Deregulate Birth Control

There are all sorts of reasons to dislike the Food & Drug Administration.

Based on the number of lives lost, the bureaucracy’s foot-dragging on drug approval would be at the top of the list.

Though the FDA’s inefficiencies also resulted in many needless deaths during the pandemic.

And let’s not overlook the other areas where the FDA has a pernicious impact.

But I’m a big believer in redemption. So I’m very hopeful that the bureaucrats will soon do something smart and allow women to purchase birth control pills without first getting a prescription.

One of the reasons I’m hopeful is that some of our friends on the left have sensible views on this issue.

The Washington Post, for instance, recently editorialized in favor of at least partial deregulation.

Paris-based HRA Pharma announced last week that it has applied to the FDA for approval to switch Opill…to over-the-counter use. If approved, it would be the first time Americans would have access to oral contraceptives without the need to obtain a prescription from a health professional. Another pill manufacturer, Cadence Health, has been discussing with the FDA switching its progesterone-estrogen combination to over-the-counter sales in hopes of also submitting an application. …The requirement for a prescription can create barriers for women who don’t have easy access to a health-care provider because of cost, lack of transportation or child care, and privacy and confidentiality concerns. Making the pill available without a prescription could be particularly helpful to women in rural, poor and marginalized communities. Oral contraceptives…are available over the counter in more than 100 countries, and clinical trials have shown them to be safe and reliable. …Major medical organizations, including the American Medical Association and the American College of Obstetricians and Gynecologists, have voiced their support for making birth control pills available without prescription. …it is important that the FDA make this matter a priority.

Needless to say, libertarian-minded people are on the right side as well.

Brad Polumbo of the Foundation for Economic Education wrote in favor of reducing government intervention.

…whatever one believes about abortion, the timing of a new debate on birth control policy within the Food and Drug Administration (FDA) couldn’t be more important. The FDA just received a request from a contraceptive company seeking authorization to sell its birth control pills over-the-counter—without a prescription, as is required nationwide under current laws. …the downsides of government mandates requiring a prescription are significant. For one thing, it makes birth control harder to access for people without health insurance or the time/resources to obtain professional medical care. It also adds significantly to the cost of birth control by introducing middlemen and additional steps. …Studies have shown that, in absence of a required doctor consultation, women are able to self-screen and determine if they meet any of the conditions where one shouldn’t take hormonal birth control. …Dozens of other countries don’t require a prescription for birth control, including Mexico, Portugal, India, Greece, and Brazil. …it’s a matter of who gets to decide. Can women weigh the risks and benefits of a medication and decide for themselves? Or should that decision be made for them by supposedly benevolent bureaucrats and the nanny state?

Brad answers his own question, stating that “the answer is clear” and that the FDA should “get out of the way.”

Amen. Indeed, “get out of the way” should be our attitude about almost every action by politicians and bureaucrats.

I’ll close by making the should-be-obvious point that a belief in deregulated birth control is not the same as a belief in subsidized birth control. Especially when such policies are a recipe for higher costs and corrupt cronyism.

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The Upside-Down Logic of Subsidized Birth Control

When writing about the Obamacare and its birth-control mandate, I’ve made a handful of observations.

• First, it is very bureaucratic and inefficient to use insurance for routine medical expenses. Sort of like using auto insurance to cover the cost of getting an oil change.
• Second, insurance coverage means third-party payer, which means birth control will become more expensive (albeit financed by premiums rather than out of pocket).
• Third, coverage mandates necessarily mean one-size-fits-all rules and regulations from Washington, limiting consumer choice and hindering market flexibility.
• Fourth, federal involvement creates opportunities for corruption as big medical companies figure out ways to obtain unearned profits via subsidies and mandates.
• Fifth, if politicians and bureaucrats really want birth control to be more affordable, they would make the pill available over the counter instead of requiring a prescription.

President Trump recently announced that his Administration would relax the mandate. I think that is good news for the above reasons.

Critics are very upset. But rather than argue about the desirability of insurance coverage and the wisdom of Washington mandates, they’re actually claiming that the White House has launched some sort of war on birth control. I’m not joking.

