I doubt if the added cost will deter bad behavior, but it is unfair that people who live healthy life styles subsidize the health costs of those who do not.

Define your terms.

I bike to work, I have a low BMI and *very* low body fat percentage, I don't smoke, have about one drink a night, eat moderately, and run 5K on my lunch hour every day that I can (i.e. its' not pouring rain and I can actually get away from my desk). I take dance classes two nights a week, and although I would not define myself as athletic, I am very active.

I also went rock climbing today, where I very easily could have fallen and broken my neck. I could go over a door on my bike, or get hit by a car. I could blow out my knee tripping on a root while running. All of those events would run into the tens or hundreds of thousands of dollars to treat.

So: would I fall into your definition of having a healthy lifestyle? Should I get affordable medical treatment if I get injured in any of my activities? Or should I only get affordable care if I sit on my couch all day, every day avoiding risk? Of course, then I would get fat so I guess I shouldn't get medical care then, either. Who exactly *should* get affordable medical care?

Oh yeah, and I stopped off at McD's after climbing and got a double cheeseburger, fries, and a coke. ConAgralicious!

Christ on a bike! Yeah, sure, here's a pill that fucks with your *entire endocrine system*, have fun handling it all on your own! No labs, no BP check, no exam, or even to eliminate patients who have a family hx of estrogen-feeding cancers... Really smart, kids.

If you test positive for Leiden Factor V, your chance of PE jumps to something nutz like 50%. Women who have that genetic marker are strongly discouraged from taking the Pill (my vascular doc is a big fan of the Mirena IUD) since they stand a 50-50 chance of dropping dead. Different brands of pills have higher or lower estrogen, and ingredients that can cause a huge variety of reactions and side effects (weight gain, loss of libido, mood swings, even aural hallucinations in the case of a friend of mine.) Even generic versus brand can cause widely divergent reactions in patients. My first pill made me so paranoid that I actually thought about taking myself to the ER for a psych eval, and on top of it gave me two periods a month instead of one. My second one gave me blood clots.

Women absolutely need to be under physician evaluation if they're on hormonal birth control. This is unbelievably bad medicine.

And who monitors side effects, checking to see if they're possibly pill-generated (and consequently tinkering with different brands/generics to get the right fit), or if they're external to the pill and should be reviewed for further diagnosis?

It's always recommended that everyone get an annual checkup, or at the very least see a doctor every 18 months if you are a healthy, unmedicated young adult.

That doesn't change when the pill is offered sight unseen

It takes about three months for your body to fully adjust to hormonal birth control. My doc had me come back three months after starting my first pill, which was a really good thing because I had started going insane and had two periods a month to boot. She switched me after my body still hadn't adjusted after those three months were up.

What if I didn't have a physician's review? Which of all the different brands of pills should I have switched myself to, to alleviate those symptoms? What about women who switch themselves to a new pill monthly, instead of giving their bodies the full three months? What if they have dramatic side effects instantly, and think they *should* wait the full three months, even though they're (say) hearing voices? What if they suddenly develop a sharp pain in their calf, or shortness of breath? Do you think they'd make the connection estrogen -> clotting disorder -> DVT -> pulmonary embolism/stroke?

I'm really shocked by the number of people who think hormonal BC should be handed out like allergy medicine or Tylenol. This affects your endocrine system, which affects pretty much *everything* in your body. Additionally, there are so many varieties that all behave differently that you should have a physician's or NP's guidance in finding the one that works best with your body chemistry. If you have a doctor that just writes you a script with no advice and without taking a history, then I'm very sorry for you because you have a crappy doctor.

And finally: yeah, if you have a clotting disorder you'll also have a clotting disorder while pregnant. I fail to see how that is an argument for giving out the pill without a full workup. Wouldn't you prefer to know *before* you get pregnant that you run a high risk of dropping dead?

Honesty – this whole needing to see a doctor each time you get the pill seems like a way to keep poor women down. I know there is a better solution and I’m really surprised that so few posters here are even trying to think of a better way – it seems so classiest and out of touch.

Much better to provide bad -- or no -- medicine, right?

I know, the siren song of "victim!" is pretty seductive, but diminishing medical care isn't the answer; the solution should be to increase and improve access to care, and to provide incentives to med students to go into primary care and OB/GYN, rather than handing out estrogen pills like aspirin.