So, I’m as big a fan as anyone of the birth control pill, even though I’m an indirect beneficiary of its wonders. And notwithstanding my generally libertarian sympathies, I even think it makes an enormous amount of sense to make subsidized—and in some cases free—contraceptives available to people who genuinely can’t afford them, if only because it’s likely to be a lot less costly to the public in the long run than supporting both the unplanned child and the parents who are a lot less likely to escape poverty once they’ve had that unplanned child. You might even want to set the income bar for the subsidy pretty high, to cover people who, though in no position to afford a child, could afford birth control but would be shortsightedly tempted to risk going without and spend the money on other wants.
Still, I’m puzzled by the general celebration over the news that insurers will be required to cover birth control pills without any copay. I mean, I understand why (employed, insured) women in their 20s and 30s might be personally pleased about the short-term drop in their expenses, but looked at more broadly, it’s just a large predictable cost that’s going to need to get baked into premiums. (The very poor, needless to say, are also most likely to be uninsured.) It just means the cost is now shared between women who do use it and those who don’t. I guess that’s nice for the women who use it, but I’m not sure why it’s necessary or, for that matter, fair.
With limited exceptions—I get that birth control can also be a treatment for certain medical conditions—it seems like birth control is just a predictable cost, not a risk to insure against. It’s like food: You might want to subsidize it for the badly off, but you don’t buy “food insurance,” because there’s nothing to “insure.” You just know you’re going to need food, and so everyone who isn’t poor just buys their own; there’s no good reason to pool the expense.
Actually, it makes less sense even than that, because while everyone needs food, people need birth control only insofar as they’re involved in a sexual relationship (and don’t want children), which (one hopes) is substantially under each policy holder’s control. If that meant everyone in the pool, then requiring coverage would make no difference to anyone, since the exact same cost would just be shifted to the premium. The only reason it makes a difference to anyone is that some people who are having sex get to shift part of their cost to people who aren’t. And that seems a little like salt in the wound: Isn’t it bad enough to not be getting laid regularly without having to pay for the people who are?
If we think it’s of public value to make sure that low income folks have access to contraception when they want it, great, I get that. But it seems like the solution is to just publicly provide it—whether directly or through some sort of voucher. Achieving that goal through the private insurance system just seems bizarre. If, on the other hand, the goal is just to give a free goodie to people who can very well afford it at the expense of those who don’t want or need it… well, that’s just not a particularly worthy goal, is it?