Providing Birth Control Over the Counter Should Be Just the Beginning

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This month, an advisory panel of the Food and Drug Administration unanimously recommended the availability of Opill as a contraceptive over-the-counter. The F.D.A. The F.D.A. will decide in the summer if they will follow this recommendation. If so, then it will join more than 100 other countries who have already approved oral contraceptives to be used without prescription.

The development is three decades later than most people expected. Health experts agree that it could have a major impact on public health in a country where nearly half of pregnancies occur unintentionally.

A F.D.A. official spoke at a 1992 birth control conference. Philip Corfman of the fertility and maternal drugs advisory committee noted that birth control pills are safer than aspirin which is available over-the-counter. The F.D.A. The F.D.A. announced plans to hold an hearing to discuss the possibility of bringing oral contraceptives to over-the counter. The idea was that by bypassing doctors - to whom many Americans had limited access - this would increase access to birth controls. Heather Munro Prescott, a historian, has recalled that the hearing was cancelled at least in part because of criticism by what may seem to be a surprising group: the nation's top feminist patient advocacy groups.

Cindy Pearson, the National Women's Health Network's program director at the time told Dr. Prescott that a birth control prescription was the poor woman's ticket for health care. Women's health advocates were worried that insurance would stop paying for birth control if it was available over-the-counter. This could create new barriers for access.

The argument was that, if insurance companies were not to pay for regular doctor's appointments and if women did not receive birth control prescriptions as a way to encourage them to do so, the health care exclusion would increase. Women who don't see doctors may be less aware of the potential side effects associated with birth control pills. This could put them at greater risk.

These concerns were all a result of the private health care sector in America, of the minimally regulated insurance markets, and of the lack of community-based prevention services and health education. The public became overly dependent on medical professionals, despite the fact there weren't enough doctors and nurse to meet the country's needs. Faced with these realities, activists tried to do their best to protect women's healthcare under less-than-ideal conditions. This included normalizing doctors' paternalistic authorities and involvement in areas of women's life that didn't require expert medical supervision.

Americans are now reaping the benefits of compromises made in decades of incremental reforms in health care. Delaying the confrontation with for-profit medical care monopolization has allowed a historically conservative medical profession to gain a large amount of cultural and policy influence over Americans.

It's no secret that a large part of the current role of U.S. doctors, who are in short supply, doesn't need to be done by medical doctors.

My colleagues and I, as practicing doctors find that our clinical workdays are shaped not by the need to provide effective care but rather because of lobbying efforts for years to maximize doctors' political influence and market share. American Medical Association has, for instance, made'scope creep' a priority. This aggressive lobbying has been done under the guise that it is protecting patient safety. It consists of preventing nurses, pharmacists, physician assistants and others - such as community workers and other lay caregivers - from gaining billing authority or legal rights to provide services which might compete with doctors’ political power and revenue targets. The medical profession's control of reimbursement has led to chronic underutilization and underpayment for non-physicians and nonprofessionals.

The abysmal outcomes of our American health system are largely due to the top-heavy and doctor-centric industry. The U.S. has always prioritized medical treatments that are reactive, rather than investing in public health services that focus on prevention, safety and support for social issues. According to a projection for 2016, public health spending accounts for less than 3% of U.S. healthcare spending, despite the fact that it can yield savings between $67 and $88 per dollar invested.

The doctors and medical institutions who have a vested interest in this fact: nearly one-fifth the nation's Gross Domestic Product is spent on health care. As a proportion of their economy, the United States spends nearly twice as much as other developed industrialized nations on health care. By 2030, this spending will increase 58 percent to $6.8 trillion. Despite all of this, approximately 28 million Americans are still uninsured. The U.S. Life Expectancy is also continuing to decrease despite being already far lower than in other wealthy countries.

Medicine is a public good. When it becomes a tool for health capitalism, where profit is more important than care and its power and scope of practice are oriented towards it, then it spreads like cancer. Ivan Illich, a philosopher and social critic, observed that without limits, the medicine itself can become a source of disease.

The question whether or not the F.D.A. The question of whether the F.D.A. It is obvious that the move to oral contraception over-the counter, which would be available to all without restriction of age and at no cost to anyone who wants it, was a necessary change for improving population health and protecting the right to self-determination. Even the A.M.A. (Even the A.M.A. It is also important to ensure that medication abortions are available without the need for unnecessary medical intervention and to protect legal rights to gender affirming care.

We need to reconsider the prescribing powers of physicians and question whether they are serving public health in the best way. But we must also stop taking it for granted that doctors should be our primary health care providers. Community health workers can provide essential preventive care such as vaccinations and referrals for screening exams, like mammograms and colonoscopies. They can also provide diabetes education, mental health assessments, nutrition and exercise counselling, and more.

We need to reverse the capture of health care by industry in order to improve reproductive health as well as U.S. healthcare systems at large. It is important to restore the industry's role to one that is more limited by investing in community-based health care systems. This will make it more efficient, effective and trustworthy.