Jeff Jacoby of the Boston Globe analyzes the issue. He starts by observing that nobody is proposing to ban birth control

…the Supreme Court ruled, in Griswold v. Connecticut, that government may not ban anyone from using contraceptives. …That freedom is a matter of settled law, and hasn’t been challenged in the slightest by President Trump or his administration.

He then points out that some folks on the left have gone ballistic.

Hillary Clinton accused Trump of showing “blatant disregard for medicine, science, & every woman’s right to make her own health decisions.” Elizabeth Warren, denouncing “this attack on basic health care,” claimed that the GOP’s top priority is to deprive women of birth control.

Their arguments, however, are utter nonsense. If Person A no longer has to subsidize Person B, that doesn’t mean Person B can’t buy things. It simply means there won’t be third-party payer.

Jacoby agrees.

News flash to Warren, et al.: There is no attack on health care, and no in America is being deprived of birth control. You are losing nothing but the power to force nuns to pay for your oral contraceptives. …As a matter of economics and public policy, the Affordable Care Act mandate that birth control be supplied for free is absurd. …Especially since birth control will remain as available and affordable as ever.

Indeed, the Trump Administration was actually far too timid. There should be no birth-control mandate for any insurance plan. It should be something negotiated by employers and employees.

…the new White House rule leaves the birth-control mandate in place. Trump’s “tweak won’t affect 99.9 percent of women,” observes the Wall Street Journal, “and that number could probably have a few more 9s at the end.” Washington will continue to compel virtually every employer and insurer in America to supply birth control to any woman who wants one at no out-of-pocket cost.

Jacoby closes his column with some very sensible observations and recommendations.

…there is no legitimate rationale for such a mandate. Americans don’t expect to get aspirin, bandages, or cold medicine — or condoms — for free; by what logic should birth control pills or diaphragms be handed over at no cost? …By and large, birth control is inexpensive; as little as $20 a month without insurance. …access to birth control, as the Centers for Disease Control reported in 2010, was virtually universal before Obamacare. The White House is right to end the burden on religious objectors. But it is the birth-control mandate itself that should be scrapped. Contraception is legal, cheap, and available everywhere. Why are the feds meddling where they aren’t needed?

The last sentence is key. The federal government (heck, no level of government) should be involved with birth control. They shouldn’t ban it. And they shouldn’t mandate it, either.

P.S. About five years ago, Sandra Fluke got her 15 minutes of fame by asserting that she had a right to third-party-financed birth control. That led to some clever jokes, including this cartoon and this video.

For what it’s worth, I think this cartoon is the best summary of the issue.

P.P.S. Predictably, the United Nations supports a “right” to taxpayer-financed birth control.

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Birth Control, Third-Party Payer, and the Politicization of Health Care

America’s health care system is a mess, and we can assign almost all the blame on government. Simply stated, we don’t have functioning and efficient markets because Medicaid, Medicare, tax-code distortions, and other forms of regulation and intervention have created a system that is crippled by a third-party payer crisis.

There’s no logical reason to expect consumers to be smart shoppers, after all, when they’re only responsible for directly paying just 11 cents for every $1 of health care they consume. And providers have little reason to be efficient when they know that consumers are largely insensitive to price.

Let’s now apply these insights to the political controversy over birth control. Except, as I explained in July, there is no fight over birth control. As far as I’m aware, nobody is trying to ban birth control.

The real fight is whether the government should mandate that health insurance plans include coverage for birth control (and certain abortifacients).

Writing for Bloomberg, Megan McArdle explains that Obamacare’s birth control mandate is silly because a modest and routine expense shouldn’t be covered by insurance at all.

I am not very patient with the political fights over the Affordable Care Act’s contraception mandate. …Generic birth-control pills are a cheap, regular expense used by many millions of people, exactly the sort of thing that insurance is not designed for. All this does is spread the cost around a bit while adding administrative overhead for your policy.

Moreover, the better policy is to allow birth control to be purchased without a prescription.

