Politics & Policy

The Not-So-Bitter Pill

Sandra Fluke’s contraception numbers don’t add up.

The question of who controls health-care costs has been endlessly discussed, but it seems that we’ve all missed the answer: the media. In recent weeks, we have watched the cost of birth-control pills rise dramatically: Three weeks ago, in the infancy of the Sandra Fluke fracas, we were told that the annual cost was, at most, $600; then Fluke upped the ante, reporting $1,000 per year in her congressional testimony; and finally, her figure was widely misreported as being $3,000 per annum. This last spike seems to have been the messy byproduct of Fluke’s claim that $3,000 would be the cost over her three-year stay at Georgetown Law.

Fluke’s figure seems to have been plucked from thin air. Planned Parenthood estimates the monthly cost at between $15 and $50, which translates to $160 to $600 per year. If we were to take their maximum figure and run with it, we’d still be well below Fluke’s oft-repeated claim. But even Planned Parenthood’s price is on the high end. As has been widely reported, both Target and Walmart (and their online iterations) have been selling generic birth-control pills for $9 per month in 41 states since 2007 — equivalent to the cost of three cheap coffees at Starbucks. (The cost in the nine remaining states is around $27, or $324 per year. For the difference, we can thank those states’ regulations making it illegal to sell prescription drugs as loss leaders.)

Over the course of a given year, these pills would cost their buyer $108, approximately one-tenth of Fluke’s estimation. In the interest of fairness, we should up that to $120 to include sales taxes in those few states that levy them on prescription drugs, and then throw in a trip to the doctor’s office to get hold of the prescription. Let’s presume it’s an expensive trip — say, $80. We’re still looking at only $200 per year, at which rate Sandra Fluke could stay at Georgetown Law for 15 years and pay for contraception no more than the $3,000 she claims it will cost her for three.

The uninsured and unemployed are irrelevant to the debate over the HHS mandate, which applies only to the insured and the employers that insure them. But even an uninsured woman who paid a (pricey) doctor out of pocket to write her a prescription would be looking at no more than $250 per year, or $21 per month.

The Walmart/Target figure is not a red herring. Brand-name drugs and their generic counterparts are identical in their active ingredients, dosages, and methods of consumption. The difference in price between generic and branded drugs is almost wholly attributable to their respective positions in the patent cycle. It is true that many insurance companies do not provide coverage for generics, but this is because drug companies often impose supply restrictions, requiring that insurers buy branded drugs instead of generics as a condition of being allowed to buy other branded medicines that have no generic equivalents. For the most part, patients do not notice the resulting increase in costs, because of the way our system takes purchasing decisions away from consumers. This is a problem in its own right, but one not addressed at all by the HHS mandate.

Day after day, we hear melodramatic stories, rarely backed up, of a supposed crisis in access to contraception. In the real world, in 41 of our 50 states, contraception costs little more per month than a trip to the movies and, in the other nine, its monthly cost is about half what the average American spends on gas each week. Rome is burning all around us, and it is time we redirected our attention from this pseudo-problem to the flames that can actually sear us.

— Charles C. W. Cooke is an editorial associate at National Review.


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