Postrel: Make the Pill Cheaper by Making it Over the Counter


Birth-control pills, the crux of an ongoing argument about public discourse and health-care mandates, are artificially expensive, writes former Reason editor Virginia Postrel in her latest Bloomberg column.

It's a must-read, as it casts a very dark light on a costly prescription regime many of us take as a fact of nature. Snippets:

Making the pill available over the counter could reduce the amount of outrage and invective available for entertaining radio audiences, spurring political fundraising and otherwise amusing the American public. But the medical risks are quite low….

Birth-control pills can have side effects, of course, but so can such over-the-counter drugs as antihistamines, ibuprofen or the Aleve that once turned me into a scary, hive-covered monster. That's why even the most common over-the-counter drugs, including aspirin, carry warning labels. Most women aren't at risk from oral contraceptives, however, just as most patients aren't at risk from aspirin or Benadryl, and studies suggest that a patient checklist can catch most potential problems….

Aside from safety, the biggest argument for keeping birth- control pills prescription-only is, to put it bluntly, extortion. The current arrangement forces women to go to the doctor at least once a year, usually submitting to a pelvic exam, if they want this extremely reliable form of contraception. That demand may suit doctors' paternalist instincts and financial interests, but it doesn't serve patients' needs. As [a 1993 editorial in the American Journal of Public Health] noted, the exam requirement "assumes that it would be worse for a woman's health to miss out on routine care than it would be to miss out on taking oral contraceptives."

Whole thing here.

Why wasn't Congress and the Executive branch working through issues like this during the debate over President Obama's health-care reform law? Or Mitt Romney when he was pushing his state-level version back in the day? Aren't these folks supposed to be interested in making things cheaper and more accessible for ordinary Americans? It's a sad fact that the smartest people aren't in charge of writing the laws that force us into bad situations.

And now, despite unemployment creeping upwards to 9 percent (according to Gallup) and one-year Greek bonds yielding over 1,000 percent (!), another war in the Middle East looming, we're stuck in a sideshow discussion about whether Rush Limbaugh or Bill Maher is the bigger jerk and whether Catholic universities should have to pick up birth-control costs for law-school students poised to make $160,000 as a starting salary if they enter the private-sector.

Can't legislators agree that those of us who are, say, over 18 years old, are adults and if we can buy condoms without a prescription, we should be able to shop for birth-control pills on our lonesome too? And a host of other drugs?

Further reading: "3 Lessons from the National Conversation About Sluts and Twats."

NEXT: Chip Bok on Rick Santorum

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  1. FIRST!

    1. Jesus fucking Christ you people are fucking retarded.

      1. Of course being First! is fucking retarded.

        That's the entire fucking point of The "Joke."

        1. If by "joke" you also mean annoying point spam, then yes you are joking.

          1. Oh, the fucking horror of having subjected you to an extra word! AND (!) a punctuation mark!

            I can't imagine how the next barrage of unwanted characters is going to make your Sarlaac Vagina twitch.

            (PS: LOVED you in Total Recall.)

  2. It also might lead to more MTF transsexuals. Birth control pills are what they use in Thailand.

    1. Thanks Robo, thats my daily creep-out.

    2. They prefer the term "ladyboys"

    3. I believe the amount of estrogen and the other hormone???? have been dramatically reduced over the last few decades so probably not a good way to grow breast.....

      1. Perhaps not, but they are cheap and widely available.

  3. Hear, f*cking hear! This is the most sensible thing to come out of the contraception debate. If liberals really want to increase access to contraception then stop using regulation to make it less accessible. This is what the GOP should have responded to Obama's proposal with, but I'm guessing the SoCons who hold the leash would not have let that dog hunt for that...

    1. MNG are you crazy? You cant just let people have sex whenever they want, however they want!

      If we have over the counter BC the lord will smite us with boils.

      1. Yes, birth control's a license to do things in a sexual realm that is counter to how things are supposed to be.

        I forgot.

    2. You are right. If that was the issue, making them over the counter would go a long ways to solving it. So why don't liberals do that? I think there is one of two reasons.

      1. They have trapped themselves into thinking that government control and funding to any problem. So other solutions never occur to them.

      2. This isn't the issue for them. The issue is using contraceptives as a wedge to assert more control over society.

      Any other suggestions?

      1. I'm betting it's just pure nannyism; hey there are these potential side effects so putting a doctor and a pharmacist between women and the drug is teh important!

        1. That is a good point. But if someone ever tried to restrict the medical requirements and oversight required for the pill, they would rightfully have a fainting fit. it is just nuts.

