# Everyone in the USA has access to birth control **URL:** \ **Category:** Great Debates\ **Created:** [March 6, 2012, 10:19pm UTC](https://boards.straightdope.com/t/everyone-in-the-usa-has-access-to-birth-control/614976 "2012-03-06T22:19:31Z")\ **Posts on this page:** 20\ **Page:** 7
**Author:** ![Kimmy\_Gibbler](https://avatars.discourse-cdn.com/v4/letter/k/bbe5ce/32.png) [@Kimmy\_Gibbler](https://boards.straightdope.com/u/Kimmy_Gibbler)\ **Post date:** [March 8, 2012, 9:50pm UTC](https://boards.straightdope.com/t/everyone-in-the-usa-has-access-to-birth-control/614976/121 "2012-03-08T21:50:18Z")
> [@DianaG](#): > > Probably it’s that preventing pregnancy among people who don’t wish to be parents is a net societal good, whereas whether or not you get your contact lenses makes no difference to anyone but you. But we like to achieve societal goods at the least possible cost. We could means-test this no co-pay system, so that we don’t have to eliminate the co-pays of those who could afford them readily. In general, we don’t want to subsidize behavior that’s already being undertaken voluntarily. Because that’s a total waste of money, right? ---
**Author:** ![Aji\_de\_Gallina](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/aji_de_gallina/32/260_2.png) [@Aji\_de\_Gallina](https://boards.straightdope.com/u/Aji_de_Gallina)\ **Post date:** [March 8, 2012, 10:27pm UTC](https://boards.straightdope.com/t/everyone-in-the-usa-has-access-to-birth-control/614976/122 "2012-03-08T22:27:03Z")
> [@Lobohan](#): > > Perhaps I am. But I’d assume they could interdict whatever state they wanted to pressure to stop slavery. But you know, that would be a lot of work. > > As to whether that would have worked, I’ll stipulate that it was less than certain to. Interdicting would’ve done nothing to stop slavery and would’ve impede effort by the Church to be on the ground helping the slaves’ situation. King Henry IV was excommunicated and he banished the pope, installed an anti-pope and meddled with the Church. Empty gestures are not important when actual actions can happen. > [@Dangerosa](#): > > And the government is paying for any of that…porn magazines, abortions, motels? Employers pay for that via insurance. I don’t get your point. > > I want the government involved in my HEALTH CARE. Birth control for me for much of my life had nothing to do with my bedroom. But even this has nothing to do with the government in my bedroom, it has to do with my compensation received from my employer covering basic health care needs for women. Like the ability to control dysmenorrhea via a medical prescription. The government doens’t pay for your company’s insurance either, you brought the gov’t into this. You still don’t get the main point as to why the Catholic Church opposes the plan. directly paying for something you don’t want and someone using the money you gave them to do something you don’t want, is different. Yes it has to do with the bedroom. Health care entails many things. Compensation packages are paid by the company, the company can decide what the compensation is. If you’re paying for our insurance you can have the plan you want. Can the government decide you MUST take birth control? Hormonal treatement for dysmenorrhea is not birth control. ---
**Author:** ![SmellMyWort](https://avatars.discourse-cdn.com/v4/letter/s/ea5d25/32.png) [@SmellMyWort](https://boards.straightdope.com/u/SmellMyWort)\ **Post date:** [March 8, 2012, 10:32pm UTC](https://boards.straightdope.com/t/everyone-in-the-usa-has-access-to-birth-control/614976/123 "2012-03-08T22:32:18Z")
> [@ITR\_champion](#): > > Well, I do not believe that when insurance companies are required to provide all types of birth control with no copay, it will reduce the number of pregnancies. This goes right back to what I started the thread to discuss, before we somehow wandered into Catholics’ non-existent support of slavery and suchlike topics. Everyone woman (and man) in the USA has free access to several types of birth control, and access to other types at a pretty low cost, and when women are asked their reasons for unplanned pregnancy, inability to afford birth control is not their answer, according to the CDC. I said as much in my OP. So since women already have access to so many good birth control options that are free or close enough to free, how is free birth control from the insurance company going to change the number of pregnancies? Consider that over the past generation some insurers have offered birth control with no