Limbaugh, Fluke, and some serious questions about birth control

The firestorm set of by Rush Limbaugh's comments is obscuring the issues behind the real question: Should contraception be provided for free for all women by all health plans? Photo: Associated Press

NATCHITOCHES, La., March 6, 2012—The firestorm over Rush Limbaugh and Sandra Fluke has generated a great deal of discussion over the uses of birth control. In particular, Limbaugh’s critics argue that almost all adult women use or have used contraceptives, and often for reasons other than contraception.

The argument is not just about birth control, but about women’s health.

The whole debate raises some interesting questions:

  1. If the issue is that contraceptives have other health benefits, should we not restrict the obligation to provide them under insurance plans to just the pill? Diaphragms and IUDs have no value in preventing ovarian cysts, excessive menstrual bleeding, or anything else other than pregnancy, do they?
  2. If we restrict this discussion to the pill, should coverage be obligatory only when it’s used to treat conditions other than fear of pregnancy?
  3. If insurance programs should be required to cover life-saving or medically necessary drugs and procedures, then religious objections to blood transfusions and non-contraceptive use of birth-control pills should be ignored. But shouldn’t they have a place in deciding whether religious groups must provide insurance that covers elective medical care that they consider improper? If they must cover gender realignment surgery, why not breast implants for women with low self-esteem or penile enhancement for men who feel short-changed by nature?
  4. Why should contraceptives be singled out for special treatment (provided free, with no co-pay), when other critical drugs and procedures are not?
  5. We do understand that there’s no such thing as “free,” do we not? All contraception provided without cost to end users will be paid for by someone, so the only real question here is, who should pay?

It would be interesting to see data on just what percentage of women are prescribed birth-control pills to control cysts and bleeding, but the focus on them is reasonable even if they’re a minority.

Many women use birth control not so that they can be promiscuous, but because it’s medically necessary, and in those cases it should be covered by insurance. Just because it’s called a “birth-control pill” doesn’t make it a contraceptive. It’s only a contraceptive if it’s used for contraception.

Many drugs are dual-use.

When contraceptives are used for contraception, are they elective? Women who use them for that purpose are usually not promiscuous (again, data would be nice, and I’m guessing), but even for those who are, a question is whether they use contraceptives so they can have sex, or whether having sex, they use contraceptives to avoid pregnancy.  

Either the tax payers on balance are being asked to subsidize women who want to have sex, or they’re on balance being asked to help women who are having sex not to have children as a result.

In either case, birth control is elective. Chastity may not be fun, but it isn’t life-threatening. If religions that disapprove of contraceptive drugs don’t want to provide them, we should ask whether having sex without risk of pregnancy is such a fundamental human right that we should all pay for it.

And, on a sarcastic but serious note, if sex is such a fundamental human right, should we not pay for it for all the unattractive people who can’t get it for free? Why subsidize sexual activity only for people sufficiently attractive to be offered sex for free?

Why not at the very least subsidize matchmaking services?

The issue of making birth control completely free to the user is vexing. Some argue that having children is a matter of enormous emotional and economic import to women, and that the long-run impact of a new life is enormous. If you think that cancer isn’t a matter of enormous emotional and economic import, you’ve not had that disease strike in your own family.

Why contraceptives should be free and chemotherapy should not isn’t explained by that argument.

Nor do we recognize the long-term costs and impact of diabetes when we say that IUD’s should be free while insulin should not. And unlike contraceptives used as contraception, there’s nothing remotely elective about chemotherapy unless you consider a painful death more optional than chastity.

Limbaugh should never have called Fluke a “slut.” That was unnecessary, unkind, uninformed and stupid. Whether he should be further punished for it is a discussion that’s occurring all over the internet.

The interest here today is on the underlying issue that motivated Fluke’s activism and Limbaugh’s anger, the idea that birth control drugs and devices should be provided under all insurance plans. But the dust-up over Limbaugh’s comment provokes another, more cynical question:

Why are the highly intelligent women who attend Georgetown University, a pricey and exclusive institution that doesn’t let trailer trash darken its campus, unable to find contraception for less than $1,000 per year?  

It can even be had in the DC metro area for free.

There are real, substantive issues involved in this debate, issues of women’s health, the limits of religious freedom, and what sorts of benefits can be covered by insurance while keeping insurance affordable.

The political theater is largely manufactured, raising questions of left-right hypocrisy, the motives of Limbaugh, Fluke, and their various detractors, and how this will all play out in the political campaigns this year. We can, of course, deal with both sets of questions, but the latter set will dominate the discussion. It almost always does.


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James Picht is the Senior Editor for Communities Politics and teaches economics at the Louisiana Scholars’ College in Natchitoches, La., where he went to take a break from working in Moscow and Washington. But he fell in love with the town and with the professor of Romance languages, so there he stayed. Now he teaches, annoys his children, and makes jalapeno lemonade. Twenty years ago he made an obnoxious faculty colleague’s ears spurt blood by saying he liked Limbaugh, and for that memory he’ll always have some affection for Limbaugh. He tweets, hangs out on Facebook, and has a blog he totally neglects at

This article is the copyrighted property of the writer and Communities @ Written permission must be obtained before reprint in online or print media. REPRINTING TWTC CONTENT WITHOUT PERMISSION AND/OR PAYMENT IS THEFT AND PUNISHABLE BY LAW.

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Jim Picht

James Picht is the Senior Editor for Communities Politics and teaches economics and Russian at the Louisiana Scholars' College in Natchitoches, La. After earning his doctorate in economics, he spent several years working in Moscow and the new independent states of the former Soviet Union for the U.S. government, the Asian Development Bank, and as a private contractor. He returned to Ukraine recently to teach principles of constitutional law and criminal procedure at several Ukrainian law schools for a USAID legal development project. He has been writing at the Communities since 2009.

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