          1. I detest provisions like this. Most states have laws that do not allow a private company to give you eyeglasses or contacts you want without a regular prescription from an eye doctor. WTF is that but a racket for those folks?

            1. We just can't understand how important it is to get regular eye exams. We can never understand. Because we're not in the cartel.

              1. Because a consumer would never realize their glasses or contacts are not working right without a doctor to tell them that...I agree, WTF is that about?

                1. Seriously. I have contacts, they're a little fuzzy, but I can't afford a new eye doctor. So I just need some new contacts. But you can't order them because the prescription is "expired".

                  I swear, if there was a button that killed all the statists I'd gloat for about three minutes and then push it. Fuck these people.

      2. If they made BC pills over the counter, how would the government pay for them? Seems like a recipe for fraud: "Here are my receipts for purchase of BC pills. When do I get reimbursed". Maybe the feds ought to just set up a bunch of those news stand machines (preferably outside of middles schools... "ovulation is not allowed within 1000 feet of a school). Whatever the feds do, "BC pills must be FREE!!!"

      3. They just don't think about it. I keep trying to get a bunch of Obama fanatics to explain why, if the goal is to expand access to contraception, this employer mandate is the best option to use, or at least to start with. All I get is a bunch of evasion, how employers should have no say in the health care of their employees (but should pay for it nonetheless), that kind of crap.

        A means-ends discussion is too complicated. It's partisanship all the way.

        1. I recently had this conversation about killing children in drone attacks. One person actually said it's OK, because the right person is doing the killing.

    3. I don't think the socons would have said boo. This is about forcing people to pay.

      1. You don't think the socons would have said boo about a move that would increase access to birth control?

        Have you heard of this guy named "Rick Santorum?"

        Socons are just fine with regulation used to counter reproductive procedures they don't like John.

        1. Show me one place where Santorum ever said we should use government regulation to limit access to birth control? I have never seen it. He has said that easy access to birth control has had some bad side effects on society. And I think he makes some valid points. But I have never heard him support outright bans or further government regulation. If he has, show me.

          1. "He has said that easy access to birth control has had some bad side effects on society. And I think he makes some valid points."


            1. He is right. That doesn't mean we should ban birth control. But you can't deny there has been a price to be paid. Now that is a different question than whether that price was worth it.

              Because of birth control, women can no longer charge sex as a price for marriage. It hasn't been all wine and roses. And contraception has done nothing to reduce the number of illegitimate children. Those numbers have exploded since the advent of the pill.

              Now correlation does not equal causation. But the argument that the pill created the illegitimacy rise, while not intuitive, at least agrees with the facts. The argument that it helped with illegitimacy doesn't agree with facts and thus can't be valid.

              1. Any price is so neglible to the benefits it's goofy to talk about it almost. Women, and by extension men, having control over when and how many children they have has not only been a tremondous net gain to women's health, but to the personal autonomy of women, men and families in general.

                That outweighs all the "evils" of grants of sexual license.

                1. "Any price is so neglible to the benefits it's goofy to talk about it almost"

                  I would say the explosion of illegitimacy in this country over the last 50 years is hardly a negligible price.

                  1. As you said yourself, there is only a "correlation equals causation" argument behind this alleged cost.

                    1. Correlation doesn't equal causation. But it doesn't preclude causation either. The argument that the rise in illegitimacy is the result of the sexual revolution which was the result of easy access to birth control is not unreasonable.

                      Again, I still think it was probably worth it. But that is a value judgment. And I can understand why other people would view it differently.

                    2. "is not unreasonable" is again pretty uncertain. But the gains from BC are not so hypothetical.

                    3. John is a paragon of the example that education (if he does indeed have a legal degree-one would think basic spelling and grammar were required) does not correlate with intelligence. "But it doesn't preclude causation either." WTF?

                      Since there has been an exponential rise in the number of televisions per household in the same time period, I say let's blame that because correlation doesn't preclude causation.

                      A quick lesson in critical thinking. Correlation is the first thing that suggests possible causation, the first step, after which a process (often scientific in nature) is used to understand whether there is a causal link between the two phenomena. And even before that, one should at least hypothesize as to the nature of the link, rather than just expositing that there may be one.

                    4. Here, I'll show you how it's done. The welfare state, which correlates temporally with the use of birth control is a much more obvious culprit for the rise in illegitimacy. Let's see, if someone has access to a pill that helps them not have children, I'll bet that is the cause for more children being born out of wedlock! Doh! Or, if someone has access to funds to provide for the raising of children without having to garner a commitment from the father to provide said funds, seemingly mitigating the risk of having to financially support a child on one's own, perhaps that is the "moral hazard" responsible for the rise in illegitimacy.