copay–despite your claim that they won’t because “they’re afraid of pissing off the crazy religious people”–and the amount of easily available birth control has skyrocketed. What effect has that had on pregnancies in this country? [The fertility rate](http://prbblog.org/wp-content/uploads/2009/01/us-fertility-rate.gif) has been pretty flat. [The number of abortions](http://www.cdc.gov/mmwr/preview/mmwrhtml/figures/s6001a1f1.gif) has been pretty flat. Please share the “several types of birth control” that are available to every woman and man in the USA. In your OP you cite one guy who found lots of free condoms and an organization that would give pills, the patch, or the ring to women under the poverty line. That’s not exactly everyone. The inability to afford BC wasn’t their answer because it wasn’t one of the 6 multiple-choice responses given in the study. Instead of citing fertility rates you might consider the rate of unintended pregnancy. ---
**Author:** ![doreen](https://avatars.discourse-cdn.com/v4/letter/d/858c86/32.png) [@doreen](https://boards.straightdope.com/u/doreen)\ **Post date:** [March 8, 2012, 11:10pm UTC](https://boards.straightdope.com/t/everyone-in-the-usa-has-access-to-birth-control/614976/124 "2012-03-08T23:10:49Z")
> [@CannyDan](#): > > We’re discussing women who work for an employer who provides them with health care and that a particular health care option (birth control) requires them to see a doctor, have an examination or at the least a consultation, get a prescription, then have it filled by a pharmacy. > > And you’re suggesting that such a woman is likely to be so lazy or indolent as to go through all those steps, then just play with the pills on her lap tray? Because the actual use of the product requires more of a “fair amount of discipline” than obtaining the product did in the first place? So what you’re suggesting is that if BC was given away on street corners like, oh, I don’t know, M&Ms, maybe, then people might not put a high value on it? OK, I’m convinced. > > But I don’t know what that has to do with the actual situation under discussion. I don’t know that **Kimmy\_Gibbler** is suggesting that so much as she is suggesting that the vast majority of insured women who wish to use birth control pills are going to obtain them , copay or no copay. And a large number of the women who are not using birth control pills would not use them , copay or no copay \*. And some ( probably many of them) use some other form of birth control. And therefore it is not at all certain that providing the pill with no copay saves the insurance company money rather than costing money - it’s not a choice of pay for either the pill or a pregnancy. It’s pay for the pill, or maybe she’ll pay for it, or maybe she’ll use some other form of birth control or maybe she’ll get pregnant. - Forget giving them away on street corners, you could send someone to my house to give me my free pills every morning and I still wouldn’t take them . I’m over 40, have a family history of breast cancer and strokes , and I smoke. ---
**Author:** ![CannyDan](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/cannydan/32/548_2.png) [@CannyDan](https://boards.straightdope.com/u/CannyDan)\ **Post date:** [March 8, 2012, 11:40pm UTC](https://boards.straightdope.com/t/everyone-in-the-usa-has-access-to-birth-control/614976/125 "2012-03-08T23:40:11Z")
> [@doreen](#): > > I don’t know that **Kimmy\_Gibbler** is suggesting that so much as she is suggesting that the vast majority of insured women who wish to use birth control pills are going to obtain them , copay or no copay. And a large number of the women who are not using birth control pills would not use them , copay or no copay \*. And some ( probably many of them) use some other form of birth control. And therefore it is not at all certain that providing the pill with no copay saves the insurance company money rather than costing money - it’s not a choice of pay for either the pill or a pregnancy. It’s pay for the pill, or maybe she’ll pay for it, or maybe she’ll use some other form of birth control or maybe she’ll get pregnant. > > - Forget giving them away on street corners, you could send someone to my house to give me my free pills every morning and I still wouldn’t take them . I’m over 40, have a family history of breast cancer and strokes , and I smoke. And I suspect that the statistics on high rates of unplanned pregnancies cited in most of these threads, as well as the anecdotal comments of many people both on and off