate addresses. It may not do so perfectly and I am all ears to realistic suggestions for preferable alternatives. Please, however, do not excerpt short segments of my comments for criticism and then act as though the remainder is invalid, or even delivered in bad faith. Just so you know, a panel of appellate judges would shred you for responding to an argument like that. This might surprise you, but the law actually places a high premium on intellectual honesty. Some economists make great lawyers. Some do not.
Ken B: Sure, and I don’t entirely disagree on it being strategic. In general, almost all outrage in the political venue is strategically selective.
But “bad faith” implies that people have really thought through it, found that they are being inconsistent, and decided to be so anyway. I doubt that’s often actually the case. Instead, most people are genuinely surprised to find that, again and again, the outrages that they happen to cherry-pick out to pay the most attention to all just happen to fit their biases. And they are genuinely, honestly surprised, and really do think that correlation is significant. But because I’m skeptical of _anyone’s_ actual independence from that sort of effect, I have a hard time getting too outraged by it. Ken’s outrage at selective outrage strikes me to be about as likely to be strategically selective and interpretive as the original selective outrage itself. But because I figure I’m probably as likely to be as guilty of the same thing, I’m not really that interested in arguing the case. I’m unlikely to convince Ken, and he’s unlikely to convince me, and neither of us is likely to figure out anything new or useful about insurance in the process.
Griffith: I may be wrong, but my understanding was that Georgetown and many Catholic institutions _will_ buy insurance plans that will cover hormonal pills for the purpose of treating serious conditions like PCOS (in the case of Fluke’s friend, the medication was available, but with co-pays).
ANY insurance plan that doesn’t involve some measure of co-pay (even if they scale with income, or even if patients are given a pool of money with which to pay co-pays, but which they can keep if they don’t spend), even for important/regular medications, strikes me as a really bad idea.
I think you’re letting your opponents assume some things that aren’t necessarily the case. Without even getting into whether the externalities of unwanted babies are positive or negative, why do we think that there are going to be fewer babies if Georgetown Law students could get free contraceptives from their health plans? I’d imagine that most of them are sexually active but because they’re well aware of the negative costs of getting pregnant at this point, they obtain contraceptives. Most of the costs of unwanted pregnancy for top law students are not externalized at all – they’re very much borne by the people engaging in the sexual activity.
The price elasticity of contraception is something I wish more economists were talking about. Marginal Rev linked to a paper on college students that did find some decrease in pill usage in response to price increases, but it found no evidence of increases in accidental pregnancy among women in general. They (“cannot rule out that the most credit constrained women did suffer an increase in the risk of unintended pregnancy”*.) My hypothesis about what’s going to happen when the contraceptive provision of ACA goes into effect is that we’re going to see some switching from condoms to other contraceptives, generics to brand names, and other contraceptives to those with high up-front cost (like IUDs), but not much in the way of decreased unplanned pregnancies. *http://www.psc.isr.umich.edu/pubs/pdf/rr11-737.pdf
Griffith:
Please, however, do not excerpt short segments of my comments for criticism and then act as though the remainder is invalid
I certainly don’t want to be guilty of this. Here, I think, is a pretty complete list of all your substantive points:
her plea did not focus solely on hormonal birth control exclusively as a contraceptive device.
Right. This has been discussed and acknowledged several times in the comments.
To say that Ms Fluke is asking to be paid to have sex mischaracterizes and trivializes the issue.
Right. I said this in last week’s post.
Ms Fluke never asked for a taxpayer subsidy for her and her fellow students’ birth control.
This, as I said earlier, is a lawyerism. She’s asking for a government mandate, which is exactly the same thing.
market forces are not what brought about this lack of coverage in the Georgetown health plan in the first place. It was a religiously motivated decision by the Georgetown board, who probably considered the cost savings only in passing.
You have a very crabbed view of what counts as a “market force”. Supply and demand decisions are frequently driven by religious considerations; we don’t declare these to be outside the market. When an Amish farmer buys a horse and buggy for (partly) religious reasons, is that transaction “outside the market”?
socializing the cost of healthcare is a net positive. It provides much needed security to students and workers, security that enables them to take greater risks and move themselves into the most economically productive position that their skills allow.
But we are not talking primarily about healthcare; we are talking about contraception. Nor have you provided any reason to expect that socialized health care is somehow “more secure” than private health care. Do you think a socialized food supply would be more secure than a private food supply?
I’d also like to address what seems to be an unspoken assumption throughout this thread, which is that sexual activity is somehow suspect behavior
I haven’t the foggiest idea where you came up with this. Feel free to point to the specific paragraphs in my blogpost that led you to this misconception.
I have identified elsewhere in my posts several distinct market failures that the mandate addresses.
Actually, as far as I can see, you haven’t identified a single one. But it is possible (and I am saying this sincerely) that I read you too carelessly. Can you provide a list of the market failures you’ve pointed to? Or at least an example?
Abigail: Thanks for this. I did say this in the post:
I haven’t seen any actual estimates of the number of childbirths prevented per dollar spent on contraceptive subsidies
You were obviously better educated than I was about this. Thanks for bringing me (and others) up to date.
Steve:
An example that I cited would be the net loss to Georgetown and the legal community that would result from a student like Ms Fluke’s decision not to attend law school or her inability to finish on time due to an unintended pregnancy, a more serious reproductive health problem, or the prohibitive cost. That is the case even if you do accept that Georgetown’s religious preferences are market-oriented as well. By expressing their market preferences by refusing to submit to a relatively unburdensome cost, they are jeopardizing their chances of attracting top talent like Ms Fluke who will likely bring credit to the school, not to mention tuition dollars. The hypothetical female student who was dissuaded from attending or finishing law school is but an case study in the relative deficit of healthy risk-taking among those who lack full health coverage. Full health coverage includes contraception. I believe, though I would welcome input from health professionals, that this is a medical fact, one that the ACA does well to recognize.
Also, I should clarify that I used the word “socialized” in this context to refer to the system of distributed risk that is the standard American health care plan. I meant no indication of who should bear the cost, government, business, or otherwise. Sorry if my word choice was sloppy (wow, I can’t actually write that with a straight face anymore).
Griffith:
the net loss to Georgetown and the legal community that would result from a student like Ms Fluke’s decision not to attend law school or her inability to finish on time due to an unintended pregnancy, a more serious reproductive health problem, or the prohibitive cost.
How is that a market failure?
It is a failure inasmuch as society does not receive the full benefit of her productive capacity if she’s unable to or delayed in entering into her chosen profession, at which she’s evidently quite skilled. I know that it might be hard to accept that one more lawyer is a social benefit, but you can’t ask me not to be biased on that score!
Griffith:
It is a failure inasmuch as society does not receive the full benefit of her productive capacity if she’s unable to or delayed in entering into her chosen profession, at which she’s evidently quite skilled.
It’s quite clear — and I don’t mean this to be snarky — that you haven’t the foggiest idea what constitutes a market failure, which is, I think, a big part of why we’re not communicating.
Sorry if this has already been covered in the earlier comments, but if so I missed it…
Steve Landsburg, I think you too flippantly dismissed the first objection about birth control being cheaper than childbirth. Switch contexts. Suppose an insurance executive says to his buddies, “We should subsidize the purchase price of car alarms for all of our car insurance customers who want to install the alarms. This will pay for itself in terms of avoided thefts, even factoring in the probabilities that some of our customers would pay for the alarms even without our subsidy.”