                      Logic, how does it work? (A secret, don't ask John. He doesn't know)

                2. if we are to pursue this logic to its end (negligble costs should not be discussed when overwhelming benefits exist) then what will the libertarians do all day. Talking about irrelevent nuances is pretty much all we do.

              2. "Illegitimacy"

                We really need to find a different word for that.

                1. How about 'bastardy'?

                  1. I was think of something less insulting. I mean bastard is technically correct, but it isn't really used literally enough to not be insulting when used in the literal sense.

          2. Actually, when the FDA planned to make Plan B OTC the socons freaked the fuck out.

            And Obama and Sebelius wet their pants and backed down.

            I think we can deduce from that incident that they'd freak out if the Pill was made OTC, too.

            Because once there's no prescription for it, the bottle or clam or what have you has no name on it. So anyone who wants can walk in to a store, buy a year's worth of pills, and hand them to your 15 year old daughter. That's why the socons will freak out.

            For the chillrenz.

            1. Plan B is not the pill. Plan B is flat out abortion in some people's eyes. And if they did freak out, they would not have near the compelling argument that had with plan B.

              1. Actually John, Plan B really is the pill, just in a higher dose. Ron Paul actually talked about this in one of the debates. And the pill is also flat-out abortion "in some people's eyes."

                1. No Nicole. IUDs are. But I don't see how anyone could claim the pill is an abortion.

                  1. As I understand it Plan B usually acts like birth control with a difference in that it can at times impact a recently fertilized egg.

                  2. It's not at all hard to find this sort of claim on various Christian sites.

                    If the pill fails to prevent ovulation and conception, it prevents the fertilized egg from growing through "changes in the endometrium which reduce the likelihood of implantation" (a form of abortion).

                    If you think preventing a fertilized egg from implanting is a form of abortion, it's possible that the regular pill could do this too.

            2. And fluffy show me one place where anyone has ever advocated preventing parents from giving their kids birth control. What they do freak out about is places like schools giving them out without any permission of their parents. And I would assume you as a libertarian would object to the state stomping on parental rights just as much as they do.

              1. You're missing fluffy's argument. If BC goes OTC then any 15 year old could walk into a store and buy it without their parents around. You don't think socons would object to that result?

                1. Cigarettes are OTC, and you still have to be 18 to buy those. So you make it OTC but no one under 18 can purchase them.

                  1. But this is not what I see Postrel positing here, as I doubt she is thrilled with such regulations. She says make it like Benadryl. Now you don't foresee socons freaking out about that?

          3. He's said he would use his office to speak out and educate Americans on the dangers of birth control. What do you think would stop him from using his regulatory powers to that effect, his deep committment to limited government and personal liberty?

            1. Maybe he would. But I don't think you can claim he wants to do something he hasn't advocated unless you have mind reading powers.

              1. Man, I'm bookmarking this one for future discussions!

                1. Go for it. I am not saying he hasn't. I just saying I have never heard it. Show me where he has and I will concede the point.

                  1. Because you never have, and never will, accuse a liberal of doing something that he has not explicitly advocate but based on their general philosophy and past actions....

                    Like I said, it's going in the bookmark.

                    1. And you have never defended a liberal with the "he would never do that" defense. We will bookmark that too.

                    2. Er, you're going to bookmark an argument I'm not making here?

                      You have some fun thinking sometimes John 🙂

            2. Oh, come on. You guys basically agree and you are still going to start a fight?

              1. The make-up sex must be really great.

                1. At least John and MNG don't need birth control, alex.


      2. Socons were pretty pissed about the FDA approving the morning-after pill without a prescription, so I think they would have been pissy about this too.

        But not as pissy as the AMA would have been, and that's surely the real problem here for politicians on both sides. Or do the Dems have special extra AMA love? I don't know. Either way, I'm looking at the cartel as the main culprit.

        1. "Socons were pretty pissed about the FDA approving the morning-after pill without a prescription"

          +1, this is exactly what I was referring to, I just wanted to see if John would get there by himself.

          "Or do the Dems have special extra AMA love?"

          Dems love putting "experts" between people and choice...It's a major failing of them imo.

        2. And I'm sure the doctors would say this was horrifically dangerous. After all, the midwife who gave me my last prescription had to use it to lecture me about the dangers of smoking and how, when I'm 35, even if I only smoke one cigarette a year she will take my prescription away because it's just oh noes too dangerous. (There are extra side effects associated with smoking on the pill, especially over the age of 35.)

