Healthcare as Social Planning

July 21, 2011

by Mario Rizzo

Although I am an advocate of voluntary birth control, I am not happy about (1) the equation of this choice with healthcare – even preventative healthcare (as if pregnancy were a disease); and (2) the government mandating that health insurers must cover these expenses, without even a copayment.

A recent “non-partisan” committee has reported its recommendations for mandatory provisions in all health insurance.  This is part of the flowering of Obamacare regulations.

The list is from the New York Times article of July 20, 2011 which in the print edition was called, “Panel Calling for Free-Contraceptive Coverage.”

To reduce unintended pregnancies, the panel said, insurers should cover the full range of contraceptive methods approved by the Food and Drug Administration, as well as sterilization procedures and “education and counseling for all women with reproductive capacity.”

This recommendation would require coverage of emergency contraceptives including pills like ella and Plan B, panel members said.

In addition to contraceptive services for women, the panel recommended that the government require health plans to cover screening to detect domestic violence;… and counseling and equipment to promote breastfeeding, including the free rental of breast pumps.

             But

Most private insurance provides contraceptive coverage, but co-payments have increased in recent years, the panel said.

             Therefore,

The panel said insurers should be forbidden to charge co-payments for contraceptives and other preventive services because even small charges could deter their use.

             And finally,

The chairwoman of the panel, Dr. Linda Rosenstock, dean of the School of Public Health at the University of California, Los Angeles, said, “We did not consider cost or cost-effectiveness in our deliberations.”  

I believe that family planning is a good idea. In general, the more control people have over the consequences of their sexual activity the better. I do understand that pregnancy among poor teenagers pretty much ensures that they will continue to be poor, and that many will choose abortion.  (To what extent is this the statist-liberal answer to the conservative concern about abortion?)

However, must the government MANDATE all of this in health insurance which we have been told is so expensive ?  Furthermore, must I pay to improve others’ life styles, however sensible?   By expanding the definition of healthcare to include the above the Obama Administration hopes to use the moral attractiveness of providing healthcare insurance for all in order to foist something more upon us. (A classic slippery slope mechanism is at work, I suggest).

Move away all the details. What is at work is clear. Healthcare reform is the wedge which will undermine individual autonomy in many forms:  what we eat, what life-choices we must financially support, the reduction of moral issues (contraception is a moral issue for some people) to healthcare and so forth.

But this is the tip of the iceberg. The key reason is in the statement by Dr. Rosenstock that the panel did not consider cost factors in their deliberations.

EITHER we allocate resources by the market (prices or cost-considerations, through direct payment or insurance costs) OR we allocate (“ration”) them by – well, panels. This is clearly either/ or.  All the Obamacare obfuscation in the world cannot change that.

The system is broken and the costs are out of control. The “solution” that is being prepared for us seems clear. We shall go on bended knee before a panel to ask for a little more than our allotment.  Maybe, if they cannot help us, they will give us some candy to calm us down. But, no, that will probably be forbidden.

11 Responses to “Healthcare as Social Planning”

  1. RR Says:

    This is a great post. But in today’s world of 5-second attention spans and instant opinion formation, I fear it will fall on deaf ears (or glazed eyeballs.) :(

  2. Jett Rucker Says:

    Pregnancy in poor teenage (16 and over) women is escape from the parental home (that is why it is so widely sought among them). Prior to age 16, payments from Aid to Families with Dependent Children (welfare) go to the (grand) mother.

    George Gilder, in “Wealth and Poverty” identified a poor girl’s 16th birthday as “Independence Day,” because after that age, the AFDC payments go to the girl (mother).

    OF COURSE the girl will remain poor the rest of her life – that’s what she has to do (that and bear children and avoid economic attachment to a man/father) to continue to collect welfare.

  3. Jett Rucker Says:

    I’m sorry – that was Charles Murray in “Losing Ground,” not George Gilder.

  4. Allan Walstad Says:

    And where is this to be fond in the Constitution? (Answer: Nowhere.)

  5. Allan Walstad Says:

    Um, “found.”

  6. scineram Says:

    ^To regulate commerce?

  7. chidemkurdas Says:

    I wonder about this panel’s logic. Consider that there are very cheap forms of contraception widely available at drugstores. By comparison, the cost of having a child is immense, if only in foregone earnings. So anyone not using contraception has to want to have a child–for whatever reason. Why would providing free contraception change that? Mysterious are the ways of government panels, presumably there is some logic there.

  8. Allan Walstad Says:

    @scineram: I hope that was a joke. The federal power to regulate INTERSTATE commerce was simply intended to prevent individual states from interfering with free trade.


  9. @Chidem,

    You may have intuited the correct answer. I know someone who works with unwed mothers. She said that, overwhelmingly, having the child is a conscious decision. It is not the result of ignorance or inability to obtain contraception.

  10. chidemkurdas Says:

    Thanks, Jerry. On that basis, the question is what free contraception is expected to achieve. Given that very cheap contraception has long been available, someone who wants to avoid having a child can almost certainly do so. In any case the cost of the contraception can’t be a substantial influence because it is negligible compared to the cost of raising a child. Clearly other factors are a lot more powerful.


  11. [...] and committees already mandate certain benefits that are not part of a typical plan—-click for Mario Rizzo’s comment on one such requirement, contraception.  The Institute of Medicine says employer plans will have to [...]


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