Would you say this is a ridiculous claim for him to make, even without needing to know the calculations? That this is like him saying, “Let’s stop eating and save money”?
Griffith and Steve: Your debate belongs in a text book.
Candice,
MY PRIVATE MEDICAL NEEDS ARE NONE OF YOUR BUSINESS.
This is bullshit when you are trying to pass a bill to make others pay for you “health”. If you expect others to pay for your health care, then your medical needs are obviously their business too.
@Ken
While I understand your point, lets get our facts straight.
The bill that Congress is attempting to pass (the Blunt Amendment) is an attempt to GET RID of the contraception mandate recently enacted by the Secretary of Health and Human Services on behalf of the President of the United States. As it stands, the contraception mandate is already the law (although it has not yet taken effect). While you can most certainly debate the legitimacy of such a mandate, you should be sure that you actually understand where the mandate is coming from and what the Blunt Amendment is attempting to do.
As stated by Rep. Darrel Issa, the Blunt Amendment is not about contraception, it is about religious liberty. While it seems to me that the Amendment was quite obviously proposed as a direct result of the presidentially mandated contraception mandate, the Blunt Amendment goes SIGNIFICANTLY further than simply overturning the mandate. The Amendment would actually permit any institution to limit insurance coverage of virtually anything that violates the conscience of the employer. Again, the worthiness and legitimacy of such an amendment can most certainly be debated, but your statement does not relate to that either.
Although I understand that this is an economics blog and not a politics blog, definitions seem to be of the utmost importance in every case. Numerous posters on this blog seem to find it acceptable to disregard entire statements when posters, not all of whom are economists, use incorrect terminology or fail to understand the terminology used in the discussion. I think that if such importance is to be given to one type of terminology, we should at least attempt to correctly state the nature of the ongoing political debates, and what bills currently before congress actually say.
Vald,
First, it is you who needs to get his facts straight. This blog post is a follow on to the one last week (March 2) talking about Sandra Fluke demanding her insurance provider pay for her contraception. By definition, insisting her insurance provider pay for her contraception, she is insisting that others partially pay for her contraception.
Second, you admit that there is a contraception mandate in the first sentence of your second paragraph, so… what are you talking about? You go off on a tangent about a proposal to repeal this, but the fact remains, there currently exists a contraception mandate.
My comment (made at 11:33) just prior to yours is about the ridiculous idea that others should pay for, or at least subsidize, medicine, then say that their medical needs are private. It’s a bullshit statement on the face of it. Anything I buy or am forced to buy is my business, even the your medical needs you want me to pay for.
Let me offer some assistance to Griffith answering in SL’s question:
It’s a market failure in the same way that a prospective lawyer may not be able to afford attending Georgetown Law without incurring significant debt and is deprived of personal fulfillment and the legal community of his unique presence. Isn’t that, in fact, the greater market failure that needs to be addressed given that the disincentive of unsubsidized cost of law school is so much higher than the cost of contraception?
On a more personal note, it’s a market failure when I’m not able to afford a Porsche 911 Turbo and am deprived of the joy that would allow me to be an even more productive member of society and my family and friends the joy of seeing me happier.
@Ken
Go check last week’s post, I was involved in that discussion as well.
And you admit that there currently exists a contraception mandate, which is ENTIRELY MY POINT. What you stated was “when you are trying to pass a bill”… what bill are you talking about?
My point was that there is no bill currently before the legislature of the federal government to impose a mandate that already exists. If you and others on this blog are going to be absurdly nit-picky about economic terminology, you should also attempt to be correct in your use of terminology directly related to the issue at hand (in this case, law).
I understood what you were arguing, I just wanted to ensure that you actually understood what was being debated in the actual halls of government, and not on stupid radio programs hosted by a blowhard fool.
Finally, while your point makes complete sense from an economic perspective, the legal perspective is somewhat different because of the right to privacy currently enshrined in American constitutional law. So yes, while you have a right to debate whether money should be taken for healthcare or anything else, you don’t have a right to tell her how to handle her own body. At most, you have a right to argue against laws which might take your money for use by others, but that’s not the same as stepping into private medical conversations between Candice and her doctor. If you lose the debate and the mandate remains, then birth control will be covered, no matter how much you hate the prospect, and that gives you no right whatsoever to be involved in how Candice handles her new-found right to free contraception.
While many on this blog try to pretend that they live in a world of pure economic principles, for those of us in the real world, law does not always comport with how economists think the world should work.
Bob Murphy:
Suppose an insurance executive says to his buddies, “We should subsidize the purchase price of car alarms for all of our car insurance customers who want to install the alarms. This will pay for itself in terms of avoided thefts, even factoring in the probabilities that some of our customers would pay for the alarms even without our subsidy.”
That’s not the right analogue. We’re not running an insurance company; we’re making government policy. The insurance company should look narrowly at costs and benefits to the insurance company. The policymaker should include externalities. The “cheaper than childbirth” calculation makes sense for the insurance company but not for the policymaker, who should also be looking at the external costs/benefits of childbirth.
“You have a very crabbed view of what counts as a “market force”. Supply and demand decisions are frequently driven by religious considerations; we don’t declare these to be outside the market. When an Amish farmer buys a horse and buggy for (partly) religious reasons, is that transaction “outside the market”?”
For health insurance, a free market will produce the optimum outcome. This means that the consumer must have a free choice among a large number of providers, must be perfectly informed. There must be no externalities etc.
In such a market, if one insurer or employer for any reason (possibly religious), offers a policy that does not cover contraception, or drug rehabilitation, or mental health cover, then the consumer is free to avoid that provider. In theory, they would have to offer some extra benefit to compensate – perhaps higher wages, or a better quality education, for example. In the perfect market, the gains for the student / employee just balance out the losses from a restriceted health policy.
The consumer must also avoid mistakes.
Lets take the model where health insurance is provided by employer or education establishment. How similar to a perfect market is this?
There are all the structural failures mentioned – externalities, monopolies, lack of information etc. Much of the above discussion focuses on these.
But there is a huge one where it comes to making mistakes. The student is faced with choosing a college. There are a large number of factors to consider. One of these is the health insurance provided. To avoid making a mistake, the student must be aware of the details of the policy, and be able to weigh the significance of the outcomes in a realistic manner, balance this against all the other pros and cons of each establishment, and use this to make a choice among the competing colleges which will provide the optimum outcome.
People are just not that good at making choices.
So the actual market cannot supply the optimum outcome – i.e. that provided by a proper free market.
But can we make it better? This is another question. We would need to believe that the market failures would mostly occur in one direction – e.g. externalities are mostly positive, or that the mistakes were mostly through overestimation.
The law mandates coverage for certain things, including contraception. Mandating for insurance is essentially the same as subsidising. To be beneficial, these things would have to be underused compared to a free market.
As far as externalities go, subsidising contraception will reduce some negative externalities, without much reducing positive externalities, as I said in my last comment. I don’t know if this is worth the cost, but it is surely in the right direction.
