- - Wednesday, July 19, 2017

Gail Collins writes in The New York Times that “While Ivanka has been making mewling noises about working moms, the Trump White House has appointed people to major health care policy jobs who don’t appear to believe in contraception.”

What does she mean? (And why “mewling? What’s Ivanka ever done to Gail Collins?) Does she mean that the Trump appointees have religious beliefs (horrors!) that contraception is wrong? Then she should say that. But that wouldn’t sound quite as scandalous. There are 70 million Catholics in the United States, and while not all of them may “believe” in (i.e., accept) the church’s conclusion and teaching that contraception is wrong, and others may believe it but use contraceptives anyway, the concept of “not believing in contraception” loses its scandal value in light of that number.

Perhaps what she means is that the Trump people don’t believe that government should subsidize contraception. That makes sense, but, unfortunately for Ms. Collins, that belief also can lead to a debate among reasonable people — which would spoil her game.

It is reasonable to ask, should government (the taxpayers) pay for contraception? Put more personally, should A be required by government to pay for B’s contraception?

There are two issues. One is the religious issue. Should people who think contraception is contrary to their church’s teaching be required, through their tax payments, to pay for it? The answer to that question is obvious — unless you write for The New York Times: No.

The other issue is, should a routine expense like contraception be covered by health insurance? Birth control pills cost about $600 a year (without insurance). The average household wastes about $600 each year throwing away unwanted food, spends about $850 each year on soda, and the typical American spends about $1,200 on fast food each year. If contraceptives were subsidized through insurance, wouldn’t that just enable people to buy more fast food or soda? Is that good public policy? Mayor Michael Bloomberg wouldn’t approve.

Why don’t the Gail Collinses lobby for government subsidization of toothpaste, too? That would raise the real question, which is, what should insurance cover? Or more precisely, who should decide what an insurance policy covers — the government or consumers who buy insurance?

Ms. Collins writes: “Insurance is all about sharing risks. If people who didn’t require maternity coverage, i.e., men, were able to save money by forgoing it, the price for the women who did need it would skyrocket.” Maybe, but the price of that insurance — if it covered all illnesses — would be offset by women’s not having to pay for prostate cancer expenses. More importantly, to require insurance to cover a risk that the policyholder does not face is to force him to subsidize the people who do have that risk. It is just a form of off-budget, hidden taxation.

It’s surprising how many people don’t understand what insurance is for. The basic goal of insurance is to spread the risk (the possibility of suffering) of an unlikely but serious, perhaps even catastrophic, expense, over many people who are exposed to that same risk (not to people who are not exposed to it), so that no single person who suffers it has to bear the whole cost alone.

There are two separate issues in the public policy debate that need to be untangled: first, coverage of wholly predictable, expenses that the insured will incur and, second, cross-subsidies for other peoples’ risks, whether normal or not, that the insured does not risk incurring.

A person should be free to buy insurance (if it’s available) that covers such predictable events as oil changes or toothpaste, but that is different from that person’s being required to buy insurance for oil changes or toothpaste if he doesn’t want to — if he only owns a bike or has false teeth.

Of course, the insurance premium for oil changes or toothpaste would be high because the events insured against are certain to occur. The premium is really just a prepayment of the expense.

Contraceptives are also a routine expense — more than 60 percent of women of childbearing age use contraceptives — as are pregnancies.

Ms. Collins seems to consider getting pregnant a risk, implying that it is also a disaster. Try telling that to the 6 million women in the United States ages 15-44 who have difficulty getting or staying pregnant.

People should be free to buy whatever health insurance they want, whether low deductible or catastrophic. Poor people can be subsidized as necessary, but not to the extent of making them better off than the people who pay the taxes that subsidize them. The inevitable free-riders should be dealt with sufficiently harshly to discourage free-riding.

The market will work if we let it. But Gail Collins, and her friends, will never understand that.

• Daniel Oliver is chairman of the board of the Education and Research Institute and a director of Citizens for the Republic.

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