“Free” Birth Control And The Future Of Public Policy In a Sharply Revenue-Constrained Environment

The non-debt ceiling political story of the day is the news that, yes, the Affordable Care Act will be delivering free birth control to American women. But as Irin Carmon writes, free doesn’t mean taxpayers will be footing the bill. What we’re getting isn’t taxpayer-financed, government-subsidized birth control. Instead the practical impact will be higher premiums, resulting in cross-subsidy of birth control by people who don’t use birth control. I’m with Kay Steiger in thinking that this is a logistically cumbersome second-best relative to straightforward provision of birth control services.

But I also think that this kind of thing is the future of American public policy in a world where the population is aging and it’s impossible to raise taxes. Where you can’t tax and spend, you instead regulate and mandate. Instead of creating a big government universal child care system, you make a rule saying that employers with more than 50 workers need to provide child care for their employees. It’s less transparent and less efficient than the tax-and-spend alternative, and it also creates a system with more holes and less accountability. But it doesn’t involve job-killing tax increases!

Over the long run, countries that accept that there’s nothing wrong with the principle of paying taxes in order to create government services are going to do better. They’ll think more seriously about the actual cost of services and whether or not they’re worth paying for, but they’ll also provide the services they deem worthwhile in a more efficient and equitable way. Both coming and going, they’ll end up getting much more bang for their buck.