A few final thoughts (following up on this post and this post) re mandated insurance coverage for contraceptive pills:
- Mandated insurance coverage means that the government requires everyone who doesn’t use contraceptive pills to contribute to the costs of everyone who does. This is exactly equivalent to a tax on not using contraceptive pills.
- The burden of that tax falls on three groups: Men, infertile women, and fertile women who choose not to use contraceptive pills. We can consider separately the wisdom of each of these taxes.
- The tax on men is easily the most defensible. First, it’s non-distorting: There is (correct me if I’m wrong) currently no technology by which a man can convert himself into a fertile woman. So we don’t have to worry about the tax changing anyone’s behavior. Second, men, on average, earn more than women do, so if you believe in redistributive taxes at all, this is a great one. (We can have, someday, a separate discussion about the merits of redistributive taxes. But given that there’s a substantial constituency for those taxes, and given that we’re therefore going to have them, it seems far wiser to tax people for being male or white than for earning high incomes, since the redistribution goes for the most part in the right direction with essentially no disincentive effects.)
- The tax on infertile women is the second most defensible. Like the tax on men, it’s pretty much completely non-distorting. But unlike the tax on men, it does not fall primarily on a particularly high-income group so it’s quite hard to see why you’d want to bother with it.
- The tax on fertile women who choose not to use birth control pills is the least defensible. It’s both distorting and there’s no apparent reason to think that these women are substantially wealthier than those who are on the pill.
- This does ignore some of the arguments I considered in a previous post about the externalities of childbirth.
So on balance (unless you believe that point 6) is extremely significant) it seems like a far better policy, with many of the same effects, would be to tax men and redistribute the proceeds to women, independent of what sort of birth control they choose to employ. No?
In other words: Mandated contraceptive coverage is really three taxes rolled into one. One of those taxes makes far more sense than the others. So why not just keep that one and get rid of the other two?
Contraceptive pills only cost about 35 cents each, retail. Are you also going to tax women to pay for condoms?
Ok, maybe I am missing something here – how does taxing men help women who have no money afford contraceptives?
@ #4. I’d just like to note/propose/suggest that infertile women don’t often know that they’re of that particular type. Assuming fertile and infertile women belief with probability 1-p that they’re fertile and with probability p that they’re infertile, the incidence of the tax would be p * [the incidence when their type is observable].
Therefore whilst they are not a particular high income group, their expected burden is lower.
Or if you want to put it in a different way: a large proportion of women who are infertile will use the pill.
I am not entirely sure though whether this increases the incidence on women who know that they’re infertile and therefore don’t use the pill or whether it remains the same. I think it increases.
@ #5. Assume there are two reasons for women not using the pill. The first reason is that women who do not use the pill do so out of a strongly held religious conviction. If this is the case, the tax will not lead to a distortion as those women will not change their behavior. The second reason is to get pregnant. If we assume that the number of children increases with income, we can conclude that those women have more income than the women who continue to use contraceptives.
What remains then is the question whether deeply religious women are richer than the women they’re subsidizing.
As I mentioned in a previous comment, the tax incidence of the mandate is different if providing contraceptives actually reduces the price of insurance. In this case most employers offer insurance that provides contraceptives, and so the mandate does not affect anyone whose employer already offers such insurance. The only people it affects are those whose employers do not offer such insurance as well as the owners of those firms (or trustees in the case of a university). Of those people, those who don’t use contraceptives after the mandate are not affected by the mandate (they get a lower insurance premium but that is offset by a lower wage). The beneficiaries of the mandate are those who use contraceptives (they get a lower insurance premium and free contraceptives which is only partly offset by lower wages). The losers of the mandate are the firm owners. While they get higher profits because their payroll has decreased, they are now forced to offer insurance that covers contraceptives, and they have already shown a preference for they opposite.
Hence, in this case (when providing contraceptives lowers the price of insurance) the mandate is a transfer from firm owners (or trustees) who prefer not to offer insurance which covers contraceptives to their employees who use contraceptives. No one else is affected.
As virtually every health economist on Earth knows, paying for the BCP is more costly to payers (public or private) than paying for the cost of the occasional accidental child. If this weren’t so, no mandate would be necessary.
The problem with – and primary strength of – Landsburg’s argument is that levying an outright tax on men is utterly indefensible; whereas, if we couch such a tax in the language of feminism or egalitarianism, we can tax men without it actually *feeling* like a tax on men.
So: Anticipate more indignant replies from people who are offended at the idea that BCP mandates are discriminatory. They want to discriminate but trick themselves into believing that they’re not discriminating.
Correct me if I’m wrong, but doesn’t the “truth-seeker” section of “The Big Questions” tackle this phenomenon?
Martin: “Assume there are two reasons for women not using the pill” Why only two? How about deciding that the costs outweigh the benefits because you did not anticipate that hunky guy at the party (or bible study) after having had a glass of wine or two?
From a purely financial point of view, it sounds an excellent proposal. Tax men half the cost and give it to the women. It could even prove popular. It would certainly avoid those embarassing moments after dinner when the woman tries to internalise the benefits of her increased attractiveness.
It does, as you say, ignore externalities – not just those on childbirth per se. There are separate externalities on wanted and unwanted childbirth, which this does not address.
Giving women the money directly also does not remedy any perceived market failures that result in under-use of contraception, for which it is important that it is free at the point of use. And it may still be harder for some women to get the pill for other non-medical needs. It would be a shame to miss out on the extra benfits (if benefits the are).
If only there were some way to make it free at the point of use, whist still ensuring that about half the burden fell on men.
anything insurance covers, ANYTHING, is exactly the same. it allows the individual to benefit at the cost of the group. that’s what insurance is all about.
