Viagra analogies have been in the news a lot lately, both in connection with contraceptive coverage and in connection with state laws restricting abortion. I love good analogies and I hate bad ones, so I’d like to take a little time to sort out the bad from the good.
Because there are several scattered points to be made here, I’m putting them in sections and labeling them with Roman numerals, to make it easier for commenters to tell us just which section(s) they’re responding to.
My insurance policy covers Viagra. I would prefer that it didn’t. Given the costs and the probabilities, erectile dysfunction seems to me like a crazy thing to be insured against. There are a whole lot of other things I feel the same way about. I’d prefer not to be insured against losing my eyeglasses. On the other hand, I’m very glad to be insured against needing chemotherapy or kidney dialysis.
I am financially pretty comfortable. If I were less comfortable, I think I would be even more unhappy about having to pay for Viagra coverage. The poorer you are, the more likely you are to prioritize things like groceries and car repairs.
In a more competitive insurance market, I might be able to find a policy more suited to my preferences. But in the insurance market we’ve got, I’m forced to accept a policy that makes me unhappy in many ways. Nevertheless, I have not asked my elected officials to ban Viagra coverage. That’s at least partly because I realize that I’m not the only one affected by this policy, and I’d prefer not to use the power of the state to impose my preferences on others.
Sandra Fluke (and others) are unhappy about having a policy that doesn’t cover contraceptives, just as I am unhappy about having a policy that covers Viagra. Unlike me, they seem to think that their dissatisfaction constitutes an argument for government intervention. I conclude that these people don’t understand (or are pretending not to understand) what an argument is.
I’ve even had a few emails from people trying to make the case that if the government does not require contraceptive coverage, then symmetry demands that the government prohibit Viagra coverage. I conclude that these people don’t understand (or are pretending not to understand) what symmetry is. For their benefit, here’s an example of an actual symmetry: If the government allows institutions to make their own decisions about Viagra coverage, then the government should allow institutions to make their own decisions about contraceptive coverage.
Even that symmetry, though, can be imperfect because your specific reasons for supporting or opposing contraceptive coverage might not apply to Viagra. You might support (or oppose) contraceptive coverage because you think it reduces the birth rate. But Viagra does not reduce the birth rate; if anything, it might do the opposite. If you think it’s important to reduce the birth rate, you might favor contraceptive coverage and oppose Viagra coverage; if you think it’s important to increase the birth rate, you might take the opposite positions.
I conclude, then, that regarding contraceptive coverage, virtually every analogy with Viagra is a bad analogy. The analogies are bad partly because they fail to address the key question “What should be mandatory?”, and partly because they fail to observe that good arguments based on externalities might well apply to one drug and not the other, or even to both drugs but in opposite directions.
On the other hand, Viagra analogies are in the news lately in a completely different way: Ohio State Senator Nina Turner (along with several of her counterparts in other states) has introduced legislation requiring men to undergo a series of humiliating procedures before they can fill their Viagra prescriptions. Here I am confident that Senator Turner is following in the admirable footsteps of Rush Limbaugh, by proposing a policy she doesn’t actually support in order to highlight its symmetry with a policy she finds appalling, namely recent legislation requiring women to undergo a series of humiliating procedures before they can have an abortion. I love analogies like this. They force people to face things they’d rather not face. Of course, no analogy is ever dispositive, but a good one can go a long way toward clearing the air.
But is Senator Turner’s analogy a good one? It depends, I think, on the intent of the Ohio abortion law.
There are two possible motivations for that law. Motivation One is paternalistic, proceeding from the assumption that women will make poor choices about abortion and that we do them a favor when we discourage them. If that’s indeed the motivation, then Senator Turner’s analogy is spot-on. If we’re going to assume (with no substantial evidence) that women make poor choices about abortion, why not assume that men make poor choices about erectile dysfunction drugs? If we’re going to arrogate the power to override women’s choices, why not do the same for men?
But Motivation Two is that the legislature believes abortion is ipso facto a bad thing and wants to discourage it in any way possible, without regard to what’s in the best interest of the pregnant woman. If that’s the motivation, then Senator Turner’s analogy becomes much weaker (unless you’re really prepared to argue that erections are ipso facto a bad thing). A perfectly consistent person might fervently oppose this legislation but still consider Senator Turner’s implicit argument a bad one.
Though I haven’t been paying close attention, I have the strong impression that Motivation One has been bandied about quite a bit by the proponents of these laws. So I think Senator Turner has got this right, and I admire both her logic and her gumption.