Monopoly power also suggests that subsidy is in the right direction, but there is no reason to pick out contraception only.
As for mistakes, the fact that people continue to have unwanted pregnancy despite the availability of contraception seems a clear indication that people frequently undervalue contraception. Some may also overvalue it – for example by taking it when celibate, but the extent of this seems unlikely to be larger than the undervaluing.
When we link this with a number of providers who wish to avoid covering contraception for idealogical reasons, this is likely to increase the extent of mistakes.
Each of these may be insufficient to justify a subsidy, but as they all work in the same direction, they can add up to a compelling case.
The original law singled out provision in selected areas, where the Govt. possiblyy felt that on balance the gains from subsidy outweight he losses. Mental health and substance abuse are examples where people might genuinely underestimate the chances of them needing the service, and under providing. There is not a huge outcry about these areas, and as Vald and others have said, no movement to strike out the mandate.
Whilst I agree with SL about the lack of coherence in Fluke’s argument, I think a good case can be made for the mandate for contraception.
Extending nobody.really’s argument, U.S. per capita GDP is about $48K. However, that is an average. Some people contribute more, or much more than that; about half contribute less. Of course, each of our contributions vary over time. Our contribution is negative early in our lives, and negative late in our lives when we are in a nursing home. And our contribution is much greater during the period when we are earning an income (say, age 20 to 65).
My guess is that if we were to look at lifetime average per capita GDP, it would look like a bell curve, with the peak at $48K. Some people’s contribution would be negative for their entire life. For example, T.J. Lane, the Ohio school killer has made very little positive contribution to GDP, if any, and will now spend the rest of his life in prison. At a cost of perhaps 40K per year, he will be a negative drain on GDP for a very long time. I would argue that if we can prevent even some of the people who make a negative contribution to GDP from being born, we’re better off as a whole. And it appears that “unwanted pregnancy” is a good proxy for people who will make a negative contribution to GDP.
Syed: Thanks for clarifying Griffith’s point. :)
@Steve
My main disagreement with you is your reason for dismissing the first argument (providing contraception is cheaper than childbirth). Think of it this way: Suppose that any externality of childbirth was corrected through an appropriate tax or subsidy on childbirth. Would the first argument hold water then? You say no because even though something is cheaper it may not be preferable. There are trade-offs.
I say this rebuttal is wrong in this instance because here there are no trade-offs: Providing contraception is both cheaper and preferable.
I think the rebuttal should go something like this: If providing contraception is cheaper than childbirth, then the mandate is completely unnecessary. Any insurer who provides contraception could charge a lower premium and thus undercut any of its competitors who did not provide contraception.
Finally, I think this argument is important to take seriously because if it is true, then the sets of winners and losers from the mandate are different than if the argument is not true. I’ll leave it as an exercise to the reader to figure out how those sets change.
One note of minor correction to how some people are stating it: the idea that Fluke is asking for other people to pay for her contraception is a bit of a misstatement. She’s asking that everyone pay for her contraception, _including_ herself.
I point that out not to defend Fluke, but because it’s worth remembering that _something_ has to get more expensive in order to cover a medication without co-pays (which, because there is now no extra financial cost to the person deciding to take it, is sure to be over-consumed, which no doubt makes drug companies happy), and that thing is, at least to the first approximation, everyone’s insurance premiums. People who do use contraception will find that cost far less burdensome than people who don’t, of course (since it’s replacing a cost they’d otherwise bear themselves), but everyone paying for the insurance will bear that cost to some degree.
People also don’t seem to understand that arguing that something is a basic, regular, predictable need by an identifiable group of people makes it LESS sensible as something that should be part of _insurance_ coverage, not more sensible.
Relevant: http://economix.blogs.nytimes.com/2012/03/06/the-economic-impact-of-the-pill/
So, it’s resolved: we should institute a tax that impacts families who have children early, thus giving them the proper incentives to figure out how to have their children later in life in any way they see fit.
Side-point: it’s worth noting that if we simply taxed everyone and paid for birth control directly, we’d no longer have the dispute with the Catholic church at least, because by their doctrine, getting taxed to pay for something morally objectionable is acceptable (they’d still object, but not threaten actions of conscientious objection). The key moral distinction between that scenario and this one is lost on heathens like myself, unfortunately.
Professor Landsburg,
As a student at Rochester (Honors Economics 05) I took multiple of your classes. I have been out of school for awhile, so I hope my economic reasoning is not off, but I want to bring up one argument that you have not directly addressed.
The basic argument is that no subsidy is occurring. I’ll accept for this argument, the premise that the insurance companies efficiently pass costs through to the insured. Given the health reform legislation we can also accept that any increase in expense will be passed onto individuals, employers who provide insurance (including the Catholic institutions fighting this rule) and the government which either directly pays for insurance or subsidizes it in a number of direct and indirect ways.
Therefore, if the cost of insurance increases as a result of this rule than I will concede a subsidy has occurred. However, there is a strong argument to be made that the cost of administering insurance is cheaper if birth control is provided for free than if it is not available except at full cost elsewhere. (In some cases such as students at Catholic University this includes additional transaction costs of getting to a doctor that will prescribe it and a pharmacy that will fill the prescription, which increases the number of woman who will fail to purchase birth control individually)
Given that insurance plans provided to employers look at the average cost of insuring individuals to determine rates, the question becomes whether the cost of providing birth control for every woman who desires it is cheaper than the cost to provide all the care associated with the birthing process * the number of increased non-aborted pregnancies that will result without providing the birth control for free.
I do not have the analytical data necessary to prove this claim, but given the costs associated with childbirth it seems reasonable that this is true.
And even if it is not true in the aggregate it is almost certainly true with Plan B – the day after pill. In this case, because of the self-selecting, situational nature of choosing to take the pill, the percentage chance of pregnancy is much higher. Additionally, the difference between the cost of the one time dose versus carrying the child to birth are clear.
Therefore I would argue that even if my general argument fails (which I don’t think is clear without, my specific case holds and the government should mandate that all employers must use insurance that provides Plan B for free.
Thanks
I want to make two additional points that respond to possible critiques of my argument.
The first is the mandate vs. currently provide. Although pre-natal, birth, and neo-natal care is not required to be covered, it is in most of these plans, therefore I make the reasonable step that these cost will get passed on regardless of this new mandate. Arguing that no one is forcing anyone to use these insurance plans is, while true, non-responsive to my argument.
Secondly, I should of stated a market failure, its one of two things but it doesn’t effect the validity of my argument (but both assume that I am right about Birth Control (at least Plan B) saving money. Either the insurance companies would be willing to always provide Birth Control (or Plan B) as it does save money, but are prevented from doing so by Catholic Institutions. Or insurance companies would prefer not to provide the Birth Control even though it saves money as the amount they can make from higher premiums as a result of unwanted pregnancies actually exceeds their marginal cost from providing care for the unwanted pregnancies. Either case presents a market failure and justifies government action.
Geoff Bowser:
1. It is not clear that the marginal cost of rejecting the pill is higher. The insurer must deal with the submission anyway. Essentially it is a matter of what drug codes go in the insurer’s database. Once there they cause acceptance, rejection, payment amounts.
2. You neglect the co-pay issue. Hard to argue the insurer bears a marginal cost increase storing 12 rather than 0 in his database.
