Fluke and Limbaugh; Pills and Insurance

So how about Sandra Fluke and Rush Limbaugh?
Let's start with Rush? I don't listen much to his show. I've heard enough to know that he has a satiric style which ought not to be taken literally. On the other hand, he ought to have know that his comments could be understood as an attack on Ms. Fluke's personal conduct and should never have made them. They detract from the debate, undermine his position and are just mean.

On the other hand, the shock and horror is a bit contrived. Limbaugh's remarks were out of bounds, but are, unfortunately, not unique.
But here's the thing. I know nothing about Ms. Fluke's personal behavior and don't need to. In that area of life, I can only wish everyone the best. I personally believe that Ms. Fluke - and everyone else - should have as much sex as they want that is consistent with the commitments that they have made to others and their own well being.
Ms. Fluke's "promiscuity" - if we have to use that word - has nothing to with sex. It has everything to do with the assumption that other people ought to be made to pay for her stuff.
I intend to write separately on the religious liberty issues. There is an economic issue as well. Insurance, properly understood, is a hedge against risk. You pay something now to be covered against an expense that is extraordinary and unpredictable.
You don't insure against routine and ordinary expenses. Our auto insurance, for example, doesn't pay for gas and oil changes. We don't purchase grocery insurance. To do so would not be to buy insurance, but to simply buy the right to have someone else pay our bills. Moreover, as the expenses that we "insure" in this way become more routine and ordinary, the cost of the "insurance" will come to approximate what we'd pay for the goods or services in the absence of insurance - perhaps a little more since we have to compensate the party who we have contracted to pay them for us. There is no free lunch.
Contraception is closer to grocery insurance than it is to insurance against, say, getting cancer or being in a car wreck.* Most people will need it for a significant part of their lives and the cost is not high relative to the other goods and services we must obtain. Ms. Fluke's estimate of $1000/yr seems to be wildly overstated and there are, of course, alternatives to birth control pills that are extremely inexpensive if somewhat less desirable. Regardless of religious liberty objections, the case for insuring against the cost of birth control pills is weak. At best and even in the context of a student health plan, it is a transfer of wealth from students who are not sexually active to those who are. The "fairness" in that is not self evident.
But, you say, what about the fact that contraception can reduce health care costs by preventing pregnancy. Again let's put aside the religious liberty objections. Catholic institutions, for example, don't say that their religious objections can be overcome by the money the save.
If this were true, then contraception coverage would not require a mandate.  Insurers and employers would be happy to provide it in the same way that you'll give you a discount for having health screenings or participating in company wellness programs.

What about the poor? I'm all for a social safety net, but that's not what this debate is about. A mandate on private insurance will cover very few people who are truly poor. If that were the issue, we'd be talking about providing contraception through Medicaid - which we already do. I have no problem with that.
Let me close by saying something unexpected. It is now well documented that Ms. Fluke is not a run of the mill law student but a left wing activist. Nothing wrong with that. It has been pointed out that she has argued that health insurance plans should be required to cover sex change operations.
I don't think that they should but as a simple matter of the nature of insurance, there is a stronger case to be made for covering sex changes than for covering contraception. The need for a sex change, after all, is unusual, unpredictable and expensive. Putting aside arguments about morality and the nature of the "transgendered," I may well want to insure against the possibility that I will one day learn that I must change my gender.
Having said all of this, I understand that we have come to use health insurance to pay for routine and ordinary expenses. That is not necessarily a good thing but it is unlikely to change any time soon. Nevertheless, it seems to me that whether or not to cover contraception ought to be left to private decisionmakers. If it is a good idea, it will happen. If certain employers have a moral objection, those rights of conscience will be respected.




*That may not be true where oral contraceptions are prescribed for something other than preventing pregnancy but, Ms. Fluke's anectodes notwithstanding, that's not what this controversy is about.