The Politics of The Pill

One day after the inauguration of President Trump, New York Governor Andrew Cuomo issued an order: his administration is going to “require” health insurance companies to pick up the tab for birth control.

In other words, no matter what may happen in the coming months regarding the anticipated repeal of the Affordable Care Act, the pill will still be provided to women in his state, for free.

Now the idea of health insurance covering birth control has been, and remains, controversial in several ways. Some of which are obvious, and some of which are not:

Religious, or ethical grounds – Of course there are a lot of New Yorkers who – based upon their personal beliefs – would object to being forced to provide birth control by paying for health insurance that covers it. But those folks can’t, since they haven’t been given any chance to speak. By issuing an all-encompassing, “Because I said so” ruling from on high, the Governor has totally negated these voices within his constituency.

Legal grounds – Cuomo’s edict is just that – an edict. It’s not a law, but rather to use politically correct legal jargon it’s called a regulation, since the command was issued from the Office of the Governor.

And not the elected representatives of the people of New York. Just like in the days of Olde, when the King could scream “Off with his (or her) head!” The deed would be done, and there was simply no further discussion to be heard about the matter.

It’s a political tool that hasn’t been lost with time, and whether we label them as Royal Decrees or Executive Orders, these kinds of directives not only carry the full force of law. They also subvert our Constitutional system of checks and balances, because they don’t reflect the opinion and will of the majority.

Economic grounds – All this philosophical pondering aside, there is a much more practical, financial reason why I find the good Governor’s plan upsetting, yet at the same time laughable.

To help get the word out about his announcement, Cuomo bypassed the mainstream media by tweeting that his new policies would “firmly secure access to reproductive health services in New York State.”

There’s that six-letter word that so often gets used by our ruling class, when they gush over the need for health insurance: access.

Read his tweet again, and let the meaning sink in. Just like the Blue Cross folks pointed out years ago, what the Governor is saying is that, only through the right kind of health insurance plan can women hope to have any access to reproductive health services.

Like…birth control pills, that can be had for as little as $10 a month, if paid for in cash.

No kidding. They really can. In fact, there are many, many birth control pills that can be bought for anywhere from $10 to $50 a month, if paid for out-of-pocket.

But far be it from the Governor to make any mention of that bit of information. Not when it pays – handsomely – for him to ignore it.

At this point I’m not sure which of these the reader should find more astonishing: the fact that a whole month’s worth of birth control can be bought for less than a tank of gas? Or the idea that a learned leader like Andrew Cuomo would be so gung-ho for “insurance” to cover such an (in)expense?

My vote is for the latter. It’s no secret that the vast majority of medicines don’t cost an arm and a leg. But the psychology that Governor Cuomo is employing here is as pervasive as it is persuasive amongst the political class: the idea that health care is just too costly to be had without health insurance (or what I call the Big Myth of Health Care). It may be dishonest, but it is genius, and it has worked on Americans for decades. So Cuomo would be a fool not to employ it, and he isn’t the only politico out there preaching this nonsense.

As we learned in the 2016 election, every elected official needs to have “both a public and a private position.” And all of his public, political posturing aside, what the good Governor Cuomo is really up to is a bit of private, professional, and profitable politics.

Because by doing everything he can to ensure that insurance covers a popular health care need (think also $25 flu shots), Governor Cuomo can curry favor amongst two groups that in turn, serve his narrow self interests:

1. The health insurers who will profit handsomely by having millions of people pay more in premiums every year, just so that a relatively few, fertile women can save hundreds of dollars on their birth control pills.

2. Those voting-age women who take the pill and believe that they have a right to all of health care – even “reproductive” health care – any will vote for any government that will either pay for the pill directly, or force private health insurance companies to bear the $10 a month burden.

Welcome to The Politics of The Pill, folks, which is really only a small case study in the much larger disease that infects our health care system, adversely affects our health, and has led to The Great American Health Care Dilemma.

No matter what you think, or how you feel about health insurance, women’s rights, or even the use of contraception, I hope you’ll agree with me on one thing: that it’s time for our elected leaders like Andrew Cuomo to stop making political brownie points by spreading the fake news that without health insurance, we can’t have health care.

When the truth is that we can, we will, and we already do have access to plenty of affordable, quality health care – before we ever need to invoke a high deductible health insurance policy.

And the fact that, as of right now, you can buy birth control for ten bucks a month? Well that just proves it.

It’s not the COSTS of health care that are outrageous…it’s the CHARGES.

Physician. Health Insurance Agent. Author. Health care humorist. Medical satirist. Disruptor. At your service. My name is Kevin Wacasey, and I’ve been practicing medicine since 1994. When I graduated from medical school, I took an oath to do no harm to my patients. To me, that includes financial harm. But since health insurance took over health care over 40 years ago, health care prices have skyrocketed. And despite what we’re told by the media every day, it isn’t the costs of health care that are outrageous; it’s the charges. So if you’ve ever wondered why we spend so much on health insurance and health care, then come along and join me as I explore the crazy world of Healthcareonomics. Health care doesn’t have to be expensive. Let me show you how. For speaking opportunities and to pass along your questions/comments, please email me at

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