“paying for the BCP is more costly to payers (public or private) than paying for the cost of the occasional accidental child. If this weren’t so, no mandate would be necessary”
If all descisions were made on financial grounds, maybe so. The problem here is that some decide to not cover contraception on ideological grounds. The monetary cost may be much greater, but this is balanced by the perceived benefits to those that do the excluding. This is fine if the consumer is the same person as the excluder. If they are different people, and you can’t “cut out the middle man” as said on yesterdays post, then the consumer might end up paying more for someone elses ideology.
‘Bout time Landsburg saw the light on this issue. Assuming no externalities, this seems like a reasonable substitute for subsidizing birth control, and would sidestep certain ethical qualms – much like a voucher system sidesteps concerns that the government is subsidizing religion.
There may be certain economies of scale/scope to subsidizing birth control, however. As noted elsewhere, various forms of birth control have benefits distinct from controlling birth. If government is already paying for x% of people to receive birth control pills for medical purposes (including the purpose of reducing cramps, which is quite common, I’m told), does it make sense to also provide tax subsidies for these women? Assuming the subsidy authority did not have access to records regarding which women were already receiving birth control via other means, the subsidy might prove to be less efficient than simply subsidizing birth control for the remaining (fertile?) women.
Don’t you oppress me!
Be careful! This is just Landsburg’s Trojan horse. He’s trying to make a case for taxing just gay women to pay for condoms.
Advo, last time I checked, people who have no money do not pay income tax…
@Harold – I just want to settle the issue of “cost effectiveness” once and for all. If the argument is that paying for BCP saves money in the long run, I want people to understand that this is not a perspective supported by any empirical evidence whatsoever. Health economists everywhere know that the most costly medications are those with low unit costs taken regularly for years. This is true independent of all ideology involved.
As for the choice to exclude or no, up until a couple of years ago, the government had no authority to force human beings to purchase a product. Most of us do not really believe that the government has any such authority.
Instead, those who support mandates do so for expediency’s sake. It’s easier for them to just mandate something than to try to come up with an indefensible theory that would justify it. This is why Fluke’s and others’ arguments are so vacuous, and also why they have quickly forced the argument to be one of “women’s health” rather than the scope of government or the most cost-effective public finance solution.
In fact, I am so disappointed by this whole issue that it makes me downright depressed. If the name of the game is to just scream and whine until you get the government to fund your pet desire, then what is the point of calling our system a democracy or a republic?
More to the point, Landsburg is hypothesizing a policy “to tax men and redistribute the proceeds to women….” That is how it would help women afford contraceptives. (Or afford anything else, for that matter.)
@Harold
“The problem here is that some decide to not cover contraception on ideological grounds. The monetary cost may be much greater, but this is balanced by the perceived benefits to those that do the excluding. This is fine if the consumer is the same person as the excluder. If they are different people, and you can’t “cut out the middle man” as said on yesterdays post, then the consumer might end up paying more for someone elses ideology.”
I would disagree with this. The “middle man” is providing something to the consumer in a market with other competitors. So the consumer can freely leave this middle man and find another middle man to do business with. This means that the consumer is NOT forced to pay for the middle man’s ideology.
For example, if the consumer receives insurance from his employer and his employer offers insurance which does not cover contraception, then the consumer/employee could always leave their employer and work somewhere else that does. Because of this threat, the employer must either offer a higher wage or hire workers who do not value insurance with contraception coverage. Either way, the employee is not paying for his employer’s ideology.
The same logic applies to students and law schools, as there are other law schools the student could attend.
@RPLong
Here is a study I saw today that purports to show that providing contraception can save money. I make no claim as to the quality of the study. Personally I am agnostic on this question. But I thought it was relevant.
http://www.brookings.edu/reports/2012/03_unplanned_pregnancy_thomas.aspx?p=1
@JohnE – A fair link. I’ll just point out that the study effectively makes the same argument made by others here and elsewhere. If you compare the cost for one individual to take BCP or have an unplanned pregnancy, obviously BCP is cheaper. But public and private payers aren’t paying for “one individual,” they are paying for the entire risk pool, for decades. Unplanned pregnancies are sufficiently rare that it is cheaper to pay for those that occur than it is to sustain the entire risk pool’s appetite for BCP.
In short, you cannot compare at the individual level the costs associated with a risk pool.
@Harold
I see now that your claim was based on the assumption that you cannot cut out the middle man. Sorry. I guess my response then boils down to the assertion that that assumption is most likely false.
tirane:
anything insurance covers, ANYTHING, is exactly the same
You’ve missed the distinction between those things that insurance covers because people have decided they want that coverage, and those things that it covers because of a mandate.
” If the name of the game is to just scream and whine until you get the government to fund your pet desire, then what is the point of calling our system a democracy…?”
Truth in advertising?
I don’t think that economics is the correct lens through which you should look at the question of mandated birth control coverage, or at least the views of the proponents of that proposition. While there are some discussions about how it may be more cost efficient to reduce pregnancies or at least unwanted pregnancies, those are mostly attempts to counter oppositions based on economics. The real reasons for supporting mandated birth control are because of its symbolism and because of fairness.