3. Your arguments are very good support though for another proposal, one I have pushed. Make the pill OTC. (Or even make it like Sudafed if the thought of women buying the pill without someone else’s permission and invigilation affronts you.) Then the marginal insurance paperwork costs drop to 0 and the real cost of the pill is reduced for all who want it.
KenB
1. Not sure what you mean by this, I’m arguing the cost of women who would take the pill if it was free but don’t if they have to pay and who then have babies is higher than providing the pill for free to everyone who wants it.
2. I think my answer to one also answers this but not sure what the 12 and 0 mean.
3. I agree with the third one except that there are problems with drug interactions that may require a Doctor’s advice.
Finally, from a data standpoint I admit my argument is lacking, but I think my specific argument for Plan B holds even without further evidence. If 1 in like 10,000 (rough estimate) wouldn’t take it if insurance didn’t pay and roughly 1 in 5 of those woman actually got pregnant than the costs would work out in favor of the insurance company providing them for free.
@Geoff Bowser:
I was assuming that you were talking admin costs based on “the cost of administering insurance is cheaper if birth control is provided for free than if it is not” So my comments are about the effect on administration costs.
If you mean costs like unplanned preganancies then I DO think the arguments about the costs of birth etc have been considered on these threads! (at length).
I don’t want to get distracted but: Your cases of ‘market failure’ are not market failure. Further a market failure is not ipso facto justification for government interference. This is just logic. The market for slaves was empty this morning when I went down there; I guess we need an intervention.
I kinda like your morning after argument. Not that I buy it, but I’m waiting to see how Roger reacts!
@KenB
The thread didn’t cover the cost of pregnancy to the insurance company and therefore to the people paying. The thread covered the cost of having a baby. Since the cost of pregnancy is something insurance plans cover the cost of that versus the cost of birth control need to be compared to determine which is cheaper to the people paying for insurance (not the person getting pregnant but the employer)
@KenB
Market Failure:
– Insurance Company wants to provide service for free
– Insurance recipient wants to receive service for free
– Intermediary party stops that transaction for unrelated reasons related to their moral code.
Also I agree with you that market failure does not always necessitate government action but it definitely supports the intervention of government. And Prof. Landsburg effectively used the absence of a market failure to defeat one prior argument.
If you could truly provide a service for free, you’re already talking about an insanely bizarre sort of “market,” and you’d probably want to figure out what’s even going on there before talking about whether there’s a market failure.
@Drew
Not really it happens a lot in insurance. They are incentivized to pay for preventative care in order to keep costs down. Take the credit that many health insurers give for joining a gym. Yes you get the benefit of the money towards a gym membership, but the insurance company tends to save money in the long run as your in better shape and thus less likely to get sick and need care.
My argument is that birth control may be the same way but the Catholic Institutions interfere with that exchange.
It’s still not helpful to model a market for something that costs money to produce as “free.” Even if you want to argue that it saves money in the long term. You’re also forgetting that when we do economics, we don’t get to say that some people’s preferences are more important than others. Catholic employers and colleges value not having to sell policies that include contraception, and their preferences count too.
Anyhow, if BC is such a great deal for insurance companies, what prevents women making a deal with insurance companies on the side: they pay a little more, but not much more, for BC coverage with the understanding that It will ultimately save insurance companies money in less pregnancy costs? Why isn’t there a market for that?
On market failure:
I agree with Ken B that government intervention will not always produce a better outcome than an unmediated market failure; sometimes the cure can be worse than the disease. But the collapse of the slavery market is a curious example to illustrate the point. If I recall correctly, the US did intervene in that market – arguably to address concerns about externalities. Much like the trade in other banned substances, the lapse of a market is not always a bug; sometimes it’s a feature.
Then again, maybe Ken B’s example is appropriate after all. I’m coming to suspect that I can only appreciate a “market failure” within a specific context; the apparent market failure may evaporate when viewed from another context.
Geoff Bowser suggests that both an insurance company and an insured party may prefer that birth control be provided at no incremental charge, but the party paying the insurance company may not. Assuming that there’s no good mechanism for the insured and insurer to cut out the middleman, this does look like a failure – two parties that would like to engage in a mutually-beneficial transaction, but can’t.
But Landsburg argues that this transaction could produce negative externalities (ok, it reduces positive externalities – can we regard that as equivalent to producing negative externalities?) by reducing the number of people born. From this vantage point, the act of subsidizing birth control creates the market failure. At a minimum, government would want to refrain from intervening to facilitate birth control transactions between insurers and insureds – just as government refrains from facilitating transactions between pot growers and potheads. The fact that two parties are happy to engage in a transaction – and ignore the externalities – does not mean that government should be happy to facilitate this.
Like the morning-after pill idea.
@Geoff Bowser
Do you have any information that suggests insurance companies provide discounts to employers who include contraception in their plans? Have you seen insurance companies offer to reduce or eliminate a woman’s co-pay if she goes on the pill? If you have not, then may I suggest that this is a tenuous argument and there is no evidence of a market failure of the sort you described.
Steve,
In your estimation, what’s wrong with the patent system.
I certainly find that many ridiculous patents are issued in some areas, but I don’t think that’s what you’re suggesting in your post.
I hope you’re not of the same mind as Tobias: http://www.andrewtobias.com/newcolumns/030122.html
Who seems to think that entertainment goods should be granted more protection than revolutionary discoveries and inventions.
@syed
Potentially a good point, but certainly not dispositive. There are many reasons an insurance company may not wish to do that, such as having to deal with backlash from the Religious right or from claims that they are discouraging child birth.
Secondly I don’t think I could be wrong about the morning after-pill, just a rough cost benefit analysis makes it highly unlikely.
@Geoff Bowser
I don’t get it. Are you seeing a lot of women moping around the corner from a CVS wondering where to scrape up the money for a Plan B pill?
Nothing you’ve referred to is evidence of a market failure. Suggesting that a fear of the religious right is the reason why you don’t see insurance companies offer reduced cost options for the use of contraception is, again, tenuous. Have you seen a movement among the religious right against insurance companies that provide birth control? (BTW, if I’m not mistaken, it’s the Catholics that are theologically averse to birth control not the Protestants usually associated with the moniker “religious right”.) Your argument is not far removed from stating that a woman may feel stigmatized if she were to pay for condoms at the local pharmacy counter because of the prying eyes around her. She certainly may have a disincentive to buy the requisite quantity of condoms. Hence the government needs to alleviate this market failure by delivering the said condoms to her home. While at it, it may be cheaper to have the newly created Department of Public Contraception have a delivery service set up to more cost effectively deliver the said condoms in discrete vans than to have each person drive around in the middle of the night looking for an all night pharmacy. Reduced fuel costs alone could justify providing the condoms free-of-charge.
Jest aside, let’s not forget that far too often, creating imagined market failures from whole cloth is simply a ploy to garner government subsidies for a group’s preferred outcome.
As a UR student and a female, I feel compelled to weigh in on this discussion.
Do you truly believe the costs of contraception outweigh the benefits? Yes, maybe you are “paying” for others to safely have sex, but you are also paying to prevent cancer and a host of other health issues that a few eloquently described in the last post (poly cystic ovarian syndrome, for example). I dislike how this debate is centering around sex and only sex. Birth control pills do differ from Viagra and should not be compared.
