The Fiscal Conservative's Case for Spending More Money on Birth Control

By Max Fisher

We're not just subsidizing female contraception. We're prospering from it.

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Evelyn Flores, 16, holds her daughter Hailey, one month, at a health clinic in Garland, Texas. AP.

Many American men have been asking some version of the same question since Georgetown Law student Sandra Fluke testified about health insurance coverage of birth control: Why should I pay my money to buy protection for someone's else's sex life?

"Let me get this straight, Ms. Fluke, and I'm asking this with all due respect," Bill O'Reilly said on his Fox News show recently. "You want me to give you my hard-earned money so you can have sex?" He's mostly wrong -- Fluke wants to promote health, not sex, and O'Reilly's money isn't that hard-earned -- but he's a little bit right. Your health care premiums (not your tax dollars, that's different) pay into a private health care system that covers birth control.

It's hard to discuss the issue honestly, in part because Rush Limbaugh has framed the conversation in such ugly terms, and that might have something to do with its staying power. You don't have to be sexist to wonder why birth control is considered standard in health care coverage. Rather than talking about whether or not Limbaugh says terrible and sexist things (he does), maybe we should be talking about why paying for birth control makes all of us better off, which it does. Expanding access to female contraception would actually appeal to some of conservatives' most cherished ideals.

Spending $235 million on family planning would save $1.32 billion.

Put aside the fact that contraception is used to treat conditions that have nothing to do with sex (this was Fluke's actual point). Put aside that a woman's ability to control whether or not she is pregnant is about as fundamental and important as the right to health gets. (I've never been pregnant, but it sure seems like a more serious medical condition than a lot of the things we expect health insurance to pay to prevent, such as the flu.) Put aside that it's only if we assume all women are abstinent or should be that female contraception is about promoting sex instead of protecting health, and that no society in history has ever made this assumption. Even put aside that O'Reilly and Limbaugh don't complain about male contraception such as vasectomies, and they definitely don't complain about "paying for people to go skiing," which is exactly what happens when your health care premiums go toward fixing all those broken legs.

Even if you reject all of the above, you should still want health care to cover female contraception, and you should be excited about paying for it. This is because health care subsidies on birth control actually save you money -- a lot of money. Every dollar that our society spends on preventing unintended pregnancies produces us "savings of between two and six dollars," according to a new report from the Brookings Institution. The savings come from averting health care, child care, and other costs associated with unplanned pregnancies. That's a rate of return of 100% to 500%, making it one of the safest and most profitable investments anywhere.

"Unintended pregnancies are disproportionately concentrated among women who are unmarried, teenaged, and poor," the report finds. Those are all groups of people who could probably use help affording contraception. If you happen to dislike the idea of your money going to help poor, unmarried, or teenage women, consider the fact that you will not just get your money back, you'll at least double it and at most quintuple. You'll enjoy this profit in the form of lower health care costs and lower taxes.

The reverse may also be true: spending less money on contraception services leads to higher health care costs and higher taxes. When Texas cut $73 million from state family planning services, the increase in unplanned pregnancies ended up costing $230 million in additional Medicaid burdens, according to the nonpartisan state Legislative Budget Board. The other result was more unintended pregnancies and, presumably, more abortions. Other states are considering similar measures.

As an added bonus, you'll also reduce the number and rate of abortions, 90% of which are estimated to be for unintended pregnancies. And you'll reduce the number of unwed mothers (if you happen to think this is a number that should be reduced), who carry 70% of unplanned pregnancies.

There are a lot of unplanned pregnancies in America (almost half of U.S. pregnancies are unintended) and these pregnancies cost all of us money. If you're thinking to yourself that unplanned pregnancies are only costly because of social safety net programs, think again. "Unintended pregnancy and childbearing depress levels of educational attainment and labor force participation among mothers and lead to higher crime rates and poorer academic, economic, and health outcomes among children," the report notes. It's not just about Medicaid spending, although the report says health care immediately related to unintended pregnancies cost the program $12 billion annually, or about 3% of Medicaid's total spending. It's about the productivity of our economy, which is something we'd all like to see improve.

Three things are driving the high number of unintended pregnancies, the report says: people who aren't motivated enough to practice safe sex, people who don't understand how to practice safe sex, and people who can't afford to practice safe sex. The third of these is probably the easiest to solve. For example, some of the most effective contraceptives are also the most expensive, such as intrauterine devices (IUDs), so the cheaper that health care makes them, the more people will use them.

Spending just $235 million to expand access to Medicaid family planning services would save $1.32 billion, Brookings projects. That's an amazing rate of return: 560%. And that's just the spending on a government health care subsidy. Paying your private health care premium is an even more efficient way to invest in female contraception because there's no new government bureaucracy to set up; the framework is already there. It's a private-sector solution that grows the economy and makes us all wealthier. It reduces the abortion rate and cuts down on the number of unmarried mothers. If that's not a conservative-friendly idea, what is?

This article available online at:

http://www.theatlantic.com/business/archive/2012/03/the-fiscal-conservatives-case-for-spending-more-money-on-birth-control/254442/