these boards suggest that, while many women do indeed manage to obtain birth control pills part of the time, they still have significant gaps in their anti-pregnancy coverage. I do not think it a stretch to assert that at least some of these gaps are for economic reasons. Thirty to fifty dollars a month may be a non-trivial expense to many women. And given the fact that pills are not a take-as-needed preventative, but must be taken regularly, any gap in obtaining the pills (“My transmission blew up - guess I can’t pay for pills this month. Maybe not for a few months. So we’ll just rely on cheap condoms and the rhythm method, and hope for the best.”) means a perhaps lengthy period of possible exposure to an unplanned pregnancy. Obtaining the pills is probably important to such a person, perhaps important enough to budget them highly “copay or no copay”, but perhaps not as important as losing ones job due to lack of transportation (or a variety of other unexpected setbacks). So a requirement that birth control be made available to working women routinely, reliably, and for a truly trivial expense (like $0) under an insurance plan they are already enrolled in anyway as a part of their compensation package seems to further an important societal benefit. It should help to prevent those gaps, some of which (not all, not every time, the incidence is clearly unpredictable) seem to result in unplanned pregnancies. ---
**Author:** ![DianaG](https://avatars.discourse-cdn.com/v4/letter/d/7ab992/32.png) [@DianaG](https://boards.straightdope.com/u/DianaG)\ **Post date:** [March 8, 2012, 11:44pm UTC](https://boards.straightdope.com/t/everyone-in-the-usa-has-access-to-birth-control/614976/126 "2012-03-08T23:44:08Z")
I entirely agree. My daughter is covered under my insurance, and her bcp’s are $30 or $35 every month. That is NOT a trivial amount of money for her (and I’ve covered her several times), and it’s not a trivial amount of money for a lot of young women, who I believe are meant to be the primary beneficiaries of this plan. ---
**Author:** ![WhyNot](https://avatars.discourse-cdn.com/v4/letter/w/c77e96/32.png) [@WhyNot](https://boards.straightdope.com/u/WhyNot)\ **Post date:** [March 8, 2012, 11:46pm UTC](https://boards.straightdope.com/t/everyone-in-the-usa-has-access-to-birth-control/614976/127 "2012-03-08T23:46:11Z")
> [@Kimmy\_Gibbler](#): > > But again, this is OTJ stuff. Maybe some other posters with experience in this realm will weigh in. I believe **WhyNot** is a nurse at an inner-city hospital. No, WhyNot is a nurse on the south side of Chicago (I’m never sure where the “inner city” of Chicago is, but yes, I work in lots of neighborhoods I wouldn’t visit after dark.) but I do home health care, mostly with elderly folks past the age of needing contraception (but NOT, as I always tell the embarrassed 73 year olds, necessarily past the age of needing condoms for STI prevention!) I am not more professionally qualified than anyone else in the thread on the issue of contraception prescriptions, although I have used PP before as a patient, I currently use a low cost LGBT clinic for my own reproductive needs (they take “straights”, too), and I do pay attention to some of these issues in the professional literature, where the hidden costs of preventative care comes up a lot lately. But again…not a professional expert, by any stretch of the imagination. Just so we’re clear. 🙂 > [@ITR\_champion](#): > > Everyone woman (and man) in the USA has free access to several types of birth control…So since women already have access to so many good birth control options that are free or close enough to free We still haven’t gotten your examples of these “several” and “many good” birth control options we have free or close to free access to. Maybe that’s why we’re not communicating. You say we have them, I say we don’t, we have one single rather sucky option. So you think this Pill thing is icing on a generous cake, where I only see crumbs. Just a list, that’s all. Give us a list of the many good free or nearly free birth control options women currently have available in the US, please. > [@Kimmy\_Gibbler](#): > > I’m asking you to prove that people, who right now are unwilling to make a minimal sacrifice of money to obtain a product that requires a fair amount of discipline to use effectively, will actually exercise that discipline if we provide it to them for free. I actually agree that this is worth studying. Especially given that it’s one of the hardest to use correctly birth