On the symbolism front, many people see sexual morality and pregnancy as ways in which women have historically been oppressed. Historically, women who had sex before marriage have literally been called “ruined,” and have been cast out of society, the same was rarely true of men, and even when it was, it was to a much lesser extent. Pregnancy and children have historically, and to a lesser extent presently, worked to exclude or limit women’s involvement in business and in political society. The birth control pill both permitted women to enjoy the same sexual freedom as men traditionally have and have allowed them to control their pregnancy and number of children to limit this roadblock. When people seek to make it harder for women to get the pill, it is seen as an attempt to push women back into this oppressed role and is objected to the same way a push for segregated water fountains would be. When that push comes from an organization such as the Catholic Church, that explicitly discriminates against women (see, the all-male priesthood), there is reason to believe that this is the exact reason those people are seeking to make it harder for women to get the pill. This symbolism also puts Limbaugh’s calling referring to Ms. Fluke as a slut and suggesting that she wanted to get paid for sex in a very particular light.
There is also an element of fairness here. This is not a general debate about whether employers can choose to provide health insurance that excludes certain coverages to keep costs down, this is a question of whether insurance carriers can exclude a particular coverage that only affects women. One way to think about this is that all things being equal, men who buy insurance through a catholic employer are getting 100% of their health coverage paid for, while women are getting some percentage less of their health coverage paid for, while both are being asked to pay the same premiums. This comes across as discriminatory.
I would also point out that, considering the tenor of this debate, the opponents of mandatory birth control coverage typically have not relied on economic arguments. Instead they have talked about “freedom of religion.” The congressional hearings on this issue did not (at least principally) involve testimony by healthcare economists, they involved testimony by religious leaders talking about their moral objection to birth control.
Maybe I’m missing something, but I wouldn’t expect insurers to raise premiums for men at all. In a competitive market, if BCP coverage were made mandatory for insurers, I would expect insurers to increase their premiums to cover the expected cost of providing BCPs. Since insurers can be reasonably certain that men will not require BCPs (assuming insurers are even required to cover BCPs for men), men’s premiums shouldn’t increase at all. It seems to me that women are likely to bear the entire cost of the BCP mandate, and that women who choose not to use BCPs would be harmed the most.
I like to think of it in terms of cost of living and effective income. Maybe contraceptives increase the cost of living so much that women have effectively a lower income than men and therefore should be taxed at a lower rate. But this ignores a lot. The cost of living for men may be more for other things (e.g. auto insurance). Men also have higher risks of incarceration, death etc. My question is that if we added up all these things and found that the cost of living for men and women were approximately equal would the tax on men still make sense? It seems to me that to be focused solely on contraception is a mistake and we should instead be looking at a much larger basket of goods to determine whether gender-specific taxation is justified.
“One way to think about this is that all things being equal, men who buy insurance through a catholic employer are getting 100% of their health coverage paid for, while women are getting some percentage less of their health coverage paid for, while both are being asked to pay the same premiums. This comes across as discriminatory.”
That would be a clearly wrong way to think about it. If there are policies that offer free vasectomies for non-medical reasons, but do not offer free birth control, you could make that argument. I don’t think there’s anybody out there offering such a policy.
If we go with three, will that negate the complaint that women make 70% of what men make?
Jon Shea: Ordinarily, for most policies (e.g. those offered by my employer), men and women are charged the same amount, though one would think that the probability this is actuarially fair must be essentially zero. I conclude that there is some insurmountable reason (probably some law) why they have to do this. Therefore any increase in payouts will be felt as a rise in premiums across the board.
@Jon Shea:
For people that get their insurance through a group rate for a group that includes men and women (most employer provided policies), the increased burden would fall equally on men and women, provided that the employer doesn’t use other compensation practices (which would almost certainly be illegal in the U.S.) to make up the difference.
@Martin, I think your assumptions are both invalid. First, whether deeply religious women have greater income, a survey a couple of years ago showed that the highest income religions were (not in ranked order) Hindu, Reformed Judiasm, Anglican, Quaker, and atheist. None of those are usually counted as deeply religious. At the other end are evangelical churches, Jehovah’s Witness, and Baptist.
Re. income and child count, this chart http://www.russellsage.org/research/social-inequality/chartbook/income-inequality-households-children/children-by-income shows that the number of children declines with income.
Johnson85:
At least according to http://www.vasectomy.com, many vasectomies are covered by insurance. I’ve never heard of a “medically necessary” vasectomy. Additionally, as noted in other comments, birth control pills have many other benefits beyond birth control for women, ranging from regulating menstrual cycles and reducing cramping to treating endometriosis and ovarian cysts.
It’s worth pointing out that this solution, a tax on men, would also side-step the contentious issue of religious institutions needing conscience exemptions.
That’s because religious institutions generally think sinful things paid for by taxation are acceptable in a way that mandates on them in particular are not (they might object to, say, the death penalty, but not so much that they will refuse to pay taxes, or demand a conscience refund).
In both cases (religious institutions, people demanding a mandate on insurers/employers), it seems like there’s a desire to obfuscate the actual, predictable consequences of some policy to avoid the _appearance_ of responsibility, even when it means avoiding the best (i.e. most efficient, given that the desired/achieved goals are basically the same) policy.
You are arguing that anytime a state subsidy is not universally used it is equivalent to a tax on non users. By your logic if I rent then I am being taxed for your mortgage tax write-off. Or if your Medicare coverage includes Viagra I am taxed because I’m just fine thank you very much. Or if you are a professor at a university receiving federal grants and I’m not a university student… etc.
You are basically saying that you don’t believe in the fundamental precepts of western civilization.
Can’t tell if you are a) joking b) kinda stupid c) lack some basic ability to reflect on where your arguments lead.
RPLong: I am not saying that the BCP is less costly, just that the fact that a mandate may be necessary does not prove that to be the case.
Prenatal and delivery costs are about $10,000 I think – they were on average $7.5k for uncomplicated deliveries in 2004. Oral contraception is say $200/year. So for every delivery you could pay for 50 women to have contraception for a year. Or about 2%. So if, as an insurance company, you give the pill to 100 women, and one does not become pregnant as a result, you lose. If two would have become pregnant, you win.