          1. The sad thing is I think they might even concede the dangers are not incredible, they just really think everyone should have to come through them for anything first.

            1. Find another midwife if you need one in the future, nicole... the one you were using, is a control freak.

    4. Socons might object to it being easier to get. 18 year olds could buy them and give them to 13 year olds. Same issues as alcohol and cigarettes.

      I loved this: "It's a sad fact that the smartest people aren't in charge of writing the laws that force us into bad situations".

      That's right M**F**, they're right here commenting and writing for REASON magazine.

      1. I don't understand why it should be limited to over 18. 13 year olds can get pregnant too and have far more compelling reasons to avoid it. The fact is that people do have sex young.

    5. It's never been about increasing access. It's been about handouts and identity politics.

  4. "Aren't these folks supposed to be interested in making things cheaper and more accessible for ordinary Americans? "

    Where the fuck did you get that idea?

  5. So now everyone who pines for the better days of Reason when Postrel was around is vindicated?

    Postrel would have never let this happen under her watch.

    But yes, it's astounding what a simple and effective point this is that she makes. Astounding because nearly no one is making it.

    1. That is because Postrel is smarter than your average bear. It is a sad commentary on our intellectual life that she is not better known. Think about how losers like Tom Franks or David Brooks get the status of public intellectual. Then someone like Postrel, makes a living, but more less works in relative obscurity.

      1. I like David Brooks, he's even handed and thoughtful imo while retaining a principled point of view. Some people are into that and he speaks to that market.

        1. I can't stand Brooks. But even if you like him, he is not near as interesting or smart of a thinker as Postrel. Postrel should be much more well known that what she is.

        2. David Brooks is a concern troll with no principles that I can discern.

          1. His concern is getting paid for doing nothing.

      2. Aw c'mon, Postrel can't hold a candle to the intellectual bonfire that is Nick Kristof:

        Yet instead of structural reforms or improved tax collection, what has changed in Greece, so far, has mostly been slashed budgets. And, as in the rest of Europe, austerity in the middle of recession has made matters worse ? just as John Maynard Keynes predicted.

        1. Because suddenly collecting double the previous level of taxes has no effects under Keynes' theory. Right?

          How do people this stupid get writing gigs?

          1. In the case of Nickie, I would venture that it has to do with daddy.

          2. They have prevented the art of telling people exactly what they want to hear. It takes years of work to train yourself never to have an independent thought or even consider anything outside of the accepted dogma. Most people can't do it. They eventually have a thought that is deemed unacceptable. Only the really dogged and exceptional can spend an entire adult life and never do it. And it those who get major opinion page gigs.

      3. America was better when Postrel was in charge?

      4. Postrel would be derided for offering solutions that are "too simple".

        Trust me, 99% of the pundit class hears this idea (for example) and gets really annoyed, because it takes a short time to explain and is straightforward. "It's not that simple!" they'd harrumph.

        Offering solutions that refuse to take into account the fact that people are stupid and will object to being given personal responsibility annoys the pundit class. We're supposed to take it as a given that freedom will not be allowed, and devise a solution that works around that premise.

    2. "...nearly no one is making it."
      Because nearly no one is interested in solving the problem, only in exploiting it for more power. See John's rationale above.

      Couple Postrel's solution with this one and the whole fucking health care system would heal itself in six months.

      Of course, there would be endless hair-tearing and teeth-gnashiing from both the communists and the SoCons. It would be like my granddaddy used to say "They are like a cut-bull, all they can do is beller' and shit, but they cant do nothing about it."

      1. Decoupling insurance from employment is the obvious first step.

        I honestly think you can do that, wait 4 years, and there may not be a need to do anything else.

        It would be such an obvious success. Hey look! I can change jobs without my insurance being effected at all! What a crazy concept!

      2. "...nearly no one is making it."
        Because nearly no one is interested in solving the problem, only in exploiting it for more power.

        ^^^ THIS ^^^^^

        And that goes for the global warming debate, deficit reduction, entitlements, tax reform, and nearly everything else that goes on.

  6. Exactly. And if they want birth control to be freely available for all, it would be more honest, straightforward, and probably cheap if the government were to provide it for free, directly.

    1. Why would Catholic Orgs not object to this just as much? What's the difference between paying an insurer for a plan for your employees that includes coverage for this as a choice and paying taxes to the government which then uses it to provide coverage for this as a choice?

