Thursday, October 25, 2012

Access to Birth Control

In every election at any level nowadays, there are attempts to create an issue from whole cloth.  Generally these fail.  One recent attempt at issue creation concerns "access to birth control". This seems to have made an impact despite being spurious.
There may be candidates running for office who really would restrict access to birth control.  Clearly no one who is running for President plans to reduce access.
One could have a legitimate discussion of who pays for birth control, but not access.  My very rough guess is that there are six or seven thousand Walgreens, and a similar number of CVS stores.  Probably 1,500 Rite-Aids.  That alone would mean condoms are available in over 15,000 locations.  The real number is certainly much higher; I saw one report stating there are over 80,000 pharmacies in the U.S.
Once upon a time, long ago, there was health care insurance.  Individuals or employers paid a premium, and insurance companies shouldered the risks. It was similar to one's car insurance, or home insurance.  In those cases, one really hopes not to collect on the premiums they've paid, that is, few of us want our house to burn or to have our car stolen and just to recoup our paid premium dollars.  Health insurance was the same. It insured people from bad things, like cancer or a heart attack, or being struck by a drunk driver while crossing the street, that could bankrupt an individual.
But for most of us, it really isn't insurance anymore, either contractually or in practice.  Employers pay most of the cost, employees the rest, it is pooled and claims paid out.  We spread our costs out over our coworkers.  Fifty years ago, pregnancy wasn't a risk per se; we have a pretty good idea of what causes pregnancy.  And while we frequently confess that young Sally or Billy was an "accident" it certainly isn't an accident from an insurance underwriting perspective.  A tornado striking your house is a risk.
And various states have weighed-in about what costs have to be reimbursed as "health care" like wigs and Viagra for old guys in some states, and breast implants in others.  This isn't insurance like it was classically known, where the risk for an unlikely event is transferred to an insurance company in return for a payment, rather,  this is just all the rest of us divvying up the expense of someone buying a wig.  This is where the "access to birth control" argument actually lies: should all the members of a group be required to chip in to buy Jane's birth control pills, or should she have to pay for them herself?  It isn't access at all; it's a money question.

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