I suspect we’re all getting bored of talking about Sandra Fluke, contraception policy, alternative solutions, and the reaction thereto, but I’ve just had an email from a reporter who’s confused on a point so basic, I thought it might be worth clearing it up for a larger audience.
The reporter writes:
As you might suspect, I disagree with your assertion that “All she said, in effect, was that she and others want contraception and they don’t want to pay for it.” I was wondering if you happened to catch the part of her speech where she talked about wanting women whose doctors have prescribed birth control pills to treat medical disorders like endometriosis to be able to get such drugs without having to pass tests demanded by religious institutions? Is this an unimportant part of the debate?
Here is a slightly edited version of my reply:
Thanks for your email. You might not be surprised to learn that I think you’ve still missed the point.
Individuals and their insurers reach certain agreements about what will and won’t be covered. These agreements reflect the needs and preferences of people on both sides. (Of course individuals usually don’t negotiate directly, but they negotiate indirectly by expressing satisfaction and dissatisfaction to their insurers and employers, etc.)
Those agreements reflect all kinds of compromises among various needs and wants, including the ones Sandra Fluke listed. Some of those needs and wants are based on health, others on religion, others on lord-knows-what. But they are all things that someone somewhere cares about. Compromises are reached, and, as always, each side wishes they’d gotten a better deal.
The key question is: Do third parties (e.g. the government) have any legitimate reason to want to modify or overturn those compromises? Most economists will say: Perhaps, if the compromise affects third parties; no otherwise. (Another exception: If there is reason to believe that the negotiators missed an opportunity to benefit both sides. We believe we’ve got a pretty complete catalogue of exactly when these exceptions occur; Sandra Fluke did not point to anything in that catalogue.)
The mere fact that one side is dissatisfied with the compromise does not count as a reason to overturn it.
If you want to see what an actual reason looks like, please see my post on contraceptive sponges, where I’ve listed a bunch of possible legitimate reasons to overturn the compromise —for example, you might think it affects the birth rate and that third parties have some legitimate interest in that. Some of these reasons are (in my opinion) much better than others, but what they have in common is that they are at least reasons.
Ms Fluke’s position, as I understand it, is not that the compromise reached at her institution affects third parties. It is that she (or other students at her university) don’t like the compromise. That’s the difference between what an economist would recognize as an actual reason for third parties to become involved, versus a mere expression of dissatisfaction, with which we might or might not sympathize, but which doesn’t seem to merit government action.
Had Sandra Fluke offered an actual reason for her position (including any of the ones I proposed on my blog), I might have disagreed with her, but we’d at least have had the basis for a thoughtful discussion. By contrast, it’s quite impossible to have a thoughtful discussion with someone who says only that she doesn’t like the outcome of a negotiation. Of course the students want their health policy to cover pills for endometriosis and unsurprisingly, a Catholic college prefers not to cover them. Neither of those preferences seems any more interesting than my preference for cucumbers over tomatoes. If I argued that supermarkets should stock cucumbers instead of tomatoes solely on the basis of my personal preference, my argument would deserve to be mocked.
I hope that’s clear. Please let me know if it’s not so I can try again.
Edited to add:
The reporter sent me a followup email containing this question:
Do you think that “reasons” accepted by an economist deserve more weight and respect than “reasons” a medical doctor might have for recommending that birth control be universally covered by medical insurance?
To which I replied:
Yes, absolutely. Here’s why: Economists are trained to look at all the consequences of a decision before passing judgment; doctors tend to focus only on some kinds of consequences (those directly related to health) while ignoring others (for example, the many other effects that flow from raising people’s taxes or insurance premiums).
I do believe that any sensible debate about a public policy ought to try to account for all the effects of that policy, not just selected ones.
Economists have thought long and hard about how to make sure we do that. We don’t always get it right, but at least we’ve got a framework for it. Doctors don’t.