      1. Nobody (yet anyway) is forced to pay insurance.

      2. The second is less complicated, and the government already funds Planned Parenthood.

        Catholic Orgs would have exactly the same objections as they do to the government funding Planned Parenthood right now.

        Standard Libertarian Disclaimers apply, of course.

  7. I still think that Sandra chick would look a lot better with my dick in her mouth.

    1. Or vice versa!

      1. The picture clearly shows that she does not have an adam's apple, meaning she was born female, and nothing to indicate she's tried to become a he.
        Nice try though.

        1. Oooooh I think Bill may have a point Sarcasmic.

          BTW how is the tranny?

          1. You really think I'm going to click that link?
            Besides, you're missing the point.
            Which is that other than John nobody would fuck her, though some of us might let her bob the knob.

            Which means she has no "need" for contraception.

  8. Because BC pills can cause blood clots in certain people with certain conditions.

    1. And aspirin can generate Reye's Syndrome, and you can overdose on Aleve, etc...

    2. And Benadryl can make you hallucinate.

    3. That's why God made warning labels.

    4. There are no risk-free, over the counter drugs....or foods for that matter.

      If the risk is low we should be able to use our own judgement and take the chance. People are also free to consult with their doc before taking any medication, or food for that matter.

      1. The last sentence did not post.

        "Should we have to have a prescription for buying bananas because a small number of people are allergic to them?"

        1. Mock not the regulatory state, for it only seeks to protect you.

          Norway's War on Butter

        2. Or Nuts, which is even higher risk.

          And you know what, if Im in a bar in the Bahamas, I ask what is in the drink special before ordering, because I prefer to avoid throwing up coconut rum (and the rest of the contents of my stomach) all over their bar*.

          *based on a true story. Note: I didnt throw up, I finally convinced them to let me know that it did in fact contain coconut, so I ordered otherwise.

  9. I was once a hive-covered monster from a reaction to antibiotics. It was made worse by the fact that I lurked the maternity ward waiting for first daughter to be born.

    1. OTC contraceptives could have fixed one of those problems.

    2. "...waiting for first daughter to be born."

      I am going to take a wild guess have grey hair?

  10. On a related note, the switch from contact prescriptions lasting 2 years to 1 years similarly sucks.

    Because of lack of disposability, I would wear glasses for multiple years between updates, no reason for contacts to be different, other than rent seeking.

  11. we're stuck in a sideshow discussion about whether Rush Limbaugh or Bill Maher is the bigger jerk.

    I learned about the equivalency between the two from you, Ringmaster Nick.

  12. Dude I Would be totally down with that! For sure man!

  13. Yeah, that seems like the right answer. There are tons of drugs that should be OTC, or available from a pharmacist.

  14. Rush's handlers should remind him to grasp a viagra tablet firmly between his knees whenever a lady enters the room.

  15. Why make it cheaper when you can play politics. Republicans really would do themselves a favor if they out-freedomed Democrats...but then Republicans would have to believe in freedom.


  16. I'm looking at that picture. She undressed in Congress? Not to rush to judgment, but that seems kind of sleazy to me.

  17. The reason birth control pills are prescription only is because it's necessary for a woman's safety that she undergo a pelvic exam before taking birth control. Women with abnormal reproductive systems shouldn't use oral contraceptives, and there's no way of knowing this without going to the gynecologist first.

    1. Scroll up, read my comment on bananas.

    2. I'm bemused at how many people simply accept why they are told by authorities without question.

  18. Anyone who thinks most law students will make 160K upon graduation is mistaken. Only the top 10% or less will get such jobs in today's market. And those who do will be working so many hours that they'll be too tired for sex, so birth control is a moot question.

    1. Very, very true. And that's the top 10% at georgetown. More like 1% or less at the average law school.

  19. Wait, that's what Fluke looks like? Why does she need birth control?

    1. We all need her to have birth control. Sterilization, preferably.

  20. BC OTC? What if someone finds a way to get high off of them?

  21. God gave Sandra Fluke all the birth control she needs. I suppose she may still need protection for the deaf and blind that want a taste.

  22. Has any maker of BCPs applied for a Rx-to-OTC switch? If not, blame them. FDA will practically never act except on an appl'n.

  23. Regarding above discussion: does anyone else think it's wierd that the FDA would be okay with approving the morning after pill for OTC, but still keeps regular birth control precription only?

  24. If somebody else has already said this, fine, but I haven't seen/heard it:

    There's something wrong with the President of the US calling a THIRTY-YEAR-OLD and saying that her parents should be proud of her. Imagine if BUSH had said that........ the charges of paternalism, etc. would have flooded the airwaves.

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