Opinion: Limbaugh drowns out his own message about the pill

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Rush Limbaugh has been trying for three days to apologize for calling Georgetown law student Sandra Fluke a ‘slut’ and a ‘prostitute’ on air without retracting any of his criticism of Fluke’s position on contraception. It’s a fine line to walk, and he’s not nimble enough to do it -- his apology and subsequent explanation did nothing to dispel the misogynistic and voyeuristic self-portrait his remarks about Fluke had painted.

So instead of actually illustrating the ‘absurdity’ of Fluke’s testimony, which he says was his intent, Limbaugh became the story. That’s why Limbaugh should also apologize to critics of the Obama administration’s mandate that insurers cover contraceptive drugs with no out-of-pocket costs. He’s trampled all over their side of the issue.


Before going any further, let me acknowledge that I’m probably wasting my time here. Writing about a Limbaugh-related controversy is like writing about Derek Fisher’s value to the Lakers or President Obama’s birth records. Facts don’t matter much, and no matter how persuasive my case might be, I’m not likely to change anybody’s mind.

Nevertheless, Fluke’s testimony cried out for a rebuttal, albeit a completely different one than Limbaugh delivered. Her basic argument is that birth control drugs are vital but expensive, and some students can’t afford them. Therefore, Fluke says, insurance should pay for them.

If something is valuable to society but too expensive for some people to afford, the right way to respond (at least, in economic terms) is by offering subsidies only to lower-income people, and only for that specific thing. The approach being taken toward contraception -- requiring that it be included in insurance policies with no co-pays -- doesn’t do that. It subsidizes contraception even for people who can easily afford it, at the expense of those who don’t need or use contraceptives.

Supporters of mandatory coverage for contraceptives say that they save money in the long run by averting unwanted pregnancies and certain devastating health problems, such as the ovarian cysts that Fluke talked about in her testimony. Those benefits, however, are spread across the healthcare system. The costs aren’t. Someone has to pay for the birth-control tablets, morning-after pills and other contraceptive services that will be provided for free to the insured.

As a result of the administration’s new policy, that ‘someone’ will be everyone who pays for coverage. Insurers will project the cost of the prescription contraceptives likely to be obtained by their customers, then recover that cost through their premiums, plus overhead and profit margin. The same will be true for all the preventive services that, according to the Patient Protection and Affordable Care Act of 2010, must be provided with no out-of-pocket costs.

The hope is that, over time, these preventive services will slow the increase in healthcare costs and insurance premiums. That doesn’t mean the services will be free. It means the initial cost will ultimately be recovered by reducing future price increases.

The Times’ editorial board has argued repeatedly in favor of this approach, and it may be the most practical way to maximize the exposure to and benefits of preventive services. It’s just not an efficient way to subsidize something that society wants people to have.

It’s also worth remembering that health insurance is designed to protect people against the risk of large and unexpected medical costs. If insurers covered the routine cost of things that policyholders know they will need -- toothpaste, for example -- the resulting increase in premiums would probably be greater than the cost of people paying for that item or service themselves. That’s because insurers mark up their costs before passing them on to consumers.

Unlike Limbaugh, I’m not suggesting that it’s wrong for Fluke to want her fellow Americans to help income-strapped female law students afford contraceptives. I’m just saying that she seems to suffer the same misconception about insurance that most everyone else does. Providing coverage for something doesn’t make it ‘free,’ and it’s not the only way -- or necessarily the best one -- to achieve the intended result.


Blame it on the pill

Birth control: What do bosses get to decide about us?

Contraception spin battle: an attack on faith or women?

--Jon Healey