It seems like there are 3 possible scenarios - 1) Insurance company doesn’t offer coverage of bc at all, 2) BC offered with a co-pay, or 3) BC offered without co-pay. Assuming you are comparing the effect of 2) vs 3), it would depend on how many more people use the BC if there is NO co-pay. If everyone who wants it gets it whether or not there is a co-pay, then offering it for free affects the bottom line.</p>
<p>I tend to think you would not get some massive uptick in usage just because it’s suddenly free, but hey, I could be wrong.</p>
I’m honestly not sure. I would have to know how many aren’t utilizing it correctly to know if providing insulin at no cost would save the insurance company money. Perhaps providing monitoring devices at no cost might be a better point of comparison. I have no data on that, though,but will take a peek. My inclination, though, is that in the specific population at issue, probably the vast majority of the insured are perfectly competent to take birth control pills and to monitor their blood sugar.</p>
<p>“isn’t that what is happening with the ACA?”</p>
<p>Sorry, I don’t know. Mainly I’m advocating the idea of a switch from lots of little groups (employers, prof societies, etc.) to one big group. Devil in the details, as usual. One big advantage is you don’t automatically lose health care when you lose your job.</p>
<p>Exactly. But the claim is precisely that some people wouldn’t get it if there were a co-pay, but would get it if there were no co-pay. In this case, we’re talking about a co-pay both for the doctor’s visit and for the prescription, btw.</p>
<p>Not quite. Generics are items that are no longer covered by patents. Once a patent expires, anyone can manufacture a product with the exact same ingredients.</p>
<p>Yes, Pharma pricing is non-transparent, and should be since they are private companies. (Is Apple transparent in its pricing of the iPhone or iPad?) But more importantly, some of the profits derived from BC pills is plowed back into research for so-called orphan drugs, of which there would be no research without the cross-subsidy since the population is too small to warrant the years of research required. If we drive out the pharma profits from BC pills, then other unintended consequences will occur.</p>
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<p>Perhaps true, but since nothing is free, the costs to the employer goes up. And since the benefit costs to the employer rises, it will tend to dampen future wage increases, or encourage more off-shoring. Also note that benefits currently are tax-free. Wouldn’t the government tax receipts be better off with a higher wage base than a higher benefit base? Again, more unintended consequences.?</p>
<p>zoos, with insulin, I think the issue is that while using insulin correctly clearly prevents terrible complications like blindness, untreatable infections and amputation, the terrible complications are not immediate. So Acme Insurance’s customer, 50-year-old diabetic Sarah, who doesn’t use her insulin (for whatever reason) may need her foot amputated at age 70. But by that time, she’s no longer Acme’s customer, so Acme has no monetary incentive to provide her at age 50 with the insulin she should be using.</p>
<p>But if Susie doesn’t use contraception now, she gets pregnant now, and Acme has to pay now.</p>
<p>“Isn’t that essentially what the government of Switzerland does for its people?”</p>
<p>Sorry, don’t know about Switzerland, but I think I’m describing a kind of Bismarck system used in France and Germany where there are various insurance companies (I lived in Germany for five years, where I, not my employer, chose the insurance company).</p>
<p>Yes, that’s how Switzerland’s universal coverage works.</p>
<p>With the ACA, everybody not covered by their employer is one big risk pool, except that employers can charge a lower premium to younger people. But they can’t charge more to people who are sick.</p>
<p>But wait, you say. They can’t charge me more because I’m sick? Hey! I’ll just wait until I get sick, and buy insurance then. </p>
<p>Um, yeah. That’s why we have the individual mandate.</p>
<p>But it’s not totally clear that free BC actually has that outcome. We might wish it did, but it’s not necessarily true. Even Planned Parenthood’s and Guttmacher’s numbers say that a majority of abortion seekers were technically “on” birth control. So prescribing doesn’t necessarily translate to proper usage. I just think the numbers are much too complicated. But reasonable people can disagree. My position is that employer-sponsored insurance plans should have the same co-payment across the board. I understand and respect that other fine people can have a different opinion.</p>
<p>BC reduces unwanted pregnancies, and unwanted pregnancies, among their other bad effects, cost money directly to (1) insurance companies and (2) the mother and/or birth family. And, all to often, to the taxpayers.</p>
<p>OK. I understand. And my position is that it’s sometimes a good idea to nudge people in the direction we want them to go. Reasonable people can disagree.</p>
<p>In the population at issue here, you simply don’t know what the numbers are or would be. We are STILL talking about a very tiny number of people, as mini always so correctly points out. You also can’t distinguish between unplanned and unwanted in this population. Respectful disagreement is a tough one on some dogmatic issues, isn’t it?</p>
<p>CF,
Insurance companies and employers are free to negotiate and offer no-copay birth control right now. We don’t need the government legislating away more of our rights to make our own decisions about how to spend our money in order for it to happen. Especially when there hasn’t been any evidence offered (at least on this thread) that free versus co-pay coverage will reduce unwanted pregnancies.</p>
I’m all in favor of nudging when public funds are in use. I just don’t think the government should be forcing employers to do the nudging. For me, that goes too far. Which comes back to my wish that health insurance wasn’t tied to employment.</p>