In other words, address the issue by reducing government regulation rather than imposing a mandate!

…make birth-control pills available over-the-counter rather than a prescription item. This is an excellent idea. It was an excellent idea before Obamacare passed, and it will remain a fine policy even if Obamacare somehow vanishes into dust. Physicians assess the danger of giving you birth control by asking simple questions you can ask yourself: Are you over 35, a smoker or troubled by a family history of early stroke?

Seems like a good idea, right? Particularly since it should appeal to Republicans that want less regulation and also appeal to Democrats that want easier access to birth control.

The Republicans are on board, as Byron York reports.

…the GOP has a new policy response… The idea is to make the birth control pill available over the counter, to all, 24/7, without a prescription. It’s becoming a trend among Republican candidates in Senate races around the country. In North Carolina, GOP candidate Thom Tillis recently embraced it. So has Ed Gillespie in Virginia. Mike McFadden in Minnesota. Gardner in Colorado. And one of the leading proponents of the move is a potential 2016 GOP presidential candidate, Louisiana Gov. Bobby Jindal. …Gardner first rolled out the proposal in a Denver Post op-ed in June. The birth control pill has safely been in use since it was first approved 44 years ago, Gardner argued. “When other drugs have that kind of track record, we approve them for purchase without a prescription,” he wrote. “Name-brand drugs like Advil, Pepcid, Claritin, Prilosec and many others were once sold by prescription only, but moved to over-the-counter sale once they’d been proven safe and unlikely to be abused.”

But some Democrats are hostile.

Indeed, a columnist for the Denver Post is very upset that some GOPers are supporting over-the-counter access to birth-control pills.

Following the lead of Colorado U.S. Senate candidate Cory Gardner, a handful of Republicans in midterm races across the country are now embracing over-the-counter sales of birth control pills without a prescription. Don’t be fooled. It’s a disingenuous move that could actually make the pill more expensive for women… But women already pay for those pills as part of the health care coverage they purchase through employers. Why would we want to pay for them twice? …What happens, however, if birth control pills are sold over the counter? Insurance companies will likely stop covering them. That means women will keep paying health insurance premiums, plus an additional out-of-pocket fee for pills. …And free doctor visits to discuss birth-control risks could also be replaced with fee-based pharmacy consults to determine whether women have risk factors like smoking, hypertension or migraines that prevent safe use of the pill, reports the American College of Obstetricians and Gynecologists. That’s hardly a “cheaper and easier” alternative — which is why Politifact rates Gardner’s claim as “mostly false.”

I strongly suspect that the author simply wanted to make a partisan attack on the Republican Senate candidate in Colorado. After all, more substantive and serious people on the left, including those at both Vox and Think Progress, favor over-the-counter access to birth control.

But let’s assume she really believes what she wrote. In which case she would get an F from any economics professors because health insurance companies obviously include predicted costs when pricing their policies. So if the mandate disappears and birth control is available without a prescription, then insurance companies will be able to lower the cost of the policies they sell.

In other words, women wouldn’t be paying twice. Indeed, they’ll pay less, though that will only be obvious to those who understand that employer-provided health plans are part of overall employee compensation.

There is another reason, other than partisanship, for some on the left to oppose Republican proposals to allow birth control to be sold over the counter. And you won’t be surprised to learn that self interest is playing a role.

Writing for The Federalist, Ben Domenech notes that Planned Parenthood wants to retain the current prescription-only approach.

You may think Ben made a big mistake, or that I misinterpreted. After all, isn’t that contrary to the organization’s ostensible mission of reducing unwanted pregnancies?

Well, Ben points out that Planned Parenthood may be more interested in maximizing handouts than it is in reducing pregnancies.

…interestingly enough, Planned Parenthood is pushing back on over-the-counter contraception. Why is this? Why would Planned Parenthood want to decrease the availability of contraception, and require women to see a doctor in order to get it? That seems awfully paternalistic of them. …birth control is a major lead generator for Planned Parenthood, to the degree that they can’t afford to lose their existing purpose as a source of prescribed contraception without it hurting their status as an institution. …Now you can understand why they wouldn’t want potential customers to be free to go to CVS or Walgreens or Rite Aid instead of heading to Planned Parenthood – providing those and other services is worth a lot of taxpayer money, $540 million in FY 2012 alone. And if you don’t provide those services, you can’t bill the taxpayers for them. …That’s why they want to keep the government’s ban on over-the-counter birth control intact.