You know that a great many of those 100 women would choose to obtain contraception even if you did not cover it. From the insurance companies point of view, it probably does not make sense to cover contraception.
Unless you consider the medical costs of the children also…
I think this was asked above, but I’ll reiterate: Are we sure that a mandate will distribute costs evenly across all covered insureds? I’m a P&C actuary, and admittedly I’m pretty ignorant of how health insurance premiums are calculated. I have no doubt that in a free market, “Gender” would be one of the variables used to set rates; it is in auto insurance. If that’s the case, then the cost would be shifted entirely to the female population, and men would not in fact be subsidizing women. Women who DON’T buy birth control would be subsidizing women who do, which would make the gender-bating tone of the debate downright absurd.
A wise insurer would actually use “purchases birth control: Yes/No” as a rating variable, which would shift the entire cost to women who use birth control (or whoever is paying for that woman’s insurance). There would be no cross subsidy whatsoever in this world, so the chant “Insurance should cover birth control!” is reduced to “Customers of birth control should have pay out of THIS account rather than THAT account.”
That being said, I realize that a lot of people get “group rates” through their employers which don’t vary by insured characteristics, so clearly at least some cross-subsidization going on.
I am against health insurance paying for ANY minor or routine medical costs. My opposition to a birth control mandate is a simple extension of that principle. Things get a lot cheaper when they are paid for directly by the consumer. I’ve seen numerous apples-to-apples comparisons of the same medicine or procedure paid for in one case by the patient and in the other case by insurance/Medicare/Medicaid. Look through John Goodman’s health blog posts and you’ll find plenty of examples.
But many women use contraception to DELAY childbirth, not completely eliminate it from their insured lives (and if they have children early, they may compensate by having fewer later on). The sort of preventive care that insurers would care most about is care that actually prevents expensive things altogether, not merely something that delays them for a time.
You might argue that all preventative care does, ultimately, is delay expensive health problems that we will all succumb to. But there are lots of reasons to think that’s a really complicated question (people dying early of a massive heart attack is less expensive than them getting an expensive cancer 20 years later), and one major reason why childbirth is not like, say, heart attacks. Most women plan to have a certain number of children. But no one plans to have a certain number of heart attacks.
What about welfare? Birth control is relatively cheap and quite accessible, so at some point you must hit diminishing returns. At some point, subsidizing birth control just doesn’t lead to a significant increase in the accessibility of birth control.
I think it’s rather difficult to argue that subsidizing birth control will lead to a significant increase in birth control usage for middle class families. Also, given the fact that this mandate ties into employer provided health insurance, the only people who will be getting the benefit of “free” birth control are lower middle class families and above, which can already afford birth control as is?
So, instead of subsidizing birth control across the board, why not subsidize it only for the poor? If the objective is to reduce unwanted pregnancies, then an increase in welfare handouts seems like a more honest solution than decreasing the cost of birth control for those who can easily afford it.
Men are already being taxed for contraceptive pills, obgyn exams, and pregnancy. In California at least, health care expenses for women are much higher than for men, but men have to pay the same insurance premiums as women.
Jon Greenbaum:
You are arguing that anytime a state subsidy is not universally used it is equivalent to a tax on non users.
Obviously this is true.
You are basically saying that you don’t believe in the fundamental precepts of western civilization.
You’re saying the laws of arithmetic are inconsistent with the fundamental precepts of western civilization?!?!?
Steve, johnson85: Ok, so you’re assuming that consumer is shielded from discriminatory pricing. That’s quite reasonable, though I’m not entirely convinced it is true. The employer, however, is almost certainly not shielded from the difference in cost. Steve, the University of Rochester (like most large corporations) is very likely self insured. They probably use an insurance company to process the paperwork, but end up footing the bill for medical treatments themselves. Mid-sized that do not self-insure are quoted rates based on the demographics of their employees. I don’t know if these demographics include gender or not, but I strongly suspect that they do.
Whether or not the employer passes demographic differences in healthcare costs onto their employees, either through differences in premiums, or (illegal) differences in wages, or discrimination in hiring, is an empirical question that I am not in position to answer.
@Harold – Implicit in the statement I made was the qualifier that economists frequently add: “Assuming people are profit-maximizers and cost-minimizers.”
You are right that a parallel universe in which insurance companies do not maximize profits may exist, but these companies are run by some pretty bright people, and I doubt this matter has escaped their attention. Health reibursement cost-driver analysis itself is pretty big business.
Jon Greenbaum:
Let’s look at the evidence
1) “Joking”. OK, not correct on thisone. Landsburg has no sense of humor. Would you in Rochester in winter?
2) “kinda stupid”. Not ‘kinda’: all kinds of. That was the scuttlebutt when he was at the Institute for Advanced Studies. Dumbest since Wolfram was the rumor.
3) “lack some basic ability to reflect ” Steve is a vampire; vampires cast no reflection.
Two out three ain’t bad.
You dumb humorless vampires are everything that is wrong with America.
@Robert Lewis
“At least according to http://www.vasectomy.com, many vasectomies are covered by insurance. I’ve never heard of a “medically necessary” vasectomy. Additionally, as noted in other comments, birth control pills have many other benefits beyond birth control for women, ranging from regulating menstrual cycles and reducing cramping to treating endometriosis and ovarian cysts.”
First, if you check, I think you’ll find that the policies that offer coverage for vasectomies also offer coverage for birth control pills. I don’t think you’ll find many employers that object to birth control for religious reasons but think vasectomies are ok.