control methods that we’re talking about: The Pill. I don’t believe this mandate covers other birth control options with less room for patient noncompliance, like the patch, ring, IUDs and Depo. That to me is a serious problem. We may be adding a contraceptive option to the table, but it’s another pretty sucky one. On the other hand… > [@](#): > > … I think it’s worth pointing out that this represents socializing private costs with little reason to think there will be much of a public benefit. If this is the wedge whereby Americans become accustomed to accept arguments for socialized health care and realize that this middle-way Obamacare isn’t nearly far enough for GOOD universal health care, I’m all for it! > [@Kimmy\_Gibbler](#): > > Well, I’m still waiting for the cite that shows that there are a substantial number of would-be compliant birth control users whose sole impediment to such use is the minimal expense. But I understand, research takes time. Especially when it doesn’t exist. I think the cites in [post 94](http://boards.straightdope.com/sdmb/showpost.php?p=14848377&postcount=94) satisfy me on that score. When insurance companies implement no copay contraception, their costs and employer costs go down. So apparently some increased number of women started using the prescription contraception and didn’t get pregnant. > [@Kimmy\_Gibbler](#): > > But we like to achieve societal goods at the least possible cost. We could means-test this no co-pay system, so that we don’t have to eliminate the co-pays of those who could afford them readily. > > In general, we don’t want to subsidize behavior that’s already being undertaken voluntarily. Because that’s a total waste of money, right? Unless freeing up that $16 or $25 or $60 a month lubricates the local economy just a bit, and the insurance companies and employers don’t see an increase in cost (as the Guttmacher and NBH studies found). Then it seems win-win. Women get a little more mad money to spend at the local coffee shop AND the costs for insurers and employers go down. That doesn’t seem like a total waste of money at all, actually. That seems like a wise financial decision, and a great example of why we should have more comprehensive socialized medicine. Maybe we should look into doing the same for weight loss supplements and gym memberships, and see if we can bring down the insurer and employee costs for obesity related illnesses, and at the same time save people the money they’re spending on the stuff out of pocket. Again, we get into the preventative medicine question: is it cheaper or not? I don’t believe that because it’s more cost effective in one case (contraception) it’s more cost effective in all cases, but it’s certainly worth looking into. ---
**Author:** ![doreen](https://avatars.discourse-cdn.com/v4/letter/d/858c86/32.png) [@doreen](https://boards.straightdope.com/u/doreen)\ **Post date:** [March 9, 2012, 12:09am UTC](https://boards.straightdope.com/t/everyone-in-the-usa-has-access-to-birth-control/614976/128 "2012-03-09T00:09:06Z")
> [@CannyDan](#): > > So a requirement that birth control be made available to working women routinely, reliably, and for a truly trivial expense (like $0) under an insurance plan they are already enrolled in anyway as a part of their compensation package seems to further an important societal benefit. It should help to prevent those gaps, some of which (not all, not every time, the incidence is clearly unpredictable) seem to result in unplanned pregnancies. I’m not saying it doesn’t further an important societal benefit. All I’m saying is that it is not as clear a \*financial \*benefit to the insurance company as some think - and it’s entirely possible that the benefit might be worth any increased cost. Although to be honest, I don’t see why the social benefit isn’t furthered by means testing- DianaG’s daughter may not be able to afford her copay, but my daughter (covered under my insurance ) certainly can. ---
