Yesterday’s determination by Kathleen Sebelius’s Department of Health and Human Services that all FDA-approved contraceptive drugs and devices, as well as sterilization, are preventative care and should therefore be covered without co-payment or deductible by all insurance plans follows on the heels of the Institute of Medicine’s recommendation to that effect two weeks ago. It is a decision that vastly expands the federal government’s commitment to promoting the avoidance of pregnancy as a public-policy priority. The government makes this move in the teeth of a mountain of evidence suggesting that its efforts in this regard have been thoroughly counterproductive over the course of the last 30 years.
President Johnson’s fruitless War on Poverty kicked off the nation’s misguided birth-control crusade with grants for “family planning” in 1965. The effort was redoubled in 1970 when, thanks to the efforts of John D. Rockefeller III and George H. W. Bush, Title X of the Public Health Service Act was signed into law by Richard Nixon the day after Christmas. Since 1970, the out-of-wedlock birthrate has tripled to 41 percent. With the help of the Supreme Court with its 1973 Roe v. Wade decision, we have also seen the number of abortions spike through the 1980s and reach an equilibrium today at between 1.2 and 1.3 million annually. Both results are at least unexpected from the perspective of a public policy based on the premise that access to contraception will decrease the rate of unintended pregnancies.
But perhaps such an outcome should not be surprising. Several economic studies, notably one by Berkeley economists Akerlof, Yellen, and Katz, indicate that access to contraception and abortion alters the sex and mating markets and, through risk compensation, actually increase the number of unintended pregnancies. Just as anti-lock brakes lead drivers to drive faster, follow closer, and brake later, the already nearly universal access to contraception seems to increase the number of sexual encounters, thereby increasing the number of contraceptive failures. We know risk compensation is at work with bicycle helmets, seatbelts, ski helmets, and skydiving gear. To deny its obvious role in the sex and mating markets is to let ideology triumph over reason and science.
While it is true that HHS’s determination is somewhat symbolic since many states already mandate contraceptive coverage and many insurance companies already cover contraceptive devices, it is nevertheless a troubling symbol for several reasons. It reveals a blind commitment to longstanding public policy which has been proven severely counterproductive over the course of four decades. It implies that pregnancy and childbirth are conditions to be prevented as though they are diseases and unsafe for women, the latter of which is only true absent basic medical care, except in rare cases. It perpetuates the notion that population growth is a hindrance to development, which is only true in the absence of economic opportunity. It blurs the line between contraception and abortion by including drugs like ella, which can act, in some cases, like RU-486, as an abortifacient. And it implies that the conscience objections of religious individuals are illegitimate. This last is most disturbing.
While the HHS regulations allows exemptions for institutions whose primary objective is the propagation of religious faith and which are not-for-profit corporations, there are no exceptions made for religious providers of health care or social services, or for individuals of religious faith or philosophical conviction who, as business owners, wish not to provide coverage for contraceptive drugs and devices to their employees, or who, as individuals, purchase insurance independently, and do not wish to contribute to the provision of contraceptives to others. Are the concerns of these individuals of no consequence? Are they to be compelled to act against their conscience? Will not this be yet another incentive for some small businesses to cease offering health insurance to their employees?
An editorial by a doctor in the employ of Planned Parenthood published in the New York Times on the morning of the release of the IOM report contains a classic example of the fake sob stories often used by those who promote government sponsored contraception. The author laments that her daughter can’t afford an IUD, and is left to make do instead with a contraceptive injection. “Health insurers continue to charge fees that make it difficult, sometimes impossible, for women to prevent unintended pregnancy.” One could quibble that there is one obvious alternative for the author’s daughter, an employed, divorced mother of three — one generally not subject to any fees.
“Today’s system of co-payments and deductibles for birth control,” the author concludes, “sends a terrible message to women like my daughter: when it comes to planning your family, you’re on your own.” Alas, it is no longer so. It is no longer enough for women to be free to make decisions about their own sexual behavior. Now we all must shoulder the economic responsibility for those decisions.
— Greg Pfundstein is executive director of the Chiaroscuro Foundation.
You forgot to say that women should be forced to be barefoot AND pregnant...
Reply to this commentLinkReport AbuseYou got nothing, huh?
Reply to this commentLinkReport AbuseForced to be pregnant? That can't happen, we've already passed laws against that.
Reply to this commentLinkReport AbuseThis is a real abomination by the Obama administration. (Obamanation?) The right has to constantly remind people that the market should decide policies of private companies, not government bureaucrats. That point of view may or may not be popular, but it is moral and works better in the end.
Reply to this commentLinkReport AbuseThe problem with the author's comparison to anti-lock brakes in cars is that anti-lock brakes are a good thing. Despite the fact that we drive much faster than we used to, we are much safer now. That's a good thing all around.
I'm all for eliminating government involvement in healthcare, but perhaps the author should rethink his opposition to birth control in light of his anti-lock brake and bike helmet examples. Reliable access to birth control is a good thing.
