In marveling at Limbaugh’s attack on college student Sandra Fluke something popped up in my brain. Did I hear that right? Does a year’s supply of birth control pills really cost $1,000? Surely not. Hormonal birth control has now been around for, well, most of my lifetime, and that’s more than enough time for it to have gone generic. A web search reveals that the cost varies a great deal and ranges from $10 to $100 or more a month. What the article did not explicitly explain was why the cost has such a wide variance. There can only be one reason: when the cost of a medicine or procedure is borne by health insurance the consumer loses her motivation to shop by cost. The article says, revealingly,
A 2009 study by the American College of Obstetricians and Gynecologists showed that one-third of women using birth control were more mindful of their contraception because of economic concerns. For women using hormonal methods, 13% reported being worried that they might not be able to pay for it.
Get that? If only 13% worry about the cost, then 77% are not worried about the cost – they have insurance. Now I’m really worried here because I am coming close here to agreement with Rush Limbaugh. OMG! No, not agreement with his misogynistic, crude, uncivil, aggrandizing attack style, but with the basic premise that something is wrong with the idea of the public paying for medical care in a way that does not control medical costs. Limbaugh’s aim is misdirected of course – he should be attacking the system and not Miss Fluke.
I have written about this before of course, but in the birth control issue we have an excellent example of why the country is drowning in healthcare costs. I submit that if hormonal birth control pills were not by prescription but over the counter and out of pocket, the cost would plunge overnight.
There is irony in the rise of this issue at this time. As has been pointed out by the Obama administration, health insurance providers actually come out financially ahead if they facilitate reproductive health. To that view, Wikipedia, as usual, is instructive. It says,
The most significant cost in birth control is the cost of failure to prevent pregnancy. Childbirth is expensive and risky, and raising a child takes a tremendous investment of time, energy and money. For example the average cost of a birth in the US is over $9,000 (cost to health plan, 2007 dollars). The US Department of Agriculture estimates that it costs $196,000 to $393,000 to raise a child from birth to age 17. (Depends on household income, total inflation adjusted estimated expenditure in 2007 dollars). By comparison, in the US, method related costs vary from nothing to about $1,000 for a year or more of reversible contraception.
The thought occurred to me that Limbaugh might have done the nation a favor here by highlighting the inefficiency of the so-called system we have, but I may have to reconsider that. Limbaugh’s obnoxious style has diverted public attention away from the real problem.
Still Skeptical After All These Years 
If there were one safe, effective generic pill out there that women could buy, they would be flocking to it. So (a) it would be nice if the profit-minded pharmaceutical companies would let their products go off patent and (b) it would be nice if Mother Nature cooperated and standardized women’s bodies so that the same pill would work for everyone. Unfortunately, neither of those is going to happen. Finding the right birth control method — one that works as safely, effectively, and conveniently as possible — can be a long process and requires guidance from a doctor.
You do come perilously close to Limbaugh’s stance by blaming women for not shopping around. It’s just not that simple. Even limiting the discussion to pills alone (which many, many women cannot use), there are still many products and formulations to chose from (with a wide variety of side effects, some life-threatening), and only a doctor (charging for office calls) can help a women figure out which product and dose is best for her, and then monitor for problems. It would be unsafe and irresponsible to sell something as powerful and potentially dangerous as these drugs over the counter.
Implants, rings, sponges, IUDs, etc., are alternative methods and each has its advantages and disadvantages. I don’t know how their cost compares to the pills, but the fact is that cost is probably the least of a woman’s concerns when she’s trying to find the best way to prevent pregnancy — something far more expensive and life-altering than any birth control method.
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Thanks for the update, PT. What you describe makes sense to me. However, knowing what the world’s most profitable industry (Big Pharma) is like I can’t help but suspect that they have found a multitude of ways to make tiny changes to the pills just enough to justify patent renewal. Continuing medications are much bigger cash cows than those that merely cure an illness and birth control fits that perfectly. Your point is valid but I hope someone else might clarify whether in fact a little shopping around might be beneficial for at least some women.