**Author:** ![CannyDan](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/cannydan/32/548_2.png) [@CannyDan](https://boards.straightdope.com/u/CannyDan)\ **Post date:** [March 9, 2012, 1:24am UTC](https://boards.straightdope.com/t/everyone-in-the-usa-has-access-to-birth-control/614976/129 "2012-03-09T01:24:29Z")
> [@doreen](#): > > I’m not saying it doesn’t further an important societal benefit. All I’m saying is that it is not as clear a \*financial \*benefit to the insurance company as some think - and it’s entirely possible that the benefit might be worth any increased cost. Although to be honest, I don’t see why the social benefit isn’t furthered by means testing- DianaG’s daughter may not be able to afford her copay, but my daughter (covered under my insurance ) certainly can. Well, I think \*\*WhyNot \*\*offers some significant support, but I would not reject having a clear cut proof of cost benefit. However, we were discussing \*\*ITR’s \*\*assertion that there is no real need for additional birth control options in the present employer-based insurance scenario. Given this, I fail to see how a “means test” could be implemented. Do you intend it to be administered by the insurance carrier? Or by the business? Would any person actually employed fail the means test of their own employer? Of course, this again, as \*\*WhyNot \*\*also offered, plainly supports ‘socialized’ health care instead of the stupid system we’re laboring under right now. If we were to go to UHC in some form or other, I might be persuaded that means testing might be acceptable in certain areas. ---
**Author:** ![elucidator](https://avatars.discourse-cdn.com/v4/letter/e/8edcca/32.png) [@elucidator](https://boards.straightdope.com/u/elucidator)\ **Post date:** [March 9, 2012, 1:25am UTC](https://boards.straightdope.com/t/everyone-in-the-usa-has-access-to-birth-control/614976/130 "2012-03-09T01:25:57Z")
I would kind of like us to edge a bit closer to what is good for our people, and a bit further from what is good for our corporations. I’m told this is a radical and crazy idea. Not as often as I used to be told. But it doesn’t matter, since I’m not listening just as much. ---
**Author:** ![doreen](https://avatars.discourse-cdn.com/v4/letter/d/858c86/32.png) [@doreen](https://boards.straightdope.com/u/doreen)\ **Post date:** [March 9, 2012, 2:43am UTC](https://boards.straightdope.com/t/everyone-in-the-usa-has-access-to-birth-control/614976/131 "2012-03-09T02:43:20Z")
> [@CannyDan](#): > > Well, I think \*\*WhyNot \*\*offers some significant support, but I would not reject having a clear cut proof of cost benefit. > > However, we were discussing \*\*ITR’s \*\*assertion that there is no real need for additional birth control options in the present employer-based insurance scenario. Given this, I fail to see how a “means test” could be implemented. Do you intend it to be administered by the insurance carrier? Or by the business? Would any person actually employed fail the means test of their own employer? Since the government is already involved in this mess, it can determine the means testing - insurance companies can’t charge a copay on policies held by people making less than some specified amount. Although I’m not necessarily for means testing- I just don’t see how it would negate the social benefit. > [@](#): > > Of course, this again, as \*\*WhyNot \*\*also offered, plainly supports ‘socialized’ health care instead of the stupid system we’re laboring under right now. If we were to go to UHC in some form or other, I might be persuaded that means testing might be acceptable in certain areas. Of course, if we had a real UHC system, there wouldn’t need to be any means testing, because there most likely wouldn’t be a $30 payment for any drug. ---
**Author:** ![Lance\_Turbo](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/lance_turbo/32/6156_2.png) [@Lance\_Turbo](https://boards.straightdope.com/u/Lance_Turbo)\ **Post date:** [March 9, 2012, 6:20am UTC](https://boards.straightdope.com/t/everyone-in-the-usa-has-access-to-birth-control/614976/132 "2012-03-09T06:20:18Z")
**ITR** , haven’t you said on this board that you’re a dude who chooses not to have sex? You seem to care an awful lot about an issue you have no experience with and doesn’t really have an effect on your lifestyle. ---
**Author:** ![CannyDan](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/cannydan/32/548_2.png) [@CannyDan](https://boards.straightdope.com/u/CannyDan)\ **Post date:** [March 9, 2012, 2:58pm UTC](https://boards.straightdope.com/t/everyone-in-the-usa-has-access-to-birth-control/614976/133 "2012-03-09T14:58:27Z")
> [@doreen](#): > > Since the government is already involved in this mess, it can determine the means testing - insurance companies can’t charge a copay on policies held by people making less than some specified amount. Although I’m not necessarily for means testing- I just don’t see how it would negate the social benefit. > Of course, if we had a real UHC system, there wouldn’t need to be any means testing, because there most likely wouldn’t