This article describes the health benefits of the pill:http://www.gladwell.com/2000/2000_03_10_a_rock.htm (and was one of my favorites well before this debate)
On a personal note, I went on birth control pills to alleviate some other health issues. I am lucky, as UR subsidizes the pill and it cost only $10 a month. After graduation, it will cost me $60 dollars a month. Hopefully my UR education will help me meet these costs, but for many, these costs are insurmountable. I believe that the preventative care the pill provides should be guaranteed—and I don’t consider myself a smooch or a leecher (although my parents might disagree).
Vald,
What you stated was “when you are trying to pass a bill”… what bill are you talking about?
Fair enough. I’ll change the language: It’s bullshit to say that your medical needs are no one else’s business when there is a law mandating that others pay for your medical needs. If you expect others to pay for your health care, then your medical needs are obviously their business, too.
If you lose the debate and the mandate remains, then birth control will be covered, no matter how much you hate the prospect
Duh. I hate abortion, but the mistake of Roe v Wade enshrined it in law.
and that gives you no right whatsoever to be involved in how Candice handles her new-found right to free contraception.
False. The whole point of the left wanting to take over so much of the health care industry is precisely to give them the right to be involved in others’ medical affairs. I know this, you know this, so why even pretend that a right to medical privacy, any medical privacy, exists when government gets involved?
JB: As has been observed several times in the comments, we’re talking about contraceptive pills used as contraceptive pills, not contraceptive pills prescribed for other purposes.
Perhaps the use of the pill for other purposes should not be dismissed out of hand as irrelavent? It seems very likely that some women do actually find it harder to get coverage for non-contraceptive uses because of the ideological position of some institutions. Whilst this may be more effectively addressed directly, mandating contraceptive cover will give these people a genuine and considerable benefit. Is this an externality, or correction of another market failure?
Ken B: “Or even make it like Sudafed” – you mean figure out how to make it from crystal meth?
Geoff Bowser: “Market Failure:
– Insurance Company wants to provide service for free
– Insurance recipient wants to receive service for free
– Intermediary party stops that transaction for unrelated reasons related to their moral code”
nobody. really: “Assuming that there’s no good mechanism for the insured and insurer to cut out the middleman, this does look like a failure”
This is important – there being no good way to cut out the middle man. Could not the student simply not go to the instituition that failed to provide the service? Or demand compensation? This was hinted at by some students, who felt that they were getting a better education at the Catholic institution than at some others. If the stuidents had calculated correctly, then better education, or lower fees, or something, would have compensated them for the lack of contraceptive cover.
So this is only a market failure if this middle man cannot in fact be cut out.
Candace mentioned that her health or medical needs are none of anyone’s business.
I wish that were true, but if we are forced to pay for them, they unfortunately are.
If Candace paid for her own medical needs with her own money, then Candace’s medical needs are none of our business. Very true. But when the government forces others to subsidize Candace’s insurance or Candice’s birth-control, Candace’s medical needs are now the subsidizer’s business.
Can’t have it both ways Candace. You want your cake and you want to eat it too.
I
Your whole argument is fundamentally flawed because no one is asking taxpayers to pay for anyone’s contraception. This is about requiring insurance companies to cover contraception the same way that they have to cover blood pressure medicine and chemotherapy. You’ve built quite the straw man, but it’s totally irrelevant to the political issue at hand.
University insurance is paid by students themselves. This affects none of you. Unless you CHOOSE to be a Georgetown University student.
End of story.
As JB states, contraceptives are used for other reasons too. I was on the pill at the age of 14 for a medical condition – if any of you men really want details I can give them to you, it’s not as taboo for me as it is for you – and not for the purpose of contraception as I was not sexually active at the age of 14. This is something men would not understand. And sadly, they are the only ones in power to vote on a topic they know nothing about.
If contraceptive pills are not covered under an insurance plan, they’re not covered. It doesn’t matter what they’re used for. Just like Viagra was initially intended to help heart conditions. Your insurance company is not going to know/care what you’re using it for – it’s one less thing they have to cover because it’s on a list of prescriptions they’ve decided not to cover. The media did a good job of creating a stir and relieving them that obligation.
Anna:
Your whole argument is fundamentally flawed because no one is asking taxpayers to pay for anyone’s contraception. This is about requiring insurance companies to cover contraception
You’re joking, right?
Much of what the federal government does is establish a baseline for something that the states may then choose to exceed, but not to fall beneath. The standards for clean air and water enacted in the 1970’s are examples. In doing so, the federal government naturally acts as a bully; someone’s ox is always gored. And these standards all come at a cost: clean air and water burden the businesses that have to install scrubbers and filtration systems. Health epidemiologists will tell you, though, that the societal costs borne by the health effects of breathing dirty air and drinking unhealthy water are far greater than the incremental costs of implementing the standards.
We don’t hear anyone picking apart any of the other Obama healthcare mandates with such vehemence. Take denial of insurance because of pre-existing conditions, for example. Establishing that women’s reproductive healthcare is a “covered condition” for everyone is no different.
Posit for a moment that I am a devout Christian Scientist who employs 60 people. I firmly and truly believe that prayer cures all illness. Following the logic presented at the Congressional committee, I should not have to buy health insurance at all for my employees, as to do so goes against my beliefs.
Likewise, if I disagree with the war in Irag/Afganistan I should be able from withhold from my taxes the amount that supports it. Or if I never go to National Parks, I should be able to withhold whatever portion of my taxes goes to the Park Service.
Baseline standards by the federal government give some “least common denominator”. Otherwise there would be 50 different standards. As one friend asked me, “Are you a team or are you a league?”
The fact that Georgetown doesn’t choose to offer insurance coverage is no more a market failure than that Dairy Queen doesn’t offer pulled pork. It hasn’t stepped in between you and an insurance company. You can buy your own coverage. Or you can take the deal that Georgetown is offerring. Or you can go somewhere that better fits your insurance values.
The failure here, not of markets, but of compromise, is simply that people who value contraceptive coverage shouldn’t go to Georgetown.
Why doesn’t the compromise work? I think that’s because people are insisting not only a right to contraception, but a right to go to Georgetown AND have the government force it to sell insurance that covers contraception. There _might_ be an interesting case to be made about how contraception is a basic need and positive right. But I’m pretty sure there’s no sane case to be made that there’s a right to go to Georgetown.
@ Drew, Justine, and anyone else arguing that the proper path is just to choose somewhere else to go to school
For Universities I basically agree with you, the market works on its own there.
For Hospitals though I don’t.
Catholic Hospitals see 1/6 of all patients in the US. I appreciate that they’ve built such a large array of hospitals in a rather low margin industry. It says a lot about their drive to serve others.
At the same time it says a lot about their control of the market, both for patients and for Hospital staff.
Assuming that staffing is similar to patient levels it means that Catholic Hospitals employ around 1/6th of Hosptial Nurses and Doctors.
In some cities the only Hospitals are run by Catholic institutions.
Given that situation although a Nurse or Doctor in one of those cities has some choice of where to work, the choices are limited enough to prevent the smooth functioning of the labor market if this is a determining factor in where someone can seek employment.