Here’s a chart from Ben’s article that shows “what percentage of Planned Parenthood’s “services” are related to contraception.” As he notes, “it’s over a third of their activity.”

So I guess it makes sense – at least from an amoral perspective – that the organization wants to limit access to over-the-counter birth control.

By the way, the GOP plan for easier access to birth control is not a move to uncharted territory.

Here’s a map from a pro-reform left wing group that shows that over-the-counter birth control pills are easily available to most of the world’s women.

Let’s close by sharing one final – and very persuasive – piece of information from the experts at Reason.

Women already have over-the-counter access to Plan B, which involves larger doses of the hormones that are present in birth control pills.

…the Food and Drug Administration (FDA) has been considering making oral contraceptives available over-the-counter (OTC) for more than twenty years. “Plan B,” an emergency contraceptive, became available OTC last year. That one-step pill is simply a more potent dose of the same hormones that make up regular birth control pills. There’s no good medical justification for the differentiation. Yet in America, regular birth control pills remain stubbornly behind the pharmacy counter and behind the times.

In other words, the usual pro-regulation argument is that prescriptions are necessary because consumers can’t be trusted to make their own decisions with strong doses of medicine.

But the government already has made Plan B available over the counter while blocking similar access to birth control pills. Go figure.

P.S. Planned Parenthood is not the only interest group that has behaved in a disreputable and dishonorable fashion.

P.P.S. If you want to know what happens to healthcare in the absence of pervasive third-party payer, check out this remarkable chart.

P.P.P.S. Since today’s topic was birth control, let’s use this opportunity to revisit our collection of Sandra Fluke humor. Just in case you don’t remember, she was the 30-year old college student who got her 15 minuted of fame by demanding that other people pay for her expenses. Anyhow, if you want to laugh, check out this great Reason video, this funny cartoon, and four more jokes here.

P.P.P.P.S. On a separate topic, I added my two cents late last year to a debate inside libertarian circles over whether America’s plethora of welfare programs should be replaced by a single “basic income” grant that would be given to all Americans. Sort of a guaranteed minimum income.

I acknowledged that the current system is a mess, but I suggested that decentralization was a better approach.

…it seems that nothing could be worse than the current system. …But what about the idea of trashing what we have today and instead offering everyone some sort of basic income? …I agree, but only sort of. I like the idea of radical reform, but I think there’s a better road to Rome. It’s called federalism.

But what if someone held a gun to my head and said federalism wasn’t an option and demanded that I choose between the “basic income” and the status quo?

There’s not an obvious right answer, but I suspect I would prefer the devil I know because of fears that we might get more redistribution and even bigger government.

And I’m not the only one to have that opinion. Here’s what a proponent of more redistribution wrote about the concept.

Basic Income, unlike the programs we have now, will be politically easy to raise once it’s in place. …if you have one big, high-profile redistribution program, you can get enough popular support to overcome the concentrated opposition of the rich people footing the bill. …by endorsing Basic Income, libertarians are walking right into a trap. Anti-redistributionists’ great fear has always been that the masses will use the power of majority rule to simply vote themselves more money. As things stand, the fragmentation of our redistribution programs makes it easier for the anti-redistributionists to punch holes in the safety net. If the fragmented system were replaced with one universal, high-profile program, the result would be a huge political gift to redistributionists.

But maybe I’m just a pessimist. Tyler Cowen has a different perspective.

…let’s say a historical accident swept Basic Income proponents into power for a term and they passed that legislation.  Over time those income transfers would prove larger, more visible, and they would at least appear superficially more anti-work than the public stomach for them.  I predict they would be restricted along a number of possible dimensions, starting with (partial) work requirements for the able-bodied. Under most plausible assumptions about the Basic Income level, most people would not be recipients, nor would they expect to be potential net gainers from the program. …So I think the “why send money to people who aren’t working?” intuition will crowd out the “I want to think of myself as someone who helps other people” feeling.

