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the birth-control brouhaha

As part of Obama's health reform law, new health insurance plans have to cover the cost of "preventative measures" without a copay or deductible. This is the kind of no-brainer idea that most people on either side of the political gulf can support if only because it's a principle that's already in practice in many other areas. (Dental insurance, for example, usually covers the full cost of semiannual cleanings but not for fillings, crowns and the like.) Earlier this week the Health and Human Services department released a list of just what new preventative services would be covered. There are some real bomb-shells on the list (not): counseling for domestic violence victims, breast pumps, screening in utero for gestational diabetes, that kind of thing.

Oh, yeah. And free prescription birth control.

Predictably, that last one is what's attracting the histrionics. Screening for a disease is obviously intended to treat the disease as early as possible. Breast pumps helps women breastfeed who choose to, which has all kinds of proven health benefits. Domestic violence counseling prevents all sorts of social ills as well as long-term psychological injuries both to the parent and the children, if any. If you're on board with the idea that preventative medicine is a good thing because it minimizes both cost and suffering, then those should be no-brainers.

With birth control, it's a little more controversial, though. Just what illness or injury is birth control supposed to address? Pregnancy is the obvious candidate, but then you have to say that pregnancy is a pathology, which obviously not everyone is going to agree with. I can see why some people would feel that way because it would connect a newborn baby to getting e. coli or some such thing - icky! But while a baby is not a pathology, I think a pregnancy could be under some circumstances. What makes having e. coli bacteria in your gastrointestinal tract a pathology while having bifidobacteria there is just the normal state of affairs? As best I can tell, the difference is all about the human function. e. coli keeps your body from functioning well, bifidobacteria helps it. I have never been pregnant, but every movie, TV show, and encounter with a pregnant friend tells me it definitely interferes with what a person can do, with a person achieving the full range of human capacities at that point in time. Sometimes it is more than worth it - if a woman wants a child - but I can see why pregnancy could be considered a pathology. If a woman is not at a life conducive to having a family, getting pregnant could even be a kind of pathology that outlasts her nine-month term of pregnancy.

Frankly, I have a hard time seeing why people would be anti-birth control. It's the kind of thing social conservatives should be able to get behind because it prevents abortion. That's apparently a big issue with that set, I hear. Budget hawks should be all for it because if you can't afford a $30/month copay how in the heck are you going to afford a kid except through public assistance? Libertarians should be happy because if taxation is slavery then pregnancy sure is, and this gives people access to the tools they need to avoid that (it basically makes it solely the woman's decision whether to conceive or not, rather than involving the insurance company's).And anyone that favors personal responsibility, planning ahead, taking responsibility, and so on should like this idea. I'd even say it's a blow for family values because prescriptions means doctors visits which for teenagers is more likely to involve the parents than (say) free distribution of contraception through the schools or health clinics. This should be a conservative coup d'etat.

Only it's not. It's become a bit of a flashpoint for the culture wars, exhibited most charmingly by Representative Steven King:



I understand what he's saying. In technical terms, less than two kids per adult on average is a dying culture - I learned that in one of my undergrad social science courses (sociology, I think). But is a little culture "death" really such a bad thing? Think about it. One of America's biggest problems is jobs. We don't have enough economic work for the amount of people we have. There aren't enough spots in the colleges to train educated workers. We don't have room for immigrants - often in truly horrendous situations - because there's the fear they'll take the jobs we have. I'm no economist, and I have a niggling fear that less population would mean less demand as well. But surely that would lag a bit? It seems to me that having a little less population growth might actually help things.

Plus, if we're really worried about declining population size, there's always that other monster under the bed: immigration. Legalizing more immigrants mean you have less of a problem of enforcement, and less of a subculture that basically exists outside the law. You get more tax revenue since you have more of your workforce living with the protection and responsibility of citizenship. And you get the added bonus of being able to rectify an unjust law that breaks families apart. Yet another blow for family values.

Geez, I never thought I'd have the opportunity to argue from birth control to immigration reform, but in this case there actually is a connection. Because Rep. King assumes the only way we can preserve our culture is through native births. Perhaps a few of those poor, huddled masses could help us out with that?

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