Originally published on February 14, 2012 on http://dontbenicetomejustbecauseihavecancer.blogspot.com/
Over the past week or so I've been hearing a lot of rhetoric about Obamacare forcing religious institutions to make birth control "free" through their health plans and I have a few opinions about this. First of all, the administration has signed off on so many waivers that surely they could just waive these religious institutions who object to this part of the legislation. I don't know, maybe they have to apply for a waiver or something. Seems to me that if the legislation is so good, why would any company need a waiver? But that's not what galls me.
What bothers me is this whole notion of "free" birth control. Heck, "free" anything, for that matter. Pharmaceutical companies make birth control pills. There are costs that go into manufacturing and marketing them. They do not appear out of thin air. So in order to give them away, those costs to the drug companies have to be covered somehow. If the insurance company pays the drug company for them, then the insurance company somehow has to recoup their costs. How do you think they do this? Well, the person using them could pay for them or it could be a cost that is spread among all the policyholders. Either way, someone is paying for them. They are not free. Just because Suzy Q doesn't pay a co-pay for them, she is paying for them in higher premiums or in higher co-pays for another service. In other words, the cost of the "free" birth control is subsidized.
Here's the screwy thing with health "insurance." It doesn't work like traditional insurance. An insurance policy is something you hope to not use. Auto insurance, homeowner's insurance, life insurance, liability insurance, all of these protect you financially against peril. If you're driving down the road and you get in a car wreck, your auto insurance pays for the damaged property if it's your fault. If your house burns down, your homeowner's insurance pays off your mortgage and helps you get into a new home or repair the damaged one and replaces your lost contents. Life insurance pays your beneficiary money if you die. You write the check or have the autodraft monthly or yearly for these insurance plans and you hope to never use them. They're insurance. Peace of mind.
Health insurance is not insurance, as least not in the same sense these others are. You expect to use your health insurance. You go to the doctor for check ups or when you're sick and you file a claim. You pick up your monthly maintenance prescriptions for high blood pressure, birth control or diabetes. You have medical tests or get antibiotics or physical therapy for an injury and you expect that your health insurance will pay for these things. In theory, anyway, the large pool of people paying premiums is supposed to be larger than the amount paid out in claims, but with so much chronic disease, the impatience of Americans to get well NOW and the skyrocketing costs due to innovation, the profit margins are dwindling. Add to that the lower investment returns in the stock market over the past several years and insurance companies have had to increase their rates to continue to make a profit.
Yes, those evil insurance companies dare to make a profit. Damn capitalism. And those horrible hospitals keep charging more so they can stay in the black as well. And don't get me started on those slimy doctors and nurses and physical therapists who want to make a good living and pay off their student loans and drive nice cars and take vacations. Horrid, horrid people, making their living on the backs of people who need their services. They shouldn't charge anything at all. It should be free.
While we're at it, there's plenty of other things that should be free as well. Everyone needs to eat, why should Wal-mart and McDonald's and farmers charge money for food? Food should be free. We all need water to live, so why should the city send me a water bill every month? Water should be free too.
I can think of about a million more things that oughta be free, but I think maybe you see my point. The farmer needs to make money to care for himself and his family. The guy flipping burgers or stocking shelves does too. The city has to pay people to maintain the water lines. Everything costs something, nothing is "free."
So why is Obama talking about "free" birth control? People who support "free" birth control say that it's to improve access, to make sure there are no barriers to women getting birth control if they want it. If you really want to remove barriers, make the FDA change it to over the counter and stock it next to the Tylenol at the drug store. As it stands, you have to go to the doctor and get a checkup if you want to use birth control. That's a barrier. You have to pay the doctor and wait for an appointment. My OB-GYN makes appointments a year in advance and even if I call tomorrow, chances are it's going to be at least a couple of months before I can get in to see her. Another barrier. If you're over 35 and you smoke, the doctor isn't going to want to prescribe the birth control pill. Yet another barrier.
Looks to me like the only barrier this plan eliminates is the $5-50 a month cost of the birth control pills. And I'm guessing if every health plan has to make them "free," those costs are going to be passed on in higher premiums. Maybe not $50 a month higher since men, children and postmenopausal women will have to pay more too, but certainly more. Likely enough more that there will be women who would have been better off had they not gotten "free" birth control.
A cost of $50 a month for birth control is peanuts compared to what some cancer drugs cost. And many insurance companies either don't cover these drugs at all or have huge co-pays. And let me tell you, cancer is something you hope you never have to use your insurance for. I'd much rather cough up an extra $50 a month to not get pregnant if I knew if God forbid my kid got cancer my health insurance would cover her medications without me having to pay $1000 a month co-pay. I think most reasonable people would feel the same way.
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