The following post was co-authored by R Street Policy Analyst Caroline Kitchens.
After R Street Policy Analyst Caroline Kitchens, who co-wrote this post, wrote about birth control access in August for The Hill, more than a few allies asked us other questions about what we think and where we stand on some related issues. We’re writing this post to clarify what we as an institution think and deal with—and what we don’t deal with—on birth control and related topics.
To put it simply: We think current rules regarding access to many forms of birth control are an example of government overregulation. As such, R Street wants to change them both for their own sake and because it will advance our overall deregulatory agenda. We don’t, however, take institutional positions on related issues, such as health care and abortion.
With regard to birth control, the current regulatory regime is deeply unjust and imposes needless burdens on the vast majority of sexually active Americans. Even though the decision to use birth control (or not) is one of the most private parts of life, access to all hormonal birth control requires a time-consuming, intrusive and often expensive doctor’s office visit. This happens even though consumers are able to self-diagnose the need for the medication (in this case, wanting to avoid unintended pregnancy) and the drugs carry no risk of overdose or addiction. While some risks do exist in hormonal birth control, there is no reason why pharmacists should not be able to deal with those risks on the basis of questionnaires or minor screenings.
OBGYNs and pharmacists themselves support this. Nearly all American pharmacists already can write prescriptions for many types of vaccinations. There’s no reason why they shouldn’t be able to do what they already can in eight states and write them for birth control pills as well. In the short term, we’d like to expand pharmacist scope-of-practice to include other hormonal birth control—including the injection, patch and vaginal ring—and look for ways to allow other professionals who are not doctors to write prescriptions for the same.
To those who might suspect that we’re doing this to advance a broader libertarian and deregulatory agenda rather than simply working to expand access to birth control itself…your suspicions are justified. Our ongoing and expanding work on professional regulation convinces us that this might be a good way to get more people talking about different ways that people should be able to make a living without government approval and to draw attention to a particularly egregious and harmful example of regulatory overreach. If this helps spark a conversation that eventually makes it easier for cosmetologists to practice their craft after having learned basic health precautions rather than having attended pointless and expensive classes, we’ll be delighted.
With all of that said, we don’t see why this agenda with regard to birth control and professional regulation should obligate us to take positions on related issues. Besides a few scattered comments on very narrow reinsurance topics, we’ve been silent on those pieces of health legislation that have come before Congress since we opened our doors a little over five years ago.
Insofar as there is to be a system that specifies a mandatory benefits package and requires zero co-pay preventative care, we have no objection to the inclusion of birth control in that package and think it is probably a good idea. Since we are not advocating that birth control be made truly “over the counter,” we do think it should be covered by insurance plans on, at minimum, the same basis as any other similar prescription, even if it doesn’t require a doctor’s office visit.
The broader questions of what the health-care system should be able to look like and how (and if) employers and individuals might shape benefits packages based on personal or religious preferences are outside of R Street’s expertise. In the long term, we might pursue health care as an issue area. But we’re not going to wade into a debate that’s this complicated and consequential without deep expertise on the topic. And we don’t have that right now.
While we might eventually work on health care, R Street will never have an institutional position on abortion, per se, or any other issue that defies a solution that’s primarily economic. In the case of abortion, this is partly a matter of comparative advantage: there are dedicated, sincere, hardworking, well-funded and committed groups on both sides of the debate over the termination of pregnancies. Starting a program devoted to the issue at R Street would not add anything.
Just as importantly, we’re a pragmatic think tank that looks for innovative, market-oriented solutions to problems. The important political debate over abortion, as it involves profound questions of individual autonomy and human life, may not be suited to a market-oriented solution. Trying to point out the advantages of “the market” would not and probably should not convince anybody to change his or her opinions, anyway.
In short, R Street favors faster, better, cheaper access to birth control and doesn’t think getting it should require a doctor’s office visit. We don’t see a need to wade into other related issues to do this and, for the time being, we won’t.
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