A Featured Response
By Michael A. Kelly
I want to respond to your post via personal letter since I am finding it hard to have a conversation about this issue where people actually listen. I’m frankly frustrated by the idea that someone yells, “Women’s health issue!” and most evidence-based conversation is expected to cease.
To start, I’d like to say that Rush Limbaugh is an ass. He’s sloppy, stupid, and is getting what he deserves. For those of us who are not left-of-center, he’s an embarrassment and an impediment to reasoned debate about important topics. What he said about Ms. Fluke was unacceptable. While the government should have no role in his demise, people are completely free to hang him in the court of public opinion and not do business with him or his sponsors.
Second, I believe that Ms. Fluke’s testimony to Congress was, at best, misleading because she’s an “advocate”. If you read her testimony, I think that you’ll see my point. Rush’s inability to actually critically analyze and respond to her testimony has imbued her with a saintly persona drawing attention away from her actual testimony.
Her testimony is here:
There are so many misleading statements, like where she actually admits that Georgetown covers birth control for non-contraceptive use after she’s painted a horror story whose basis was the lack of coverage, but let’s just focus on affordability and access:
Without insurance coverage, contraception, as you know, can cost a woman over $3,000 during law school. For a lot of students who, like me, are on public interest scholarships, that’s practically an entire summer’s salary. 40% of the female students at Georgetown Law reported to us that they struggle financially as a result of this policy.
One told us about how embarrassed and just powerless she felt when she was standing at the pharmacy counter and learned for the first time that contraception was not covered on her insurance and she had to turn and walk away because she couldn’t afford that prescription. Women like her have no choice but to go without contraception.
Just last week, a married female student told me that she had to stop using contraception because she and her husband just couldn’t fit it into their budget anymore. Women employed in low-wage jobs without contraceptive coverage face the same choice.
And some might respond that contraception is accessible in lots of other ways. Unfortunately, that’s just not true.
Women’s health clinic provide a vital medical service, but as the Guttmacher Institute has definitely documented, these clinics are unable to meet the crushing demand for these services. Clinics are closing, and women are being forced to go without the medical care they need.
Law school is three years, so her estimate is that birth control “can” cost $1000/year. She insinuates that cheap and affordable birth control is unavailable without insurance. Her statements, as I’ll show below, don’t even come close to reality. First, a little primer on birth control in the United States.
In 2002, 61.9% of all women used some method of contraception (over 99% had used contraception at least once in their lives). Of women who use birth control, female sterilization is the choice of 27% of those using contraception (primarily in the 25-34 and 35-44 age range). Male sterilization is 10.4%, once again mostly in the higher age ranges. The pill is used by 31.0% of women (with 53.5% of those aged 15-19 and 52.5% of those aged 20-24). Condoms are used by 23.8% of women’s partners (with 44.6% of those aged 15-19 and 36.0% of those aged 20-24). (All of this data comes from “Vital Statistics of the United States 2010: Births, Life Expectancy, Deaths, and Selected Health Data” edited by Mary Meghan Ryan and published by Bernan Press. It uses mostly CDC and National Center for Health Statistics data. The private publisher took over when the US stopped publishing the data.)
So condoms and the pill are the primary birth control of “young” women. Since condoms are over-the-counter and not covered by health insurance, Ms. Fluke confined her comments to oral contraception.
But the pill is not just cheap. It’s REALLY cheap. Nearly all of the commonly used formulations of the pill are generic drugs since these drugs were invented decades ago.
Wal-Mart offers generic versions of Ortho Cyclen and Ortho Tri-Cyclen, which, in 2007, comprised 20% of all oral contraception prescription in the US (according to a Sep 28, 2007 NY Times article). Wal-Mart charges $4/month or $10/quarter, i.e., $40/year if purchased quarterly. Target offers Tri-Sprintec (which is generic Ortho Tri-Cyclen) for the same price. Walgreens is more expensive. They’ll charge you $48/year ($4/month) for the Ortho products and $12/month for Mononessa and Trinessa, an alternative form of birth control. Rite Aid charges $20 per month but goes off the chart with availability. They offer 25 different contraception prescriptions. One is offered at $60 per quarter. The others are offered at $20 per month. See http://www.riteaid.com/www.riteaid.com/w-content/images/pharmacy/RxSavings_Directory.pdf.
Let’s compare these prices, which are available at tens of thousands of locations in the US, to Ms. Fluke’s statement. “Without insurance coverage, contraception, as you know, can cost a woman over $3,000 during law school.” We all know that? Really? Over a thousand dollar per year? Of course, she used the classic lawyer weasel word “can” in her statement. That means that she “can” say that anything is true.
A car “can” cost a quarter of a million dollars, but cars, in general, cost about a tenth that amount. If you can take the generic Ortho pills, you’ll pay $48/year, 95% less than what Ms. Fluke says the pill “can” cost. If you can’t and use Mononessa or Trinessa, they are $144/year at Walgreens, or 85% less. Rite Aid gives you a list of 25 drugs that cost $240/year, i.e., 75% less than what she quotes.
Yet, birth control “can” cost $1000/year. 40% of Georgetown female law students “struggle financially as a result of this policy”. Wow. 40% of Georgetown female law students are either really poor or they can’t find the local Wal-mart. My bet is on a misleading survey and a survey group that wants to “send a message”.
My point is simple. Rush is poison to the reasoned discussion that we need as country; however, Ms. Fluke isn’t any help either. My opinion is that nearly everything she said was misleading, including the stories. Most oral birth control was formulated decades ago and is now off-patent, solving the issue of cost and availability for nearly all women who take the pill. The issue of “reproductive freedom” has, for the most part, been solved by normal market forces. In terms of healthcare, we have other real and pressing issues to discuss honestly.
A pox on both their houses. We need better than this crap.
Michael A. Kelly