Jindal: Make the Pill an over-the-counter medication

For the past year, the US has spent an enormous amount of time debating what the CDC rather conclusively reported was a non-issue in 2009 — access to birth control.  Democrats rode the “war on women” meme to a decisive advantage among single women in the election last month, despite the evidence that this was nothing more than demagoguery.  Since the evidence got subsumed by the emotional appeal in the election, though, Republicans have wondered how to defuse this “issue” in future elections.  Louisiana governor Bobby Jindal offers a proposal to make birth-control medication an over-the-counter purchase to simplify access and end the potency of the political argument:

As an unapologetic pro-life Republican, I also believe that every adult (18 years old and over) who wants contraception should be able to purchase it. But anyone who has a religious objection to contraception should not be forced by government health-care edicts to purchase it for others. And parents who believe, as I do, that their teenage children shouldn’t be involved with sex at all do not deserve ridicule.

Let’s ask the question: Why do women have to go see a doctor before they buy birth control? There are two answers. First, because big government says they should, even though requiring a doctor visit to get a drug that research shows is safe helps drive up health-care costs. Second, because big pharmaceutical companies benefit from it. They know that prices would be driven down if the companies had to compete in the marketplace once their contraceptives were sold over the counter.

So at present we have an odd situation. Thanks to President Obama and the pro-choice lobby, women can buy the morning-after pill over the counter without a prescription, but women cannot buy oral contraceptives over the counter unless they have a prescription. Contraception is a personal matter—the government shouldn’t be in the business of banning it or requiring a woman’s employer to keep tabs on her use of it. If an insurance company or those purchasing insurance want to cover birth control, they should be free to do so. If a consumer wants to buy birth control on her own, she should be free to do so.

Over-the-counter contraception would be easier to obtain if not for some unfortunate aspects of President Obama’s health-care law. One of the most egregious elements of that law is the hampering of Health Savings Accounts, which have become increasingly popular in recent years because they give Americans choices in how to spend their money on health care. By removing the ability of citizens to use their HSAs to purchase over-the-counter medicine tax-free if they don’t have a doctor’s prescription, President Obama hurt many middle-class families who counted on using their HSA dollars every flu season to take care of their children. Health Savings Accounts should cover over-the-counter purchases, and those should include contraception.

It’s time to put purchasing power back in the hands of consumers—not employers, not pharmaceutical companies, and not bureaucrats in Washington. The great thing about America is that power doesn’t come from government, but from people. It’s time to reclaim that power. It’s time to stop government from dividing people or insulting deeply held religious beliefs, and return the country to the path that has always made it great—one where Americans respect and value their fellow citizens, no matter their creed.

As an unapologetically pro-life Catholic who is also Republican, I have no problem with this, either.  I may not choose to use birth control, and may argue that its use has eroded family life and created a number of social ills, but that’s true of many products and services in our time that are not illegal.  Those arguments can and will be made in cultural debates, but it’s not the role of government to deny access to medication that doesn’t harm others, or to needlessly put barriers to its access.  That’s not at all the same thing as arguing that “access” equates to “someone else pays for it,” but it puts the responsibility for its use — and its consequences — on the consumer, where it belongs.  The arguments against contraception should take place in the cultural arena, not the political arena.

Two issues arise from this proposal, though.  First, while I appreciate what Jindal says about the hypocrisy of having morning-after abortive pills available OTC but the Pill on prescription-only access, this same hypocrisy can be offered about the need to restrict access to most medications based on doctor’s notes.  The Pill has significant hormonal impact and other side effects, short- and long-term.  If that’s acceptable for OTC sales, why not Lipitor?  Cialis? Synthroid? Epogen?  If we can trust women to handle the Pill responsibly (and we can, even if we have other disagreements about its use in general), why not men and women for most other medications, too?  Stopping at the Pill seems a little difficult to justify intellectually except as a way to defuse an incredibly dishonest political line of attack.

Second, while I’d support this idea anyway, Jindal is being a little naive about this proposal’s ability to defuse the “war on women” attack.  First, the attack was nonsense on stilts from the very beginning, since Republicans never proposed restricting contraception in the first place, not even to scale back the Title X federal funding of contraception through Medicaid.  The Pill might require a prescription, but the overhead on seeing a physician once per year to get one isn’t enough of a barrier to create unwanted pregnancies at a level detectable in the 20-year CDC study linked above, and one can get generic versions of the Pill for as little as eight dollars a month now.  The abortion battle won’t end with this proposal, and I suspect Jindal would be less sanguine about dropping his opposition to that as a fellow pro-life Catholic.

Finally, demagoguery doesn’t work because of rational arguments and evidence.  It usually works in contravention to both, since one doesn’t need demagoguery when the facts are on one’s side.  Demagoguery works in ignorance of facts and rationality by playing on fear and emotion. This proposal should be pursued on its merits, but don’t expect it to change anything.