be a $30 payment for any drug. I’m still not comfortable with even this kind of means testing. Am I means tested only on my compensation at that job, which of course my employer is fully aware of and can report to the insurer? What if I work two jobs? What if my spouse works too? Will the test extend to my household income as reported to the government (presumably the IRS), a matter that neither my employer nor the insurer has any right to know? As for “a real UHC system”, it could be set up such that every possible elective or discretionary medical desire might not be 100% free to everybody. Means testing for certain medications and/or procedures might be a way of holding down system-wide costs while still allowing important medical services (including preventative and diagnostic services) to be more readily available to everyone. A face lift could be a medical/psychological necessity for someone severely disfigured. And surgical obesity treatment could be life saving for someone pathologically overweight. And hormonal birth control pills for reasons other than pregnancy prevention are a medical necessity for certain women. Under any rational UHC, these should be covered. But I might not object if the same procedures/medications were means tested when they are elective rather than medically required. Of course this is just hypothetical, and I’m not sure how workable it would be. Rich people seeking rhinoplasty probably wouldn’t have much trouble getting one or several doctors to sign off on its “medical necessity”. That said, I’ve stalled long enough for **ITR** to have composed a post providing cites supporting the assertion that “Everyone woman (and man) in the USA has free access to several types of birth control, and access to other types at a pretty low cost”. But I’m still not seeing them. What exactly are those several free types once again? Did I miss them? ---
**Author:** ![gamerunknown](https://avatars.discourse-cdn.com/v4/letter/g/6bbea6/32.png) [@gamerunknown](https://boards.straightdope.com/u/gamerunknown)\ **Post date:** [March 9, 2012, 9:34pm UTC](https://boards.straightdope.com/t/everyone-in-the-usa-has-access-to-birth-control/614976/134 "2012-03-09T21:34:45Z")
> [@](#): > > But they are only 85-88% effective. That’s interesting, do you have a cite? That seems like a significant risk of pregnancy and I’m guessing that rates of pregnancy are roughly equivalent to risk of contracting an STI (as in, if a condom fails to perform its function then the “roll” for chance of contracting the STI is performed). I was under the impression that the studies of condom effectiveness do not always take into account performance errors (clinical tests may be unethical, or there would be at least a sampling bias taking into consideration people willing to be observed having sex). I have an anecdotal account that someone I know’s sister swore that her boyfriend’s condom broke when she got pregnant, but later revealed that they’d foregone prophylaxis use due to the prohibitive costs. So self-reports may not be entirely reliable. ---
**Author:** ![WhyNot](https://avatars.discourse-cdn.com/v4/letter/w/c77e96/32.png) [@WhyNot](https://boards.straightdope.com/u/WhyNot)\ **Post date:** [March 9, 2012, 10:03pm UTC](https://boards.straightdope.com/t/everyone-in-the-usa-has-access-to-birth-control/614976/135 "2012-03-09T22:03:48Z")
> [@gamerunknown](#): > > That’s interesting, do you have a cite? That estimate was high, actually. > **[Compare Birth Control Effectiveness All in One Place](https://www.verywellhealth.com/compare-birth-control-effectiveness-906617)** > > Birth control effectiveness is a concern when choosing contraception and depends on different factors. Get the details here. > [@](#): > > Barrier methods, which include the male condom, female condom, diaphragm, spermicide, the cervical cap, and the sponge (for those who have not given birth) also yield fair typical user success rates between 71 to 85 percent. Here’s a nice chart: [http://www.plannedparenthood.org/health-topics/birth-control/birth-control-effectiveness-chart-22710.htm](http://www.plannedparenthood.org/health-topics/birth-control/birth-control-effectiveness-chart-22710.htm) “Typical use” includes user error - doubling condoms, not using enough lube, taking off the condom and reinserting the penis without washing it, etc.. “Perfect use” or “theoretical failure rate” only includes the statistical likelihood of a product failure. For condoms, this includes statistical likelihood of the condom breaking, slipping off, having a pinhole leak, etc. As I’ve pointed out before, condoms are about as useful as “pull and pray”, or withdrawal, for preventing pregnancy. They’re crap. OTOH, they’re the best thing we have for preventing the spread of STI’s. As far as I’m concerned, we should hardly be calling them contraception at all, but Cootie Preventers. ---
