Thursday, March 08, 2012

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.


Anonymous said...

You're missing the crucial voice in this: the health insurance companies themselves, which have not opposed this -- because they well know that the cost of contraception is much less than would be the cost of pregnancy, childbirth, potential complications, etc.

And, of course, you're neglecting that Ms. Fluke's testimony also covered extensive prescriptions for these medications that are not at all about contraception but about preventing other conditions -- which also, if they progressed, would be far more costly for the health insurance companies.

As ever, follow the money, and as ever, always ask about what/who is not in the picture, i.e., why the health insurance companies have not weighed in on this debate. We certainly all know that they have lobbyists ready to derail anything not in their interests. These medications are in their interest.

Anonymous said...

1) Ms. Fluke testified to the need to have birth control covered under health insurance for health reasons--not for having sex.

2) You're as bad as Rusho--rushing to conclusions that women only want to have birth control to have sex.

Rick Esenberg said...

Anon 3:02

Read again. I addressed both. If it saves money, then they won't need a mandate, will they?

Anon 4:15

If we were to say that birth control pills for non-birth control reasons must be covered but birth control pills for birth control are not, do you really think that would solve the controversy.

There's no need to be disingenuous - as Ms. Fluke was. Birth control pills are overwhelmingly prescribed for birth control, i.e., so men and women can have sex without pregnancy. If you think I disapprove of that, you're wrong. I made that clear. But I don't disapprove of eating or any other number of things that it doesn't make sense to "insure" as I explained in my post.

Anonymous said...

Nope. You must have missed the stats from medicos that 46 percent of prescriptions for oral contraceptives are not for pregnancy prevention.

Or why not just make the Pill for women over the counter, like condoms? The AMA lobbied for birth control to be only by prescription, 'way back before the Pill, just to ramp up business for physicians. Men don't have to pay for medical visits and tests and more to get condoms.

I'm looking forward to more progress on the male pill, the oral contraceptive for men, and what that will do to this debate -- and wait and see, men won't be required to have prescriptions.

Anonymous said...

Anon 3:02 again here. I've read through your essay again. I still don't see where you quoted or referred to Fluke's testimony on prescribing of oral contraceptives for reasons other than preventing pregnancy, as in use for preventing uterine cysts, etc. Please point to the paragraph (albeit the problem may be odd formatting of paragraphs). Thanks.

Unknown said...

Follow the money indeed. Big Pharma sees dollar signs from Big Government giving away free non-generic formulas. Big Pharma was a big contributor to Oilbama. Gotta keep that Superpac money coming in.

As a two-fer Fluke is a crusading lefty agitator ginned up to push the meme that women are oppressed and can't afford birth control. Too bad the American public knows that bc is cheap and readily available.

Unknown said...

Ms. Fluke's testimony also covered extensive prescriptions for these medications that are not at all about contraception but about preventing other conditions -- which also, if they progressed, would be far more costly for the health insurance companies.

--- and as purely medical treatments will be covered by Georgetown's health insurance.

Anonymous said...

Professor, the members of the Jehovah's Witness faith oppose blood transfusions on religious grounds. I am not aware of any insurance policy which doesn't cover blood transfusions. Do we trample on the religious freedom of these people by not prohibiting insurers from covering blood transfusions?

It seems to me that when you start down this path, you get into trouble pretty quickly.

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