Hence market failure. For anyone who hasn’t read my prior posts I understand that market failure does not dispositively prove the need for government action, but some see the lack of market failure as dispositive evidence that no government intervention is needed.
@Steve:
“Anna:
Your whole argument is fundamentally flawed because no one is asking taxpayers to pay for anyone’s contraception. This is about requiring insurance companies to cover contraception
You’re joking, right?”
Actually I wonder if it is not you who are joking. You MUST have noticed that many (most) of the posters here believe
1. denying coverage for a my beer is the same as denying me access to beer.
2. not paying for leeches to treat the flu is the same as not paying for leeches to treat hemochromatosis.
3. if the price is high that’s market failure.
4. if you decline to pay for my Debussy it’s because you are anti-Debussy, probably because you are too privileged to understand.
5. covering contraception is free.
Given all that, are you really surprised at Anna’s comment?
Geoff Bowser:
This is not market failure.
One reason is nobody is preventing the doctors and nurses setting up their own facility.
Just because the price will be high does not make it a market failure.
But there is a more fundamental confusion here. There aren’t two parties here there are three.
The third is the hospital. The other two want to buy a service from the hospital.
Assume the hospital does not want to sell it.
It is not a market failure if the hospital does not wish to sell a particular service, or demands a high price.
@Steve Landsburg, yes—but how do you determine what they are being prescribed for?
@JB: As part of the submission made to the insurer. This can be done directly or by the insurer doing an audit or spot check.
@Ken B. If you would have read the transcript of what instigated Fluke’s arguments (her friend being denied insurance for contraceptive medication for non-contraceptive health issues), you would know that you are incorrect. Insurance companies don’t care what purpose your medication is for. If it’s a particular medication on a list that they don’t cover, they don’t cover it. Simple as that. Same thing for medication typically used for depression which could be prescribed for other purposes as well. Birth control pills have also been prescribed (often) as an acne medication as well.
If you’re not a doctor, not an insurance agent, nor have had direct experience with this particular topic (working with an insurance company directly for these seemingly taboo medical coverage), please do your research or take the word of someone who has. I shouldn’t even need to say this to those who work/study in a higher education field.
Justine:
First, you are just wrong. There are for instance drugs that will only reimbursed for with extra paperwork, or after other drugs have been prescribed for the specified condition.
Second JB asked for a mechanism. I gave him one, it matters not if the mechanism is in place. A careful reader would note I said “can be done’ not ‘is done.’
Third Fluke also testified about about a women whose prescription for the pill WAS covered because it was not for contraceptive purposes. Here is part of Fluke’s testimony:
“A friend of mine, for example, has polycystic ovarian syndrome and has to take prescription birth control to stop cysts from growing on her ovaries. Her prescription is technically covered by Georgetown insurance because it’s not intended to prevent pregnancy.”
Finally there is such a thing as honesty. A woman my get the pill paid for by lying about it, but that is a separate issue. When I travelled for work no-one checked my dinner receipts, but I calimed only what the policy allowed anyway.
Now perhaps Justine knows more about my medical history than I do, but I have in fact had to have my doctor fill out ‘pre-qualification’ questionnaires for very expensive medications on two occassions. These included specifications about the condition.
I have also had to use ‘intermediate’ drugs and see them fail before I could get a more expensive one.
@Geoff: Is it a potential market failure anytime I want a 60-second hamburger, served in my car? Might some universities be in small towns served by one hospital? Not seeing the distinction there. Is it just that young people are more mobile? It does seem your claim rests, to paraphrase Drew, on an alleged right to work for a particular employer or live in a particular town.
BTW I agree only having access to one hospital can raise some thorny issues…but in this case I don’t think we need a hospital to prescribe the pill. If you like, perhaps this could justify ‘govt action’ in the form of a municipal clinic. Or again, why isn’t this precisely the type of role organizations like Planned Parenthood are for (which allows us to avoid the legislating morality bit)?
On conscientious objection:
If I haven’t acknowledged this point before, let me do so now: I agree wholeheartedly that the Administration’s policy on contraception burdens liberty. Indeed, there’s a name for this type of burden on liberty. It’s called TAXATION.
I don’t begrudge anyone their religious views. I don’t begrudge Catholics saying that they object to paying money that will be used to finance contraceptives. And I don’t begrudge libertarians saying that they object to government, period. Indeed, if I ever encountered a person that had NO qualms about government, I’d suspect I’d encountered someone who wasn’t paying attention.
What do I object to? I object to government discrimination on the basis of religion. I object to government privileging one person’s religion over another. Whatever policy we adopt for the Catholics we should also adopt for the libertarians. I may not have learned much from Fair Play, but I may have learned that much.
My deepest liberty concerns go to acts of physical coercion and compulsory personal services: War, arrest/detention, drafts/slavery, truancy, compulsory child birth. Duties that can be reduced to simply paying cash – rendering unto Caesar – occupy a lower position in my hierarchy of concerns.
As far as I can tell, ObamaCare does not compel any private party to do anything other than pay money to government. Yes, a private party has the option to buy certain types of insurance in lieu of paying money, but that’s an OPTION, not an obligation.
I find this current furor over birth control easy to understand from a partisan perspective, but hard to understand from a liberty perspective. I understand the Catholic Church, and others, may have doctrinal objections to a variety of things – birth control, capital punishment, war, etc. And I understand that the money I pay to government finances all of these things. Thus, I have difficulty taking Catholics seriously when they argue passionately about the harm of paying for birth control, yet placidly pay their taxes financing war and capital punishment.
Hard-core libertarians argue that no one should have to pay anything to government if he doesn’t feel like it. Wise or not, that’s a consistent view. A contrary, and consistent, view is to conclude that we make many decisions collectively, and the duty to pay for the collective does not depend upon your approval of every aspect of the collective. But people advocating some middle ground – objecting to paying for this one aspect of public policy, but not all the other (more egregious) ones — leave me puzzled.
For what it’s worth, the Framers did not discussion conscientious objection much when working on the First Amendment’s Free Exercise and Anti-Establishment clauses. But they did when discussing the Second Amendment – you know, “A well regulated militia being necessary to the security of a free state, the right of the people to keep and bear arms shall not be infringed.” Oddly, the Framers seemed to imagine that this amendment pertained to well-regulated militias. Consequently they discussed at length whether to adopt the policies found in other states’ constitutions pertaining to conscientious objectors to war. Specifically, these provisions declared that contentious objectors could not be drafted into the military – provided that the objectors recruited a replacement, or paid money sufficient to hire a replacement. While contentious objectors could be freed from providing personal services that offended them, there was never any idea that they could be freed from PAYING for policies that offended them.
(Ultimately the Framers couldn’t agree whether contentious objector status should be a matter of individual right or executive discretion, so the subject was eventually excluded from the amendment.)
Of course, others HAVE objected to contributing to paying money to a government that does things they find offensive: famously, Henry David Thoreau refused to pay his taxes due to his opposition to slavery and the Mexican-American War. And he went to jail until the taxes were paid. For better or worse, not even the Obama Administration can deprive contentious objectors of this option.
WAS IT O.K. FOR A SATURDAY NIGHT LIVE HOST TO INVITE THE VIEWING AUDIENCE TO MOON A GIANT PICTURE OF RONALD REAGAN?