Second, and this is getting to be a broken record but everybody seems to keep falling for this, to my knowledge nobody objects to providing medicine just because it is also effective as birth control. If your insurance covers treatment for endometriosis or ovarian cysts, there is no Catholic teaching that would suggest not using the medicine simply because it is also effective as birth control. Not saying there’s not a religious group out there that would object to this, but I don’t think anybody has identified a group with this intention.
To rephrase: The distribution of attributes among women differs from the distribution of those attributes among men; the bell curves deviate. Some of these differences seem to be innate. Women seem innately more likely to get pregnant than men; men seem innately more likely to commit violent crimes than women.
I favor socializing the cost of mitigating burdens where doing so creates little moral hazard. Women’s propensity to get pregnant seems innately greater than men’s. To the extent that pregnancy is expensive, I favor socializing the cost. One way to do this is to socialize the cost of birth control. (This does not necessarily mean subsidizing those costs.) I don’t mean socializing these costs FOR WOMEN; I mean socializing these costs FOR SOCIETY, via women. Yes, the mechanism by which we implement this policy may involve a wealth transfer to women, just as the mechanism by which we implement a policy of fighting fires involves a wealth transfer to fire fighters. But the goal is to reduce social risks; the consequence for the agents of that policy is incidental to the analysis.
Similarly, the fact that men commit most of the violent crimes arguably reflects something innate about men. If we can identify appropriate policies to mitigate these burdens — and those policies don’t create a moral hazard, e.g., an incentive to commit crime — I’d favor socializing those costs as well. For example, we might socialize the cost of impulse control classes or drugs.
It’s entirely possible that the net effect of all these transfers would cancel each other out. It’s also entirely possible that they wouldn’t. Let’s find out.
@nobody,
Yes I agree that we should socialize costs to reduce externalities. However, I was approaching the question from more of a fairness perspective. Quite a few people, such as Sandra Fluke, argue that birth control should be free based primarily on the unfair financial burden it places on them.
How about your own argument that “more sex is safer sex”? Perhaps it is the third group — fertile women who choose not to use birth control and presumably choose less sex as a result — that *should* bear the burden of the tax precisely because we *want* to change their incentives.
AndrewG:
Quite a few people, such as Sandra Fluke, argue that birth control should be free based primarily on the unfair financial burden it places on them.
This is not an example of an argument. If it were (i.e. if it stood on its own as an argument) then it would be equally correct to say that someone else should pay for my house because of the unfair financial burden it places on me.
Hi Steve,
I am mostly skeptical of the argument as well but I do see a possible role for fairness. In your example, payment of housing is mostly gender neutral. Contraceptive costs mostly fall on women. If we grant that sex is a normal part of life, then the cost of living for women is inherently higher all else being equal and that may merit a lower tax rate. But as I mentioned in a post above, all else is not equal and men face higher costs for other things. The cost of living may be higher or lower for men or women I dont know. It depends on how you calculate cost of living. In my opinion, the fairness argument for subsidized contraception is wobbly not because it is not an argument, but because it is too one dimensional at this point
Will you respond to Seligman?
Bradley Calder: Yes, tomorrow morning.
@ Prof. Landsburg:
It seems to me your beef is with group plans. I’m assuming that if the government required insurance companies to cover pap smears you would be just as upset (at least your post hints of indignation) because group plans charge the same regardless of gender.
My employer offers group life insurance which of course a tax on non-smokers. It’s an outrage.
AN OUTRAGE
I do though reserve the right to not be so upset though if it turns out that group coverage costs me (non-smoking male) less than an individually underwritten life or health insurance policy.
Why does it cost $83/mo (~$3 per pill)?
Will A:
It seems to me your beef is with group plans
Where did you ever get such an idea? We’re talking about policy mandates, not voluntary contracts.
@Ken B,
Two out three ain’t bad.
That reminded me of this.
@ Prof. Landsburg:
Maybe it’s more of a quibble with the broad term of Mandated insurance coverage.
Mandated insurance coverage means that the government requires everyone who doesn’t use contraceptive pills to contribute to the costs of everyone who does. This is exactly equivalent to a tax on not using contraceptive pills.
My company offers vision coverage. My company pays for part of it and the employee pays for part of this. Because of this, only those who need glasses purchase the insurance.
If the government were to mandate that companies with more than 50 employees supply vision coverage for their employees, my company would change nothing and there would be no tax on those who don’t use glasses.
If the government mandate is that employers provide birth control pill coverage, this would not necessarily imply a tax on those who don’t use birth control especially if birth control pill coverage was handled in the same way that vision care is handled.
The more appropriate comment seems to be:
“This” government mandate in an environment where most people have group insurance and that doesn’t allow for the coverage to be sold separately (if this is true) causes a tax on men.
In the vision care example there would be of course a tax on employers, but since you didn’t mention employers in your list, I’m assuming your point was restricted to those men, infertile women, etc. who are not employers.
“The burden of that tax falls on three groups”
I’m just being silly here, but isn’t it true that the burden of a tax doesn’t necessarily fall on the group on which the tax is levied? For example, might not highly taxed men somehow contrive to obtain higher wages to compensate? Or mightn’t infertile women contrive to ensure that IVF treatment is also required to be covered by any insurance that covers contraception?
On a related note, can someone remind me what’s the name of the economic principle that determines where the burden of a tax actually falls, or who gets the lion’s share of the benefits of economic activity?
Mike H, from what I’ve gathered from Steve’s books I think the economic incidence of a tax is determined by the elasticities of the supply curve and the demand curve.
