It Should All Be Free

Mona Charen
"It Should All Be Free"

Free medicine! That's what Obamacare has brought you -- or should bring you, at least according to CNN.


The story's opening sentence set the tone: "Contraceptives, sterilization and reproductive education should be covered by health insurance plans with no cost to patients under the health reform law, a new report recommends."

In a tone that can only be called cheerleading, CNN tells its audience that the Institute of Medicine has made these recommendations to the secretary of Health and Human Services. "Historic" is the way HHS Secretary Kathleen Sebelius described the report, adding that "we will release the Department's recommendations of what additional preventive services for women should be covered without cost sharing very soon."

Now, why, you may wonder, does the secretary of Health and Human Services get to decide whether to adopt the report's recommendations? Well, under Obamacare, health care has been nationalized. Among the roughly 700 references in the law to "the Secretary shall" is one mandating that the secretary shall decide which health care plans are acceptable in America and which are not. If a plan does not comply with HHS mandates, companies and individuals who purchase their products will have to pay a fine. In other words, under Obamacare, the secretary of HHS decides who gets covered for what.

The secretary is now considering whether all health plans in America will have to cover birth control, annual HIV tests, well-woman care visits, annual counseling on sexually transmitted diseases, breastfeeding support and counseling including rental of breast pumps, and screening and counseling for interpersonal and domestic abuse. These services should be covered "without any co-pays or deductibles," the report by the Institute of Medicine urges. In other words, these products and services should be "free" for all women, not just for the poor.

CNN quotes the president of The American Congress of Obstetricians and Gynecologists, Dr. James Martin Jr., who believes that "unimpeded access to affordable contraceptives for all women is foundational."

But why stop there? The biggest killer of women is heart disease. Shouldn't cholesterol tests, EKGs and stress tests be covered by insurance at no cost to the women themselves? And surely counseling about the risks of a high-fat diet and sedentary lifestyle should be included, too, no? At no cost to the patients, of course. And then there's cancer, the second biggest threat to women's health. So mammograms and annual doctor visits should be free. And certainly counseling about the dangers of smoking, excessive drinking and poor diet should be "fully covered," as well. Come to think of it, gym memberships should definitely be covered at no cost to the women.

But what about men? Men are far less likely than women to seek medical treatment. And men are dropping every year from heart attacks, strokes, accidents and cancer. Surely if their "well-man" annuals were "free," they would be more likely to get the treatment and preventive care they need.

And what about helpless children? Surely only an ogre would want to charge children a fee to get their vaccinations, checkups and medicine. And certainly adolescents should receive counseling about sexuality, date rape, drugs and alcohol. Shall we say monthly? Perhaps weekly?

Sebelius praised the IOM report as "based on science and existing literature." By literature, she perhaps means Cinderella, in which a kindly fairy grandmother waves a magic wand and produces dresses, coaches and jewels "at no cost" to Cinderella. She surely cannot mean the medical literature.

Though the Obama administration never tires of repeating this falsehood, the science does not support the claim that increased spending on preventive care reduces overall costs. The journal Health Affairs has studied the literature and concluded, "Over the four decades since cost-effectiveness analysis was first applied to health and medicine, hundreds of studies have shown that prevention usually adds to medical costs instead of reducing them. Medications for hypertension and elevated cholesterol, diet and exercise to prevent diabetes, and screening and early treatment for cancer all add more to medical costs than they save."

An administration that preens about its "evidence-based" policymaking constantly errs about what medical research has shown. But even more flagrantly, it fails to grasp the very first lesson of economics: Nothing is free. Someone will pay. As the great P.J. O'Rourke put it many years ago, "If you think health care is expensive now, just wait till it's free."