In this instance, the federal bureaucrats deliberated and the progressive arguments prevailed. "The fact that it is women, rather than men, who have the ability to become pregnant cannot be used to penalize them in any way, including in the terms and conditions of their employment," the agency stated in its decision. "Contraception is a means by which a woman controls her ability to become pregnant. The PDA's prohibition on discrimination against women based on their ability to become pregnant thus necessarily includes a prohibition on discrimination related to a woman's use of contraceptives. Under the PDA, for example, Respondents could not discharge an employee from her job because she uses contraceptives. So, too, Respondents may not discriminate in their health insurance plan by denying benefits for prescription contraceptives when they provide benefits for comparable drugs and devices." Whether contraceptives are "comparable" to other drugs and devices was, of course, core to the controversy. The agency concluded, plausibly, that contraceptives are comparable to other preventative health care measures and prescription drugs. After the decision, an employer could stop offering its workers health insurance that covered preventative care and prescriptions, but with few exceptions it couldn't offer those benefits and exclude birth control coverage.

Enter President Obama, whose progressive vision -- shared by the aforementioned New York Times editorial -- is a population of women who are 100 percent insured, and entitled (via their health insurance) to their choice of birth control without a co-pay or increased premiums. A relatively small number of Americans object to that vision because they're averse to birth control generally. Although their dissent is most frequently talked about, there are other Americans, like me, who favor universal access to birth control but object to a universal subsidy.

Covering birth control for the poor may reduce costs overall insofar as it prevents unintended pregnancies that would ultimately cost more to cover. But the higher up the income scale you go, the less this logic applies. As noted in the 1995 study the Obama Administration has cited for its contested claim that its broader mandate is cost-neutral, "If, by expanding coverage, a payer simply finances the contraceptives that would otherwise have been purchased by individuals, then the payer's net costs are likely to increase." Among the middle and upper classes, providing 'free' birth control is inevitably going to subsidize it among a lot of people who'd be paying for it themselves if it wasn't covered. And it's also going to permit them to consume more expensive forms of birth control without bearing any added cost, even as pharmaceutical companies are incentivized to raise prices on even the cheapest products they offer, and to develop more expensive forms of birth control to exploit the lack of price-sensitivity. The Obama mandate may be cost neutral compared to some hypothetical alternative, but it is more expensive than the alternative that I am proposing - subsidizing birth control for poor women, and everyone else paying their own way - and also more expensive than a system that subsidized only the cheapest form of birth control pill. It also creates incentives for the cost of birth control to rise in the future.

The Case Against Subsidized Birth Control For All



A short history of health care in the United States might go something like this: once upon a time, people could pay a doctor, rely on charity, or go without medical treatment. Then some employers began offering health insurance as part of the compensation package negotiated with workers. The government encouraged that system through tax incentives, and later by requiring an increasing number of employers to offer health insurance. More recently, government has increasingly dictated even the coverage details of the policies that are negotiated.