Rush to judgment on birth control

Rush Limbaugh is the reigning shock jock of conservative political punditry — insults, outrage and outsized bluster are his stock in trade — so it takes quite an uproar for him to apologize. But that's what he has done at least twice now, if unconvincingly, after calling 30-year-old Georgetown law student Sandra Fluke a "slut" and "prostitute" for testifying to a Congressional panel in favor of the Obama administration's birth control mandate.

Last week's personal attack was outrageous, particularly given that Ms. Fluke's testimony was never about her desire to have "recreational sexual activities" as Mr. Limbaugh continued to describe the matter in his on-line apology. She spoke out about a friend who had to have an ovary surgically removed because she could not afford birth control pills that would have otherwise controlled her condition.

We would not waste our time exploring the depths of Mr. Limbaugh's misogyny or the likelihood of any genuine "heartfelt" remorse on his part, but we would note that he remains the poster child of public incivility, and the likelihood of further such incidents is high. The fact that advertisers are dropping his show, and some stations have decided no longer to carry it, is no surprise. Mitt Romney and other Republican candidates for office who wish to promote conservative views without them being associated with such personal attacks would be wise to offer a more robust denunciation of the talk show host than they have so far produced.

The episode, particularly in light of religious objections to the same mandate, suggests that much of the public, Mr. Limbaugh included, still don't understand why the administration sought to make contraceptives more available to women — at least why medical experts perceived them as so important that they should be offered by health insurers without a co-pay.

The genesis was in the Affordable Health Care Act and its mandate that Americans be covered by private health insurance policies. The law requires the Department of Health and Human Services to establish exactly what medical products and services should be covered at minimum (what's known in the trade as "essential health benefits").

A report released last year by the Institute of Medicine described the mission succinctly: "Finding the right balance between making coverage available for individuals to get the care they need at a cost they could afford." Contraceptive coverage was far from the only benefit that HHS determined should be offered without co-pay — diabetes testing, immunizations and certain types of cancer screening were also recommended.

Why? Because, as the IOM noted, the administration should try to get the most value for the money. Even setting aside the various non-contraceptive health benefits of birth control pills (from reducing the severity of premenstrual syndrome to preventing endometrial cancer), reducing incidence of unwanted pregnancy ought to be a high national priority.

Not because it's a nice thing to do or even that women might welcome it, and certainly not to restrict "religious freedom" as some claim. But because unwanted pregnancy costs society a huge amount of money purely as a matter of public health. A recent study by the Guttmacher Institute noted that public expenditures for unintended births in one year (2006) exceeded $11 billion, and that's just for child birth and delivery.

It's really much more costly than that. Higher rates of abortion, poverty, poor prenatal care and myriad other social ills can be traced to unintended pregnancy. That doesn't happen when women have ready access to contraception. Only about 5 percent of unintended pregnancies involve women who use birth control regularly, according to the Guttmacher report.

That's why Medicaid has been paying for family planning services for years. Preventing pregnancy is not a burden for taxpayers but an investment with so lucrative a return as to make a hedge fund manager blush. If Medicaid did not pay for family planning, one study estimates, the rate of unintended pregnancy among poor women would double.

Now, it's fair to say the rich don't need the insurance mandate or help from taxpayers. They'll either behave responsibly — or deal with the consequences. But the mandated health insurance coverage is going to affect millions of women who are neither wealthy nor Medicaid eligible. And not an inconsiderable number of them work for religiously-affiliated institutions.

Conservatives can continue making the claim that Mr. Obama's health care reform law amounts to socialism and that the mandate offends the Constitution (although we would disagree with either point). But what they can't argue, at least not rationally, is that increasing access to contraception is merely some kind of indulgence when everyone stands to benefit so greatly from it.

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