@ALV,
1. Where did I assume that religious women were richer than non-religious? My assumption about religiousness was rather that it was not ‘for sale’, ie. religious women will not abandon deeply held religious convictions when the pill is subsidized.
2. You have to control for other variables to see whether children are negatively correlated with income. See Caplan’s post on this for example: http://econlog.econlib.org/archives/2011/06/kids_are_normal.html
@Harold, of course there can be multiple types/reasons.
“If only there were some way to make it free at the point of use, whist still ensuring that about half the burden fell on men.”
You’d still be burdening gay men, which account for about 10% of the male population if I am not mistaken? We’ll just have to make due with whatever second best solution we can think of I am afraid.
@Keshav, thanks.
So in terms of elasticity of supply and demand, If we tax men for being men, one might argue that the elasticity of supply of men is almost zero – men won’t change their inclination to be men much in response to changes in financial incentives – whereas, perhaps, the elasticity in demand for people to be men is comparatively higher (why?? what, in fact, is the product we’re taxing here????), so the financial burden of a man tax would indeed fall on men….???
RPLong. I was imagining the employer being the non-cost maximiser. The catholic employer may choose to buy a more expensive policy which excludes birth control. The insurance company will still maximise profits. The employer is maximising value by their own preference. The only loser is the student / employee if they for some reason do not or cannot incorporate the costs of the restricted policy in their choice.
You are arguing that anytime a state subsidy is not universally used it is equivalent to a tax on non users.
SL: Obviously this is true
This depends what you mean by equivalent. In a strict sense I disagree.
Exact equivalence requires that two universes, one enacting the tax and another the mandate, would be exactly the same. This is clearly not true in some trivial senses – the methods for collecting the tax would be different etc. I do not think these need to worry us.
But they universes could be very different in more significant ways. We could end up with different presidents, for example, because people may perceive the systems as being very different.
Professor Landsburg wants people to “take a look” at his blog posts and see that there is an intellectual conversation taking place. I’ve just spent (wasted?) the last half hour reading them, and the comments connected to them. I am still looking for the “intellectual” discussion. I find a large group of (mostly) men waving the flag of economics to shield misogynistic remarks against a young woman who was willing to testify before government on health coverage, not on the personal issue of her sexuality. Mr. Limbaugh, in his typical fashion, has tried to make Ms. Fluke’s sexuality the issue. The blogger and the vast majority of his commenters are only too happy to follow Limbaugh’s lead and lasciviously and in the most demeaning and sexist manner criticize Ms. Fluke, and most women who have the capacity to have sex, and/or bear children. What I read on these posts reduces the importance of birth control, and the use of birth control medications for other medical conditions to a superfluous “box of pills” for which somebody else should pay. (BTW, for birth control pills to be effective in preventing pregnancy, the must be taken daily and month by month; an occasional “box of pills” will likely not work.)
To the ignorant gentleman who wondered why he had to use a condom when having sex with women on birth control pills, may I remind you about the need for both partners to protect themselves from sexually transmitted diseases? The shred of economic debate displayed revolves around the injustice of paying for something that you do not personally use that may benefit a whole other group in society. This specious argument has been used by seniors who do not think it’s fair that they pay school property taxes if they have no children in school. But perhaps you gentlemen agree with them, and don’t think that all of society has a responsibility to educate all our children. If that’s so, then Professor Landsburg and all the other educators worried about their tenure (job guarantee?) on this blog may want to figure out where their students are going to come from. Finally, for those of you too busy railing about liberals to read Dr. Seligman’s letter carefully, he is not threatening Professor Landsburg’s job. He is distancing the U of R from the professor’s opinions. And that is a good thing.
Necessity; the Tyrant’s plea
if you want my response to all this hoopla besides the above, check my reply in Contraceptive Sponges thread.
@nobody.really: “just as the mechanism by which we implement a policy of fighting fires involves a wealth transfer to fire fighters”
So you consider paying someone to provide you with a (in this case dangerous) service a transfer of wealth?
@Will A: “My company offers vision coverage. My company pays for part of it…only those who need glasses purchase the insurance.”
Any $ the company spends on this benefit could’ve gone into the general compensation pool. You don’t think that places a burden on non-users?
“there would of course be a tax on employers”
I guess maybe you really don’t think this affects employees.
Christina A.
The summary of your comment: women who call for others to pay for their medical needs are brave and courageous. Those who say people should pay for their own medical needs are misogynistic.
It’s a laughable and ridiculous stance to take.
I know it’s too late to really be worth pointing this out, but this post pwned dozens of you. It’s that old Landsburg stand-by the reductio ad absurdum. Starting from the premise that we should force people to pay for oral contraceptives for any woman who wants it Landsburg builds a careful argument to a silly conclusion. This discredits the premise. That’s how reductio ad absurdum works. If you didn’t catch it, and it is clear a great many did not, you were pwned.
“Let’s Just Tax Men.”
Hmm. Let me think that over. Interesting concept, but I worry about where this might lead.
Next you’ll be advocating limiting the military draft for males only. Oh, forget that one. If we reinstate the draft, that’s still the law, isn’t it?
Or maybe you’ll advocate that we, as a nation, do absolutely nothing about the following gender differences: the fact that men have higher death rates for virtually all of the leading causes of death; or that men are approximately 50% of the workforce but account for 93% of job related deaths; or that males between 20 and 24 have a seven times greater rate of suicide than their female counterparts, and overall, men commit suicide at rates three to four times greater than women; or that males are between 1.5 to 2 times more likely than females to be assaulted; or that government funding for breast cancer research outpaces funding for prostate cancer research by nearly two to one even though prostate cancer and breast cancer have roughly the same caseload; or that death among young men due to testicular cancer in the 15-34 age group outpaces the number of deaths from breast cancer among women in the same age group; or that victims of war, both combatants and non-combatants, are more likely to be male; or that responsible young men are legally charged considerably more for auto insurance than irresponsible young women, simply because they were born male, but gender differences for health care premiums are being outlawed in the US since women claimed they were discriminatory; or that when
a woman who commits the same crime as a man will receive, on average, only a fraction of the sentence.