**Author:** ![JoelUpchurch](https://avatars.discourse-cdn.com/v4/letter/j/f05b48/32.png) [@JoelUpchurch](https://boards.straightdope.com/u/JoelUpchurch)\ **Post date:** [March 10, 2012, 2:37am UTC](https://boards.straightdope.com/t/everyone-in-the-usa-has-access-to-birth-control/614976/136 "2012-03-10T02:37:34Z")
> [@WhyNot](#): > > That estimate was high, actually. > [Birth Control Effectiveness Rates and Comparison](http://contraception.about.com/od/birthcontroldecisions/p/effectiveness.htm) If you look at your link you will notice that birth control pills are only about 92% effective. That means after 8 years you have about a 50/50 chance of being pregnant. ---
**Author:** ![WhyNot](https://avatars.discourse-cdn.com/v4/letter/w/c77e96/32.png) [@WhyNot](https://boards.straightdope.com/u/WhyNot)\ **Post date:** [March 10, 2012, 6:21am UTC](https://boards.straightdope.com/t/everyone-in-the-usa-has-access-to-birth-control/614976/137 "2012-03-10T06:21:02Z")
> [@JoelUpchurch](#): > > If you look at your link you will notice that birth control pills are only about 92% effective. That means after 8 years you have about a 50/50 chance of being pregnant. No, I do not believe that’s how the math works. But I’ll leave it to someone who understands the math better than I to explain it. ---
**Author:** ![JoelUpchurch](https://avatars.discourse-cdn.com/v4/letter/j/f05b48/32.png) [@JoelUpchurch](https://boards.straightdope.com/u/JoelUpchurch)\ **Post date:** [March 10, 2012, 7:59pm UTC](https://boards.straightdope.com/t/everyone-in-the-usa-has-access-to-birth-control/614976/138 "2012-03-10T19:59:09Z")
> [@WhyNot](#): > > No, I do not believe that’s how the math works. But I’ll leave it to someone who understands the math better than I to explain it. That would be me, the guy with the math degree. This is a very simple case where you just have to multiply the probability of each event. I calculated the net probability of getting pregnant for each year. Yr Prob 1-Prob 1 0.920 0.080 2 0.846 0.154 3 0.779 0.221 4 0.716 0.284 5 0.659 0.341 6 0.606 0.394 7 0.558 0.442 8 0.513 0.487 9 0.472 0.528 10 0.434 0.566 11 0.400 0.600 12 0.368 0.632 13 0.338 0.662 14 0.311 0.689 15 0.286 0.714 16 0.263 0.737 17 0.242 0.758 18 0.223 0.777 19 0.205 0.795 20 0.189 0.811 As you can see, by year 8 you are down to a 51-49 chance of getting pregnant during those 8 years. I suspect most of those failures are operator error, since implants use similar or the same chemicals and they are around 98 to 99 percent reliable. ---
**Author:** ![ITR\_champion](https://avatars.discourse-cdn.com/v4/letter/i/c67d28/32.png) [@ITR\_champion](https://boards.straightdope.com/u/ITR_champion)\ **Post date:** [March 10, 2012, 9:35pm UTC](https://boards.straightdope.com/t/everyone-in-the-usa-has-access-to-birth-control/614976/139 "2012-03-10T21:35:44Z")
> [@SmellMyWort](#): > > Please share the “several types of birth control” that are available to every woman and man in the USA. In your OP you cite one guy who found lots of free condoms and an organization that would give pills, the patch, or the ring to women under the poverty line. That’s not exactly everyone. > > The inability to afford BC wasn’t their answer because it wasn’t one of the 6 multiple-choice responses given in the study. Surely we can agree that if there was any significant number of women in the United States who were avoiding birth control because they were unable to afford it, the CDC would have included that as one of their choices in the study. If it was a decent study, there would have been an option for the respondents to choose “other” if they had an unlisted reason for not using birth control. Moreover, even if we suppose that the CDC was incompetent at polling women for the reasons why they don’t use birth control, surely some other study would report on the large number of women who avoid birth control because they can’t afford it. If there’s actually a large problem (or even a small problem) with women not using birth control because they can’t afford it, finding a reliable survey that documents that fact shouldn’t be hard. My claim was that “everyone in the USA has access to birth