Reply to this commentLinkReport AbuseThe culture of contraception has fundamentally changed our culture so that -- like the mother quoted -- we believe we have a "right" to engage in unlimited sex with no consequences. This is not a good thing.
Reply to this commentLinkReport AbuseThe issue isn't access to birth control. The issue is who pays for it! Why is it that every time a Lib wants to justify birth control or abortion they act as if the only way a woman can access her rights is for someone else to pay for it? We can have a debate on whether birh control or abortion is a right or whether it is a good thing. There shouldn't have to be a debate on who pays for it.
If I want to print a newspaper, I have to buy a printing press (or rent one). If I want to broadcast on the radio, I have to buy one or get hired by one. If I want a gun, the cost comes out of my pocket. I believe I have a right to housing but I have to pay for it. I believe I have a right to medical care but I have to pay for it. Why is it every time we talk about "women's rights" someone else has to pay for them or they are being denied. If I, as a guy, want condoms, are they going to be free? Of course not.
If the issue is "the poor" then I respectfully suggest that every adult living in poverty be given a gun every year (send then the coupon for it with their "earned income" tax refund) that they are in poverty. We should also give them 50-rounds of ammo. Let's face it, "the poor" live in some pretty crummy areas with lots of crime. This would help prevent the crime by acting as a deterrent and should help us save money on municipal services (police, etc). Let's face it, if you can't afford the 10-20 dollar copay, how can you afford a gun!
It is really simple, act like a human being and not like an animal. Every time you engage in sexual intercourse, you are "risking" getting pregnant. We used to acknowledge that. If you don't want to get pregnant (or be a Father), control yourself. Don't decide you want to control my wallet!
My wife and I wouldn't have an abortion but, I have to pay for them in my health insurance. A lady that works with me had her tubes tied but, she has to pay for maternity insurance (and abortion coverage). It's insanity!
Remember, the only truly effective barrier to pregnancy is a zipper! Works every time.
Reply to this commentLinkReport AbuseI predict people like you, as well as many proponents of artificial birth control, will re-think your talking points by the end of this decade.
From a purely economic point of view, we've reached the point where our demographics have finally caught up with us. If you subtract Hispanic immigration (both legal and illegal), our national birthrate since 1990 would be a paltry 1.6 live births per female. There would be at least 15 million less people in this nation. The national median age would be 40 instead of 37, on its way to to national average of 48 by 2025. Do the math; less taxpayers; fewer consumers and producers. And certainly fewer people paying into Social Security and Medicare.
And even with Hispanic immigration, our rate of population growth peaked last decade. We added fewer people last decade since anytime since 1929. The demand for consumer goods will never match that of the last 30 years. Niether will the demand for property. Aging socieites consume less, and produce less. We are now that society. We are aging because we are selfish. Our legacy will be the massive debt that we accumulated since 1970. And the Baby Boomers are bound and determined to make sure that the last check they write will bounce.
But at least society had a good time while it lasted. The period of 1970-2007 was one huge binge - a binge of meaningless trysts, consumption of goods bought on credit, and borrowed legacies. And The Pill was the means of having such good times.
Reply to this commentLinkReport AbuseThe Pill did not cause our declining TFR. It may be a symptom of the same forces, but if you have evidence it's anything else it's not present in your argument. In fact, nothing in your screed implies anything one way or another about access to birth control; just complaints about the state of our society. There are many things wrong with our society, but denying people access to birth control won't fix any of them, and I am certain a large increase in unwanted births would make many of them worse.
Reply to this commentLinkReport AbuseEvidence? If artificial contraception has not been the means in reducing our birthrate, then what was the means? Abortion? Abstinence? You want evidence, just check out 2 surveys of Catholic married couples completed during the the 1990s and early 2000s. Over 85% of Catholic couples admit to using artificial birth control on a regular basis. And these are couples who belong to a religion that still teach such usage is a Mortal Sin. And if Catholics are represenative of our public in general, we can assume the usage in general is slightly more. If that is not evidence, you can always check birth control sales, as well as polls done with college students and other demographic groups.
One has to be blind not to see the drop in our fertility and how it is tied to artificial birth control.
Reply to this commentLinkReport AbuseThe author's point is empirically denied, regardless of economic modeling. All models must be compared to statistical reality to test their validity. This one fails in this context.
The teen pregnancy rate dropped precipitously with the advent of birth control, by about 40% between 1960 and 1980 according to national vital statistics. (The pill became available in 1960). Today, it is less than half what it was prior to 1960.
Britain's teen pregnancy rate is less than half of the U.S.'s, Germany and France a quarter, Denmark a fifth. All comparable sexual activity rates to the U.S. but with far greater access to contraception. Their abortion rates are also correspondingly lower.