Oh, wait, wait, wait. We, as a nation, already do absolutely nothing about any of those differences. (And just imagine the outcry from women’s groups and chivalrous progressive men if the genders were reversed!)
On second thought, you can keep your dumb tax idea.
Prof. Landsburg, is there no truth to this article and savings in the billions of dollars due to the use of BCPs? Just wondering…I realize it’s not the latest article, but it would prove you incorrect, I would think.
http://www.thedailybeast.com/articles/2011/08/02/obama-s-birth-control-shakeup-contraception-free-without-co-pay.html
CJP: Obviously if these things will pay for themselves, then there’s no need to mandate them. (Except perhaps for a few religious institutions that prefer to take a financial hit than to provide contraceptives.)
But far more importantly, as I’ve stressed multiple times in these threads, there’s far more at stake here than just the financial accounting; see the long string of arguments and counterarguments in my “Contraceptive Sponges” post from Monday.
@ iceman:
“there would of course be a tax on employers”
I guess maybe you really don’t think this affects employees.
To me this point is not on topic of this post since Prof. Landsburg didn’t mention this in his argument.
If Prof. Landsburg were to post on how a government mandate creates a tax on employees, I might have a reply that applies to costs that are born by an employer’s employees and customers. And I might say something like:
”
There would be of course be costs associated with the employer’s customers also, but since you didn’t mention customers in your list, I’m assuming your point was restricted employees.
“
@ iceman:
Perhaps less of a weasel answer.
As it relates to this mandate, it seems to me that Prof. Landsburg would be making the point that this tax would apply to all men in a company.
As it relates to a mandate on employers, it’s possible that data shows that not every employee benefits from company profits.
McDonald’s for example may still pay it’s base line employees minimum wage whether or not a government mandate affecting McDonald’s profits is removed.
Steven,
Allow me to restate your own argument in another way:
“Mandated insurance coverage means that the government requires everyone who doesn’t use contraceptive pills to contribute to the costs of everyone who does. This is exactly equivalent to a tax on not using contraceptive pills.”
By this logic, is the Child Tax Credit exactly equivalent to a tax on those who (1) choose not to have children, (2) are men who lack adept flirtation techniques and thus cannot secure a mate, or (3) are morally opposed to child-rearing (I do not believe that chaste Nuns are allowed to be mothers).
It seems that you believe that all targeted government spending is economically irrational or morally reprehensible. What is this, the Austrian School?
David S:
By this logic, is the Child Tax Credit exactly equivalent to a tax on those who (1) choose not to have children, (2) are men who lack adept flirtation techniques and thus cannot secure a mate, or (3) are morally opposed to child-rearing (I do not believe that chaste Nuns are allowed to be mothers).
Yes, this is basically correct. Do you understand why?
It seems that you believe that all targeted government spending is economically irrational or morally reprehensible.
It’s not terribly fruitful to have a discussion in which we invent positions and attribute them to each other. It seems that you believe there are purple dinosaurs on the dark side of the moon. See what I mean?
PS—I haven’t thought about it terribly hard, but I tend to favor the child tax credit.
Professor, if the government has decided that it’s worthwhile to encourage reproduction through the Child Tax Credit, wouldn’t they also want to do what they can to ensure that it’s responsible individuals having these kids? Subsidizing bc would help to create this vision by increasing access to bc and doing more to ensure those that aren’t ready and don’t want to have kids don’t have em.
A tax on child birth would not achieve the same goal of deterring unwanted pregnancies simply because they’re not intended in the first place. Unwanted pregnancies are likely bad for society, on average, while planned child birth is usually good. The government already works to encourage wanted pregnancies, it would make sense they’d work to discourage unwanted ones.
@tirane
Incorrect, for events that are highly random/unknown, this isn’t so. You can charge people for their portion of the risk, and then pool the risk. Your argument is only true for things that are already known.
@Steven Landsburg
Anytime a person plays around with calling women prostitutes, I recognize they have an incredibly personal and shaky relationship with women. It’s just not a thing most men, these days, do. It says so much about you, and the reason people are upset is that they did not assume you had the same issues with women that Rush Limbaugh did (with him everyone was given full warning).
In any case, to say that Ms. Fluke did not have an “argument” is to ignore the history of argument, and I don’t know why it is fair to do that. We developed standards for “argument” far before economics was developed. Arguing that birth control ought to be covered by insurance that covers similar benefits for men, or for the overly stressed, over-eaters, or for the rest of us – is in fact an argument.
We aren’t all newcomers, and now I wonder if readers of this blog just have some sycophantic desires the rest of us lack. They think argument is really only want this one person says it is? Who else but the fawning types here would agree? It just is not going to fly. It’s playing around. The term, the concept, the use and history of argument are already established.
And one more point: I’ve known plenty of economists, many who make contributions far (faar) beyond any here, and they were not hateful towards women and would never joke about an earnest woman’s sex life to make any point. That has nothing to do with economic reasoning.
@ Will 12:10 pm
Nowhere in Ms Fluke’s testimony does she make anything resembling what you asserted to be a valid argument(similar benefits for men, the overly stressed…), so you failed to make a point.
