Like all wealthy countries, the United States has made a policy commitment to ensuring that everyone, regardless of income level, has access to enough food to sustain their health. One way we could make good on that commitment is by a system of compulsory food insurance: Everyone pays in, either via plans purchased on the individual market or through coverage employers are required to provide, and then you swipe your insurance card at the grocery store, and your insurance picks up the tab.
There are a bunch of obvious reasons this is not, in fact, the way we do things. The need to eat is not really a “risk” people need to “insure against.” Everyone needs to eat, and so the grocery bill is just a predictable, usually relatively stable, recurring expense. Second, while some bodies will need more food to sustain themselves than others—and there’s some minimum everyone’s going to have to spend on food to stay healthy—the cost, quality, and quantity of food people consume is also substantially a matter of individual choice and preference. You have foodies who devote substantial time, energy and money to culinary pleasures, and folks who keep a far more Spartan diet than they could afford.
So, of course, what we actually do is generally leave individuals with the responsibility of buying their own food, while providing subsidies of various sorts to the poor to ensure everyone is able to obtain some basic minimum, much as we do with necessities like housing or clothes. Many regard the current level of subsidy in the United States as inadequate, but that is no objection to the underlying structure of the arrangement, which seems to be widely accepted. Some expenses related to nutrition or diet are, of course, covered by insurance: Consultation with a doctor to identify medical conditions that may impose special dietary needs, or intravenous feeding for people who are either temporarily or persistently unable to consume ordinary food. But those cases provide no reason for covering routine food purchases on an insurance model.
The current debate over mandatory, no-copay contraceptive coverage under the Affordable Care Act is somewhat idiosyncratically focused on issues of religious conscience, and whether it is reasonable to compel employers with religious qualms about birth control (or certain forms of birth control) to directly underwrite it. That is surely a debate worth having on its own terms. But it strikes me as a bit odd that so little attention is given to the question of whether an insurance model really makes sense for contraception qua contraception—when it is not prescribed for some independent medical purpose.
There’s a dizzying array of condom brands and birth control pills, IUDs and long-term implants, surgical interventions, and so on, and people have an equally diverse array of reasons for preferring one option or another. Some people use one method or another of contraception pretty consistently throughout their adult lives, others only when they have chosen to be sexually active with a particular partner. While the costs of long-term birth control requiring surgery may be relatively high, the most popular forms typically involve regular, predictable expenditures within the means of the average person—costs which would doubtless be reduced if we sensibly allowed chemical birth control to be sold over the counter without prescription.
In short, birth control resembles food—surely a more vital health-related need—a whole lot more than it does the types of costly and unpredictable medical treatments that are the main reason for adopting an insurance model to pay for those types of healthcare. As a pure policy question, then, it seems more natural to adopt a similar model for contraception: Let everyone buy their own in accordance with their personal needs and preference, with subsidies for those below whatever income level we decide is appropriate.
The obvious reason we don’t do this, it seems to me, has very little do do with the policy merits and everything to do with politics. People who are opposed to mandatory contraceptive coverage are often simply opposed, on socially conservative or religious grounds, to contraception as such—or at any rate, to any government support for it. As with Social Security, the rationale for making coverage universal is a concern that a narrower means-tested program, though probably a better fit for the underlying policy goals, would not be politically viable over the long run. (“Programs for the poor,” as the saying goes, “tend to be poor programs.”) If conservatives were to accept the general desirability of guaranteeing broad access to contraception, it is hard to see any very compelling argument for using an insurance model to make good on that guarantee that would not apply at least as strongly to food, clothing, and housing—though I welcome any I may not have thought of in the comments.