I'm not talking, btw, about the healthcare mandates. There are solid, conservative reasons to oppose mandates of many kinds. But this hostility to birth control IN GENERAL that is on display by some SoCons right now is just unproductive, and frankly incoherent. If conservatives decide to "stand athwart history" by trying to get women to stop using birth control, a defeat is in the offing, with a loud "thud" at the end.
Reply to this commentLinkReport Abuse"But this hostility to birth control IN GENERAL that is on display by some SoCons right now is just unproductive..."
But, is it moral? I don't know if your statistics are correct, but if they are there must be some other factor present in America that is not accounted for in these studies. Here, the use of birth control correlates with high abortion and illegitimacy rates, just as common sense would dictate.
Your claim that Americans don't have access to contraception is untrue. Buy your own condoms, Goldstein.
Reply to this commentLinkReport AbuseAlmost 54% of all births in the US are illegtimate. Teen pregencies was never the issue. And BTW, birth control has been widely available in the US for over 40 years. Try another strawman. If you like statistics, try this these:
The Total Fertility Rate in this nation in 1958 was at 3.8 live births per femlae. Teen pregnancies were statistically insignificant when compared to total pregnancies. The Pill at that point was not available for widespread use. Fast forward to 1978. The Total Fertility Rate in the US dropped to less than 1.7 births per female. But the use of the pill and other artificial contraceptive devices as well as abortion became widely used and available. And teen pregnancies exploded.
Can't make the correlation? The so-called experts predicted in the early 1960s that the pill would cure the "problem" of teenage pregnancies (which wasn't a problem at all). Instead, the opposite happened (as predicted by those nasty so-cons). Pope Paul VI who wrote Humana Vitae in 1968, predicted the rise of rapes, illegitimate births, divorce, and adultery. He correctly tied the use of artificial birth control to an entire host of social and spiritual pathologies.
The question here isn't birth control.Like I said it's been widely available for over 40 years -even to teens. And the rise in social sexual pathologies mirrored that to the wide use of artificial birth control. But, you argue that what we need is not only more birth control, but government subsidies to boot. Take your strawmen and go home.
Reply to this commentLinkReport AbuseIn focusing on the issue of birth control, the author misses the larger issue: the government should not be telling me what goods and services I have to purchase, it should be a matter of voluntary exchange.
Reply to this commentLinkReport AbuseIf children represent the future, then HHS officially treats the future as a "meidcal" condition. In a society that is quickly being Europeanized, it shall not be long before we have birthrates that compete with Europe. What I find ironic is that HHS is charged to manage a new huge public entitlement that will require a large, growing and prosperous population to subsidize it.
Progressives live in a fantasy land. The pill and artificial birth control in general represents the foundation of the Culture of Death. It is just like Progressive to demand we subsidize it. And with every child "prevented" is another gain by that culture. They are winning one child at a time.
Reply to this commentLinkReport Abuse"One could quibble that there is one obvious alternative for the author’s daughter, an employed, divorced mother of three — one generally not subject to any fees."
Yes, I will quibble. According to *my* mother, there is a fee - a dime. It's what the woman in question should be holding between her knees.
Reply to this commentLinkReport AbuseThe whole moral chest thumping hides the fact that the Obama administration has decided to treat this whole range of services as special in both mandating it be covered and 2nd there is no co-pay or deductible. You will have every lobby with their own pet cause in health care (I can't wait for the infertile couples to testify on Capitol Hill with their sob stories about how they can't afford fertility treatments and the Gov't must treat their issue the same as some woman wanting to get a Morning After pill) descend on Washington, DC demanding their pet cause be mandated in acceptable health insurance and as bonus perhaps get these services or treatments with no co-pay etc. We have seen all this on the state level. Try to buy an individual plan in NY and you might die from the sticker shock. One of the major reasons is the politicans in NY and other states to score political points have mandated tons of expensive things be covered that the vast majority of people would not need coverage for, for example drug/alcohol rehab, AIDS treatment, infertility, etc. This lobbying on the state level will now be shifted to DC keeping K Street very happy and making the ObamaCare policies more and more expensive.
Reply to this commentLinkReport AbuseA box of 36 condoms costs about $15 at Wal-Mart or your favorite chain pharmacy and will last even the most affectionate couple all month. Any woman can afford $7.50/month (the man should, of course, pay at least half).
Reply to this commentLinkReport AbuseClothing, furniture, and housing are also "preventative care". There is a clear correlation between lacking these things and ending up sick or disabled. Therefore, the government should pay for everyone's clothes, furniture, and housing.
Jewelry, identifying marks such as piercings and tattoos, and the possession of status symbols are an essential part of self-esteem, and should therefore also be viewed as essential "preventive medicine" and covered by the government.
Without a car, you can't get to work, and unemployment is bad for emotional health. So why not just let the government pay for everyone's transportation costs?
Hey - why not? If pregnancy is a disease, then so is anything that makes you feel bad or out of control.
(Why is my captcha "no dice"?)
Reply to this commentLinkReport AbuseCan anyone say, "Eugenics?"
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