I guess it depends on how the “basic income” is designed. If the government sends checks to everybody (as some are proposing), then Tyler’s “plausible assumption” about recipients would be wrong.

Which reinforces in my mind that my original idea was right. Let’s go with federalism and get Washington out of the business of redistribution.

The decentralized approach has been very successful in Switzerland and its also the system that’s consistent with the Constitution.

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Sandra Fluke Now Has a Human Right to Taxpayer-Financed Birth Control

Every so often, I share breakthrough stories about advances in “human rights” around the world.

• In France, it is against the law to say your husband is under-endowed or that your wife is fat.
• Across Europe, a satellite dish is now a human right.
• In Finland, broadband access is a basic right.
• There’s now an entitlement for free soccer broadcasts in Europe.
• In Italy, you have the right to…um…your testicles.

Now, in honor of Sandra Fluke, the United Nations has decided that contraception is a human right. Not just a human right, a universal human right. The New York Times reports on this big news.

The United Nations says access to contraception is a universal human right that could dramatically improve the lives of women and children in poor countries.

So what’s the big deal? Surely people should have the right to buy a condom.

Paid for with your tax dollars?

Yes, but we’re talking about the United Nations, so you won’t be surprised to learn that there shouldn’t be any “financial barriers” to birth control, which means  people have the right to have other people pay for their fun and games.

It effectively declares that legal, cultural and financial barriers to accessing contraception and other family planning measures are an infringement of women’s rights. …The global body also says increasing funding for family planning by a further $4.1 billion could save $11.3 billion annually in health bills for mothers and newborns in poor countries.

Well, Sandra Fluke surely will be happy about this news. Even though national governments safely can ignore U.N. pronouncements, this is yet another sign of a growing dependency mindset.

P.S. Speaking of Sandra Fluke, you can enjoy some laughs with this great Reason video, this funny cartoon, and four more jokes here.

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Another Reason TV Video: Mocking Ms. Fluke, Remy Says It’s Time for a Cough Drop Mandate

I’ve already posted some humor about Sandra Fluke and the Obama Administration’s contraception mandate, including this set of four cartoons and posters.

But the folks at Reason TV always do things worth sharing, so here’s a video about a cough drop mandate. As you can see, a healthy dose of sarcasm.

By the way, if you want something more serious about the issue, including a discussion of third-party payer and the proper role of insurance, check out the excellent analysis of Prof. Cochrane in this post.

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Fluke Humor

I’m a big fan of political humor, particularly when it exposes absurdity. This is why I shared all these jokes (here, here, here, here, here, and here) about the Occupy Wall Street crowd.

But I also appreciate good jokes that target me and other libertarians (here, here, here, here, and here).

If I had to pick a favorite, though, it would be the jokes that teach economics. That’s why I like this joke about Keynesian economics, this cartoon about Obama’s stimulus, this video on Halloween taxes, this cartoon about the minimum wage, and this joke about the perverse incentives of redistribution.

And it’s also why I shared the cartoon yesterday about Ms. Fluke and the controversy over the birth control mandate.

This motivated readers to send several others, all of which make the point that this is an issue about subsidies and redistribution, not birth control.

Here’s one that was posted on the Powerline blog.

This one’s obviously a photoshop creation, but definitely appeals to me because of my support for the 2nd Amendment.

And here are a couple of posters featuring Ms. Fluke.

I especially like these two posters because there’s no attempt to personally demonize Ms. Fluke. It’s her ideas are bad because she wants to coerce others.

I’m not making an indirect dig at Limbaugh, by the way, who does a rather impressive job of staying on the right side of the line while spending three hours every day trying to be funny, entertaining, and informative. I shudder to think how often I would step in you-know-what if I tried to do the same thing.

Instead, my goal is to change hearts and minds. We won’t win the battle for liberty if we focus on personalities as opposed to ideas.

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