It all started with puppets.
A few days ago, the women’s rights group Ultraviolet sent out a satirical video highlighting how absurd it is to let bosses make private decisions for their employees and deny them access to the birth control coverage to which they are legally entitled. In the video, Creepy Puppet Boss and Creepy Puppet Judge follow a married woman with kids into her bedroom, complain about paying for all the sex she will be having with her husband, and lie about contraception being the same thing as abortion. It’s all very cute and horrifying.
I tweeted about it. Then Vox Senior Editor Timothy Lee tweeted back with this:
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And, well, it caused a kerfuffle. People questioned Ezra Klein’s judgment for hiring Lee at Vox, Klein’s journalism startup that promises to “explain the news”; Planned Parenthood jumped in and explained to the explainer why the contraception mandate is needed; and of course trolls from both sides leaped out of the bushes begging to be fed.
Lee, it should be noted, is a libertarian technology writer who almost certainly won’t cover reproductive health for Vox. He’s also a nice guy with whom I’m casually acquainted in person. But he was still very wrong about the issues surrounding the birth control benefit, and he drew attention to why a lot of people are still very wrong about it, even mere days before the Supreme Court is scheduled to hear arguments on whether corporations have religious freedom that they can use to curtail their employees’ freedom.
According to Lee, women are “free” to “pay for their own birth control” if they choose. Thus, “luckily,” there are no real barriers to getting contraception. Great—problem solved! Birth control isn’t illegal, so it’s a party at the pharmacy! Cast off your chains and open your wallets, oh ye of the unfettered access!
Except: We already pay for birth control, with our monthly insurance premiums and with the labor that earns us our health coverage if we are insured through our employer.
Insurance is required to do certain things for us in return for those often exorbitant premiums, and right now one of those things is providing coverage of numerous forms of basic primary health care, including basic contraceptive and reproductive health care, without a copay. Not free.
Simply put, people who say women are getting “free birth control” don’t know what they’re talking about. Premiums aren’t cheap, nor is birth control if we don’t have insurance; it can easily run from $600 or more per year just for prescriptions, never mind doctor’s visits.
Women who don’t have much money to begin with aren’t as “free” to spend it, as Lee assumes; indeed, 55 percent of women report experiencing a time when they could not afford to use birth control consistently. Not using birth control consistently (depending on how inconsistent you are and how false your sense of security is) is, in the worst cases, probably not much better than not using it at all.
It’s absurd that many of us depend on employers for health care, but it’s what we’re stuck with, and if health care is going to be a part of our wages, it should be treated that way. Employers can’t decide how their employees can spend their paycheck, and they also can’t dock an employee’s pay because they don’t like what she does in the doctor’s office.
Make no mistake: Denying women contraceptive coverage that they are legally entitled to, forcing them to pay much more out of pocket than they otherwise would have, amounts to a pay cut.
It’s also a lousy idea, because an ounce of prevention is worth a pound of, um… baby? You know what I mean. Pregnancy is incredibly expensive, and unintended pregnancy even more so, for both women and society—much more than the cost of making sure unwelcome pregnancies don’t happen in the first place. The public health and individual benefits of access to contraception are well established, and there is no reason to treat birth control any differently than other forms of preventive care.
Now, the option to deny women this opportunity is supposed to be about religious liberty. But in all the hand-wringing over the souls of secular corporations like Hobby Lobby, many forget that employees—flesh-and-blood people, not abstract entities—have religious liberty too.
Moreover, why are we taking seriously the “conscience” claims of an organization that, until the Affordable Care Act (ACA) became controversial, actually covered emergency contraception for its employees through its insurance plan?
It’s funny, isn’t it, that there has been so much public outrage over an issue that just happens to be about helping women determine their sexual and reproductive autonomy. Is there any other procedure covered by insurance but objected to by a religious minority—blood transfusions for Jehovah’s Witnesses, or vaccinations for Christian Scientists—that we would seriously consider letting members of those groups not just refuse to use themselves, but also deny to others who don’t share their beliefs? Why do we give so much deference as a society to people with sincerely held beliefs that just happen to harm women, and why do we consider letting them set such a dangerous precedent that could so easily restrict other freedoms in the name of an employer’s “conscience”?
It’s worth noting that birth control isn’t the only preventive care that the ACA requires to be covered without copays. There’s maternity care and well-baby visits, prostate exams for men, cervical cancer screenings for women, and on and on. The maternity care coverage got some pushback at first too. (Not so much with well-baby exams, but that’s stigmatization of women’s health care for you.)
Birth control, though, has remained the right’s wedge to try to pry apart the whole system. They’ve framed it as a reasonable accommodation of religious liberty—the least we can do, really. And less-religious conservatives, libertarians, and centrists have started nodding along with them, as Lee seems to be. They’ll point to the limited selection of $9 generic pills at Target and ask, “Why can’t you just use your own money for this?” (Never mind that not all women react well to those select brands, or that some women may do better with an IUD or other method of birth control.)
The thing is, that’s not a question people are bothering to ask about Viagra—which does require copays but is still covered under insurance—or prostate exams, or well-baby visits. The “we’re paying for you to have sex” meme really got off the ground when people got it into their heads that women are getting “free birth control.” C’mon, we can’t have freeloaders, can we? Freedom isn’t “free”!
Except it’s not about the no-copay thing, at least not really. That fueled the fires of indignation, but the religious right is pushing for insurance plans that don’t even cover birth control—and most of them already did, even if they required copays. That’s an extra step back, and one that makes coverage for Viagra that much more awkward to explain.
Most of the people who whine about “paying for your sex life” have probably always done so, just as you have for theirs, unless they’re celibate and never went to the doctor for sexual health checkups—and even then, you probably “paid” for some other personal habit of theirs (except everybody paid less than they would have for themselves in isolation). That’s how insurance works, and that’s how society works.
None of us is an island, and we all pay into a giant pool of money to cover a variety of issues that crop up when people live their lives every day. Driving is pretty dangerous, but you don’t see most people arguing that they’re being required to pay for your poor choices if you get into an accident, or that you can always avoid one by just not driving.
Many of the fundamental problems in this debate boil down to differing understandings of the word “freedom,” not to mention the word “responsibility.” It’s almost a reflex for many conservatives to add the word “personal” in front of both—and to claim the freedom not to be responsible for others.
A friend of mine tweeted that many of her male friends were simply ignorant of how much hormonal birth control can cost women, and that they’ve confessed “how awful they felt when they found [out the] cost of their behavior to women in their lives.” The cost of their behavior. It behooves us to start talking about shared responsibility, not just personal.
Women are not the only people who have sex, whose lives are affected by pregnancy, and whose participation in society will be better and healthier if they can choose when or if those pregnancies happen. So when somebody like Timothy Lee comes along, dismisses cost barriers, and glibly implies that it’s women’s problem to figure that out because they can always just “buy their own” birth control, it exposes views that are a problem for all of us. Birth control isn’t women’s “own,” it’s not like most other purchases, it’s not a luxury, and everybody owns the consequences of making it harder to access.