Should ***Congress*** have intervened?
The Left reminds me of the Cowardly Lion in the Wizard of Oz: a roaring bully that whimpers loudly the minute anyone stands up to him. They present themselves as the champions of satire, the cool hard-edged culture of late night comedy, the defenders of a political culture that skewers actors on the political stage, as when a famous actor hosting Saturday Night Live invited the viewing audience to collectively pull down their pants and “moon” a giant picture of Ronald Reagan. That’s alright with them. That’s proper democratic political discourse. That’s funny. That’s cool, and anyone who complains about hurt feelings is a wimp or a censor or a bigot. The American left can certainly dish it out, but they can’t take it. Any rudeness directed at them and they whine loudly that their souls have been injured. They actually expect CONGRESS to intervene (God help us). Rough satire against people on the left is out of bounds. They systematically conflate economic issues with bigger moral issues, on purpose, to lend extra weight to their arguments, because they know they can’t win the economic argument. This is like adding a swear word to the end of a sentence. It is a childish and outrageous debating technique. Asked why we should pay for such-and-such, they change the subject. They deliver melodramatic speeches about rights and social injustice, like a teenager protesting that he has been “abused” because his father refuses to give him $100 for a date. Miss Fluke is a member of a privileged elite attending a privileged university. For her to claim that she has a right to a janitor’s tax money to pay for her contraception is too outrageous for words. For her to then to justify this narcissistic outrage by appeals to “women’s rights” makes me want to grab a musket and man the trenches.
Ken B. I had thought that barriers to entry were a form of market failure. It is not really possible for a nurse to set up an institution competing with a hospital because the barriers to entry are too high.
And here is surely an example of where it is impossible to “cut out the middle man”. For colleges, the student can go somewhere else. For employees of the hospital, they cannot (without considerable cost). A clear market failure.
A very oood blog post SL.
There has been some discussion here about socializing the cost of medical care. Just to be clear — the purpose of socializing any cost is to spread the cost out from those who are currenting believing the incurred cost to be too high to also include those who do not yet find the cost to be too high. Others may call this having other to pay for own’s own comsumption choices. Ms. Fluke and the contraceptive debate is simply a proxy for the entire medical coverage debate.
There is a problem with socializing costs when the complaint is the cost is too high. Socializing does not lower the aggregate cost and probably does not lowere the unit cost either. It does nothing about the original concern that medical costs are too high. Socializing medical care simply attempts to increase the number of peolple that will now find medical costs too high.
Once more people are pulled into the system to be paying for consumption, it is likely they will also then increase aggregate consumption. Such an increase in demand should then lead to even greater increases in unit costs. Thus the original complaint that medical costs are too high will in effect be aggravated. This is not to suggest that a minority with the initial complaint will not be better off, but a direct income sensitive subsidy has to be a cheaper alternative and economically less disruptive to socializing all medical costs.
John: “The American left can certainly dish it out, but they can’t take it. Any rudeness directed at them and they whine loudly that their souls have been injured. ”
I see the exact same behavior on the right. But since we’re both partisans, our opinions about who does this more often are probably full of crap, based largely on what we selectively pay attention to. And even if one of us were right, and the other wrong, and one side had, say, 40% more gassy babies than the other, what would we do with that information? What purpose does it serve insofar as getting across any substantive point? Or does it simply make you feel better? Ok. There, there. It’s all okay. You and your tribe are better people. Go forth proudly.
And then lets continue the debate.
Amazing the rise of neo-eugenecism here, just on the topic of birth control (which of course is always undefined for maximum effect). Some of you sound right around the corner from forced, or coerced, sterilization (birth control) due to ‘faculty’ or ‘status’.
So which form of ‘birth control’ is “monopolized”? Most are not. Spectacularly lacking is ever a point of the cheapest forms of non-conception such as, SAYING NO to sexual activity. Women also have a natural ability at certain times to prevent conception. Where is all the personal responsibility? Sex is not a requirement or a human right or an obligation. It is not necessary in order to live. ‘Birth control’ is also not necessary, it is a luxury. Luxury should not be subsidized.
Perhaps people should be taught self-restraint and integrity before being given a hall pass and encouragement to debauchery. Remember ‘birth control’ is an industry, many businesses, disguising the ‘help’ they provide as a facade for profits. Useful idiots are not the sole provence of Soviet-style communism.
Where do you all stand on euthanasia? Since the basis of support seems to be population control (which is what birth control always was). What about abortion? Genetic-based, partial birth, sex-based, infanticide, abortafacients? This debate isn’t just about a pill or condoms, so don’t let people stifle it so. How far are you willing to go? How far do you think others are? At the end of the day, it’s always more, go further.
@nobody.really: One line of ‘libertarian’ reasoning is that taxing someone = taking from them the amount of time it took to earn those resources = in a real sense taking a prorated share of their life. You’d surely find “enslaving” a bit hyperbolic here, but I do find that a helpful perspective to focus the mind when deliberating over legitimate purposes of taxation…like the examples of ‘internal and external defense’ you cite, where we might expect to disagree on the details but recognize the inherent need for public provision in some form (e.g. cases where we literally *can’t* do something for ourselves or others, as opposed to just ‘might choose not to’).
Speaking of arguments “worth taking seriously”, I wanted to circle back on yours with the caveat that “unplanned” seems descriptive; to me “unwanted” requires an uncomfortably speculative leap. For example, negative externalities from babies born into an uncaring / unsupportive environment (which I take to be the premise here) seem less likely if and where, as others have suggested, the main purpose may be primarily to delay childbirth (e.g. among students or employees who are over 26, the focus of the testimony at issue?). That is, the real criteria here would seem to be the underlying desire to have children, even if the timing doesn’t always go quite according to plan. A bigger source of concern over negative externalities might actually be the reverse case, where other social policies distort the underlying motivations for *intended* pregnancy (or reduce the cost of unintended pregnancy) under the ‘wrong’ conditions.
@Drew – I agree 100% any argument that involves “our guys are morally better than your guys” is doomed from the start, and usually just a cop-out. Which is not to say some *ideas* are not superior to others. But certainly seems best to assume all elected officials are playing the same game.
From an economic standpoint isn’t it cheaper to pay for contraception than to pay for surgical treatments of complications due to poly-cystic ovarian syndrome or endometriosis? Isn’t it also more responsible to cover contraception than to later pay for government support of women who are left with depression or in debilitating pain?
The problem with the statement that “It is cheaper to foot the bill for contraception than to to foot the bill for childbirth”, is that it poses a false choice. Of course, contraception for one woman is cheaper than for her to have a kid (and the Prof. does suggest that the long term benefits of having a kid may (and I think often are) be larger than not having the kid.
But, I think that the real economic question there that is being avoided is the extent that women will forgo contraception and engage in sex with men, if they are not able to get their choice of contraception free (i.e. w/zero copay) from their insurance company. And, I will suggest that in most cases, they will either forgo sex entirely, pay for contraception themselves, or utilize a less preferred method of contraception. Keep in mind that condoms, for example,are apparently freely available at the Georgetown student medical center, and that Planned Parenthood is also in the near vicinity.