Wait- so if you don’t think arguing that in the strangely employer-insurance Co.- govt. decided insurance packages an argument for pooling resources for some benefits over others- is *not an argument* (it is) then Limbaugh’s ad hominen applies, this is an personal issue of Fluke’s? She does not in her transcript invoke her own self-interest (or sex life) she gives examples of why covering birth control is not different than covering the rest of what has been standardly paid for.
If argument is something that does not involve self-interest, she is not invoking self-interest. If argument is only something that is abstract- ? where do you find support for that? We’ve used the concept for too long. Very seriously- where is this definition of argument? Can you lay it out? Refer us to it?
If other men call women in public debates prostitutes and talk about their sex lives, I’ve yet to meet them and/or they are known for their misogyny. I would do anything to keep my daughters out of a man’s class who revealed himself as this type of man. No one is being fooled.
Will:
Wait- so if you don’t think arguing that in the strangely employer-insurance Co.- govt. decided insurance packages an argument for pooling resources for some benefits over others- is *not an argument* (it is) then Limbaugh’s ad hominen applies, this is an personal issue of Fluke’s?
My reading of Fluke’s statement is that she’s listed a whole lot of benefits of contraceptive pills, and then leapt to a conclusion about who should pay for those benefits. That is at best a non sequitur.
Moreover, the benefits she’s listed all accrue to her and her fellow students, which means she’s taken a very narrow view of the costs and benefits, to the point where she’s contributed nothing to the policy debate. Almost any policy anybody dreams up will have some benefits and some costs. Pointing to some of the benefits (or pointing to some of the costs) contributes absolutely nothing to the question of how we’re going to weigh the costs and benefits against each other.
So yes, it seems to me that this was a statement that expressed nothing more than a personal preference, dressed up as a contribution to a policy debate, and as such it should be recognized as having no value.
Very seriously- where is this definition of argument? Can you lay it out? Refer us to it?
The “contraceptive sponges” post offers a long list of examples of arguments. An argument is a reason to believe that the benefits of mandated coverage will outweigh the costs.
As far as the rest—If I had suggested, without any argument, that others should buy me a car, I can easily imagine a responder saying “Well, then at the very least you ought to do our grocery runs for us”. That’s not to be taken seriously; it’s to make a rhetorical point. Rush did something similar, and I don’t see why the fact that it’s sex-related makes it any more (or less) offensive.
I can restrin myself no longer.
M: An argument isn’t just contradiction.
O: Well! it CAN be!
M: No it can’t!
M: An argument is a connected series of statements intended to establish a proposition.
O: No it isn’t!
Fluke’s northern cousin http://fullcomment.nationalpost.com/2012/03/10/rex-murphy-the-human-right-to-convenient-parking/
@Steve:”Rush did something similar, and I don’t see why the fact that it’s sex-related makes it any more (or less) offensive.”
Yet that is pretty much all of Murphy’s argument isn’t it? He made a to-do about the fact that this joke wouldn’t work if some old fat woman not a young attractive one like Fluke were involved, and that the sex content of it matters. Somehow a shadow of an emanation of the penumbra of this sex joke — which turns as much on stereotypes about men liking porn as much as on any other factor — colours the rest of your comments and means he can infer from what you did not say more reliably than from what you did. I don’t quite get the linkage myself. You admired the cleverness of the SEX joke, so you must have subconsciously admired all the sex-related talk? Bosh.
@Ken B: Some people prefer the following line of argument:
“Spam spam spam spam spam spam spam spam spam spam spam spam spam spam spam spam spam spam spam spam spam spam spam spam spam”
@Iceman: Some days it does seem Monty Python was a seer and a prophet don’t it?
Er, y’all seem to be missing a couple things here. People (including women) PAY FOR their health insurance. It’s not something that drops like manna from the government tree. You buy your basic preventive care through paying for health insurance, plus pay a bit extra to insure yourself against catastrophic events, plus the odd co-pay. No one insured person pays enough to cover the case where they’d have millions of dollars in health care, because that cost is shared. But most people DO more than pay for the basic preventive care they receive. The only question is whether birth control is considered basic preventive care, which in my view it clearly is.
Another thing is that birth control is something that is necessary for ANYONE who has potentially cross-fertile sex. It’s not a woman’s expense just because it’s usually implemented within her body. My IUD benefits my husband just as much as it does me. He’d sure as hell be affected if I had another baby, after all.
Irene:
The only question is whether birth control is considered basic preventive care, which in my view it clearly is.
But toothpaste is also basic preventive care, and my policy does not cover toothpaste. So the issue is not just “is birth control preventive care”, but rather “should this particular preventive care be covered?”. Or actually, the real question is: “How should we decide which basic preventive care gets covered and which doesn’t?”. Sandra Fluke testified quite elegantly that this particular preventive care is important to many people — but that doesn’t begin to touch the question of whether it should be covered, or of who should decide.
Birth control pills, IUDs, NuvaRings, etc., are prescription-only, and require that the patient consult with a doctor before use. Most toothpaste is available over the counter, and no consultation with a dentist is required in order to use ordinary toothpaste. Seems to me that birth control is much more like other traditionally-by-prescription meds and devices than it is like toothpaste. Also, any costs that you incur by not using toothpaste pretty much stop at you: they don’t involve creating another person who then needs expensive public services such as schools and prisons.
Irene:
1) Of course one possible policy response to mandatory prescriptions is to abolish mandatory prescriptions.
2) they don’t involve creating another person who then needs expensive public services such as schools and prisons. As I’ve stressed repeatedly, this cuts both ways. That other person also adds to the world’s stock of love, ideas and diversity. It’s certainly by no means obvious that people are net negatives.