control”. It seems we agree that women under the poverty line can get multiple types of birth control for free. Besides the facts that I’ve listed, there are a small galaxy of government and non-profit programs in this country devoted to making drugs and health services available to the poor. Hence I feel safe saying that poor women have access to multiple types of birth control. As for women who aren’t poor, if they truly couldn’t get free birth control from their government, insurance company or anywhere else, they could still get it by the esoteric method of paying for it. > [@](#): > > Instead of citing fertility rates you might consider the rate of unintended pregnancy. I’d be happy to look at any statistics concerning how rates of unintended pregnancies have changed over time. The CDC report says that half of pregnancies currently are unintended; it doesn’t give data for past years. If readily available birth control pushed down pregnancy rates, surely the rate of unintended pregnancies would be less than 50%. ---
**Author:** ![SciFiSam](https://avatars.discourse-cdn.com/v4/letter/s/47e85d/32.png) [@SciFiSam](https://boards.straightdope.com/u/SciFiSam)\ **Post date:** [March 10, 2012, 9:46pm UTC](https://boards.straightdope.com/t/everyone-in-the-usa-has-access-to-birth-control/614976/140 "2012-03-10T21:46:21Z")
> [@CannyDan](#): > > I’m still not comfortable with even this kind of means testing. Am I means tested only on my compensation at that job, which of course my employer is fully aware of and can report to the insurer? What if I work two jobs? What if my spouse works too? Will the test extend to my household income as reported to the government (presumably the IRS), a matter that neither my employer nor the insurer has any right to know? > > As for “a real UHC system”, it could be set up such that every possible elective or discretionary medical desire might not be 100% free to everybody. Means testing for certain medications and/or procedures might be a way of holding down system-wide costs while still allowing important medical services (including preventative and diagnostic services) to be more readily available to everyone. > > A face lift could be a medical/psychological necessity for someone severely disfigured. And surgical obesity treatment could be life saving for someone pathologically overweight. And hormonal birth control pills for reasons other than pregnancy prevention are a medical necessity for certain women. Under any rational UHC, these should be covered. But I might not object if the same procedures/medications were means tested when they are elective rather than medically required. Of course this is just hypothetical, and I’m not sure how workable it would be. Rich people seeking rhinoplasty probably wouldn’t have much trouble getting one or several doctors to sign off on its “medical necessity”. Most UHC systems I know of don’t provide for cosmetic plastic surgery except for when it’s to correct something really disfiguring and detrimental to life, like facial scarring or disfigurement - though there are some medical reasons for that too (scarred skin is more susceptible to sunburn, for example). If someone is suffering _really_ severely mentally due to their facial features, and has tried to commit suicide several times, has tried self-surgery, has undergone counselling, etc etc, and probably been diagnosed with something like body dysmorphic disorder, then they might _possibly_ be allowed surgery under the NHS. Eventually. Or they’d get it due to having cut off their nose to spite their face. 😃 It doesn’t seem to matter how rich someone is - they can’t get doctors to sign off on surgeries which aren’t permitted, and in any case, if they’re rich, they can just pay to get it done privately. But anyway, it is definitely workable. I imagine it’s the same as private healthcare plans which might allow for plastic surgery to fix a nose that was badly broken in an accident but wouldn’t cover just making the nose a little less big. Unless perhaps you paid extra for a special type of health insurance that did cover cosmetic plastic surgery. Private insurance doesn’t cover absolutely everything, and neither does UHC. (I realise this sounds like I’m arguing with you - I’m not intending to; just adding information). [Previous page](https://boards.straightdope.com/t/everyone-in-the-usa-has-access-to-birth-control/614976.md?page=6) [Next page](https://boards.straightdope.com/t/everyone-in-the-usa-has-access-to-birth-control/614976.md?page=8)