I would suggest that the number of women who would have unprotected sex at a fertile time in their cycles, if they did not get free contraception of their choice, is very low. The cost to them of an unwanted pregnancy and resulting child is far higher than the cost to their insurance company of an unwanted pregnancy. Of course, on the flip side, some of the alternatives are not as reliable, so you would have to figure in the odds of failure times the cost of failure.
In other words, before making the argument that pregnancy is more expensive than contraception, I think that you also need to factor in the probability that depriving a woman of her choice in contraception at no cost to her will result in an unwanted pregnancy, taking into consideration that most women will utilize other means of payment for and/or types of contraception if deprived of their choice being supplied to them effectively for free.
From an economic standpoint isn’t it cheaper to pay for contraception than to pay for surgical treatments of complications due to poly-cystic ovarian syndrome or endometriosis? Isn’t it also more responsible to cover contraception than to later pay for government support of women who are left with depression or in debilitating pain?
But, that has never been the issue. The issue is contraception of their choice for the sole purpose of contraception being supplied effectively free to women. Contraceptive pills used for other medical reasons, esp. the type that you mention, are almost always covered by insurance, even when those same medicines are not paid for by insurance if prescribed for the sole purpose of contraception.
Indeed, this brings up the argument that this is a women’s health issue. It really isn’t, because women are likelier healthier if they do not utilize these forms of contraception. Pills, IUDs, etc. all have negative side effects, and, indeed, while pregnancy itself has short term adverse affects on women’s health, there is mounting evidence that the long term affects are positive.
http://www.slate.com/articles/health_and_science/human_nature/2012/03/rush_limbaugh_sandra_fluke_and_college_sex_does_contraceptive_insurance_change_sexual_behavior_.html
This article references a new study (admittedly not yet peer reviewed) that shows that the removal of a subsidy on oral contraceptives did not decrease the number of unplanned pregnancies (while sexual activity did decrease students tended to substitute the pills for less reliable birth control methods). If this is the case then SL’s concern over the reduction of positive externalities caused by unplanned pregnancies is moot.
If you actually read Sandra Fluke’s testimony she gives an account of her friend who could not get covered for PCOS and subsequently underwent surgery to remove an overy after a cyst ruptured. This IS a women’s health issue and puts the burden of determining medical necessity on an insurance company rather than on a doctor. Invasive procedures are required to differentially diagnose many of these conditions, and if claims are denied repeat procedures and second opinions are the norm. Additionally, in cases of severe cramps, and largely irregular cycles that are not traceable to a recognized disease contraceptive pills are rarely covered regardless of whether these issues temporarily incapacitate the woman. And, how many of these insurance companies recognize PMDD as a diagnosis to be covered?
This entire debate is completely ridiculous. Money is fungible. When a Catholic university provides healthcare for their employees, the dollars that go towards employee benefits are indistinguishable from the dollars that go towards employee paychecks. One dollar goes to the insurance company, one dollar goes directly to the employee.
Would it make any difference if the dollar that pays for the insurance was first given to the employee, and then they passed it along to the insurer themselves?
Can a Catholic employer legally bar their employees from spending their paychecks on hookers and condoms?
Can a Catholic employer refuse to pay their employees any wage at all, for fear that the money is spent on something they find morally reprehensible?
The answer to all of these questions is no. Your employer has no legal right to impose their moral standards on what you do with your own pay. The day the government starts forcing birth control pills down religious women’s throats, give me a call. Until then, mind your own f*cking business.
Cameron:
Would it make any difference if the dollar that pays for the insurance was first given to the employee, and then they passed it along to the insurer themselves?
Of course not. As with any tax/subsidy/etc, all of the interesting economics is at the margin — the employee who would *not* choose to spend that dollar on birth control, but who accepts the birth control when that’s all that’s offered.
The economic value of having children can be viewed as either positive or negative depending on your point of view. If you are 30 today, you can reasonably argue that parents who had large families during the Baby Boom were acting with little concern for the costs of doing so and as a consequence, you are now left to subsidize their retirement – at considerable personal cost. That would be a negative. From the perspective of a Baby Boomer, you were brought into the world with little concern over the cost of doing so and you will retire with some sort of subsidy that you have only because you were born. From you perspective, that would be a positive. And to the extent that your Baby Boom retirement might be better guaranteed and more comfortable, more babies born in the Echo Boom might have been a positive despite environmental and other costs.
Either way, Sandra Fluke was just trying to pick my pocket, and that’s a negative.
And Seligman’s remarks were stunning for their obtuseness.
If you actually read Sandra Fluke’s testimony she gives an account of her friend who could not get covered for PCOS and subsequently underwent surgery to remove an overy after a cyst ruptured. This IS a women’s health issue and puts the burden of determining medical necessity on an insurance company rather than on a doctor. Invasive procedures are required to differentially diagnose many of these conditions, and if claims are denied repeat procedures and second opinions are the norm. Additionally, in cases of severe cramps, and largely irregular cycles that are not traceable to a recognized disease contraceptive pills are rarely covered regardless of whether these issues temporarily incapacitate the woman. And, how many of these insurance companies recognize PMDD as a diagnosis to be covered?
So, your position is appears to be that because 1 woman was unable to get birth control pills prescribed for free for an actual medical condition, and, therefore, the debate is about womens health, and insurance companies not paying for birth control pills.
But, did you ever stop to think that this was one instance, and that a lot of insurance companies do routinely pay for birth control pills for this sort of thing, based on health, and not contraception issues? And, that maybe something else was going on. Plus, if this was another law student, why the heck didn’t she appeal, bring suit, etc.? That is part of what they train’em to do in law school.
In any case, what you seem to be doing is arguing from a specific single instance to the general, with no attempt to really explain why the specific instance would adequately represent the general case.
Birth control pills are not a monopoly. They compete with every other method of birth control, including other drugs, condoms, diaphragms, and “natural” methods.
SL:
I just discovered your excellent website–I have tried to read all of the commentary on this issue to date but, I apologize if I raise issues that have already been covered.
I found it interesting, as this debate unfolded, that the biggest supporters of subsidizing Fluke’s personal choices can be frequently seen questioning people’s personal choices in other areas of life.
Government officials who have no problem telling citizens what kind of car they should drive, what food they should eat, etc. Perhaps one of these officials should have told Ms. Fluke that there are ways of having sex that do not require any expenditures for contraception.
Tim
What about the first amendment? Free exercise of religion? I’m not catholic, but if I was, wouldn’t this mandate to pay for birth control for others be a violation of my civil rights, and therefore unconstitutional? The catholic church is against anybody using birth control. We can’t force them to pay for it.
@Eliezer: If you read some of the comments, or research Fluke, you will find that for some infringing upon the freedom of religion is in fact the point and best feature of the plan. “We can’t force them to pay for it.” We can and we can rub their noses in it too.
Mr. Ken B, do you know how many people are using birth control pills for medical purposes other than to prevent pregnancy? I don’t either, but its probably a small proportion. I don’t think this is a strong enough case to go ahead and violate the civil rights of a large population of Americans (Catholics). I believe the right to the free exercise of religion is, umm…, sacred, and shouldn’t be trampled on lightly. Freedom of religion includes the freedom of no religion, so either way, everybody has some interest in its protection.