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Okay, I’m going to explain this in a way that is going to be way too much information for most men out there and I apologize for the ick factor that is about to follow. Birth Control pills are not all the same, they all have different levels of estrogen and progesterone. The pills of today are not the same pills our mothers took in the 70s. I can tell you that I take the pill for several reasons – both as a method of birth-control as well as to manage some ‘women’s health issues’ (without going into too much detail there). I have had to switch pills about six times in the last two years due to problematic side-effects (mood swings in one, others gave me problems like spotting, skin irritation, dryness, etc). One would work for about a six months and then problems would creep up. I just went to the pharmacy last week to get a new type of BC filled (and it’s generic) and the pharmacist told me that my health insurance denied it, so I needed to pay the full price: $108 (that’s $1250/year). Now, on my fancy teaching salary that’s nothing but women of less means may not be able to afford it. So now I”m on the hunt for a new brand (and those problematic pain issues – I’m having to deal with using more dangerous means like opiate pain killers – which are $5 for 30 in spite of their other problems). Birth control pills are not just a method of birth control, they’re used by doctors to treat a variety of legitimate medical health problems: severe cramping, severe PMS, poly-cistic ovaries, endometriosis, interstitial cystitis, various forms of cervical and uterine cancers, just to name a few).
I would also highly argue against their use as an over the counter drug because birth control pills can have severe and deadly side-effects that should be measured by a doctor – blood clots, high blood pressure, etc. It’s also a good way to get women in for their annual well-woman’s exam (just like my doctor on prescribing contact lenses requires that I get to the eye doctor once a year).
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Wow. This is all new information to me. Color me red, and also thankful for contributing your personal experience, Jennifer.
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If it makes you feel better, a lot of women don’t realize this either. It’s also a very important reason why women should be in close communication with their doctor when taking hormone therapy (which is exactly what hormonal birth control is). It’s also one of the reasons why I get so uncomfortable when a group of men (who are not medical professionals) start making decisions about my gender-specific health and make such broad, inaccurate assumptions in the way of Rush Limbaugh or Bill O’Reilly.
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You’re right, I asked Mollie about it and she was surprised too. When we were young, back in the ’60’s and ’70’s, she said when she and other Navy wives went to the doctor for BC pills, they all got the same thing. She started on them after having first one boy and then twin boys, and we weren’t sure what mathematical progression might be starting. (1, 2, 4, 8, . . ?) The pills ended when she had increasingly painful periods and opted for a uterine hysterectomy in her mid-40’s. The doctor said after the fact that it definitely looked suspicious and it was a good thing she did it – that wasn’t clear at all before hand. Now I’m wondering if her hormone therapy might have played a role in the problem?
Mollie also reminded me of a now-amusing story about the pills. One of our twin boys, aged about 5, found a fresh wheel of her pills at home one day and one by one dialed and ate every darned one of them! I was at sea, as I usually was in those days, but she rushed him to the Navy clinic. They dithered around for quite a while, she said, and finally decided that it didn’t warrant stomach pumping. It must have been OK because he’s still like his twin brother! 🙄
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Good Points all around it seems to me,
Actually I was considering a blog on this subject but Jim’s blog and ensuing discussion makes my essential point. DON’T JUST LISTEN TO SOUND BITS!!
Birth control pills are medications and should be controlled by doctors, period, in my view. Based on the female input above, they seem to be like anti-depressants, many difference types and some work, others don’t for particular individuals. Doctors need to monitor and control such matters.
But doctors and pills cost money, so the ultimate question becomes who should pay for BC for females or anti-depressants for all genders, suffering from a potentially deadly disease called depression. If I worked for a company controlled by say Christian Scientists, a religion that rejects almost all medical treatment, who would pay for my anti-depressant medications. The company would tell me to pray hard and “gut it out” with God’s help while I was trying to survive in “pit” of depression. I of course would purchase my own health insurance in such a case and would not ask the government or insurance company to provide “free” medications.
But try to have a reasonable discussion over such an issue today and all you get is Limbaugh back in your face with his “sound bite”. Sure demeans the debate process for a legitimate issue needing resolution.
Anson
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