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Brooks Wilson's Economics Blog: The Allegory of the Breast Pump

Tuesday, August 2, 2011

The Allegory of the Breast Pump

(HT Drudge Report)  Yesterday, Health and Human Services Secretary Kathleen Sebelius announced that beginning January 1, 2013, that insurance companies must cover women's preventive care without copays under the Affordable Care Act of 2009.  Tens of millions of women are initially expected to gain benefits and that number is expected to grow over time (“Federal health department approves free birth control”).  Included under the decision are breast pumps and here begins the allegory. 

In our fictitious economy, 1% of GDP is spent on breast pumps and 10% of pregnant women use them.  The government changes insurance laws so that all women have a zero copay.   Prior to the change in insurance law, on average, women paid $200 for a breast pump.  After the change in the law, doctors recommend pumps that cost 50% more than the average expenditure.

An informed pregnant woman, Molly, considers breast feeding her baby.  Given her schedule, she estimates that she will need to use a breast pump eight times per week or make small alterations to her schedule.  After talking to friends, she learns that pumps are a little uncomfortable and somewhat time consuming.  As part of her research she looks at the price of breast pumps.  Because Molly believes that there is a good chance that she will decide that it is easier to alter her schedule than use the pump, she tentatively decides to buy an inexpensive $100 pump.  If she does not like it, her loss would be small.

During her next checkup Molly asks her doctor, Dr. Who, about feeding options for her baby.  The conversation centers on breast feeding.  She describes her research.  Who realizes that she is unaware of the change in law and suggests that she try using a breast pump costing $300 because it causes less discomfort and because of the zero copay.  Molly agrees.  The order is processed through her insurance company adding an additional $100 to the cost. 

This conversation is repeated with all pregnant women. The 10% of women who originally decided to use breast do not alter their decision but they do decide to alter the breast pump models that the purchase so that the average cost is $300 per pump.  Women who had decided to use a less expensive pump decide to use the $300 model.  An additional 20% of women decide to try pumps.  Half find the pumps satisfactory and continue their use and half stop using the pumps after a brief time.  Another 10% of women are embarrassed that they do not want to breastfeed and agree to try the pumps with no intention of continuing their use.  All women who are persuaded to try a breast pump choose the $300 model.  

The change in the law chased an 800% increase in breast pump purchases.  Because women now on average buy $300 pumps rather than $200 pumps and four times as many women purchase them, breast pump purchase now represent 6% of GDP.  The cost of processing claims represents 2% of GDP.  Breast pump manufacturers wake up and smell the coffee.  There is no reason to specialize in producing inexpensive pumps.  The average price of pumps increases.  Doctors retain their practice of recommending breast pumps that costs 50% more than last year’s average.  Breast pump prices spiral upward.

How much better off are we as a country?  The original 10% of women using breast pumps are clearly better off.  They wanted to use breast pumps and they end up using a more expensive model at a cheaper price.  The next 10% of women who chose to try a breast pump and continue its use are $300 better off if they correctly measured their costs and benefits.  The remaining women are no better or worse off.  In total, pregnant women are gifted an additional 6% of GDP but their welfare gains total only 2% of GPD.  Insurance companies also gain 2% of GDP.

The same cannot be said of taxpayers.  They are clearly worse off.  They are paying an additional 7% of their income for breast pump purchases and insurance processing.  The lesson from this allegory is simple.  Markets produce a better allocation of resources that produces a higher level of well-being for society.


  1. The purpose of this legislation is to PROMOTE feeding of our future generation with breast milk. Not an easy task when women are often expected to return to work full-time within few weeks after giving birth.

    If you are going to write about the economics of providing breast pumps, without out-of-pocket expenses to a woman, please consider all aspects of this topic. Few points you have not considered:
    1. Breast milk is rich in antibodies that protect the baby from infections and are not found in commercial formulas. According to WebMD, "Except for wellness baby visits, ear infections are the most common reason for trips to the pediatrician, accounting for approximately 30 million doctor visits a year in the U.S. Today, almost half of all antibiotic prescriptions written for children are for ear infections, and the cost of treating middle ear infections in the U.S. has been estimated at $2 billion a year."
    2. Breast milk has the right amount of fat, sugar, water, and protein to help the baby grow appropriately. Something to think about while our nation is struggling with morbid obesity and obesity related health care costs. For example, a bariatic surgery for weight loss, performed on adults and children, ranges from $6,000 to $8,000 per procedure.
    3.For most babies and especially premature babies, breast milk is easier to digest than commercial formula made with cow's milk. Take a look at rising incidences of child and adult allergies and gastrointestinal conditions, that may be prevented.

    So, "How much better off are we as a country?" The benefits might take time, the time it takes for these breast-milk-fed children to grow up and become healthy, intelligent and productive members of our society.

  2. As a mother of three children, all breast fed (with twins ta boot!) without the help of any sort of government incentive, I would like to respond to anon's comments.

    Dr. Wilson is not refuting the benefits of breast milk, he is analyzing the affect laws have on the economy.

    There is no proof that eliminating the copay has increased the number of breast fed babies. If that's your goal than educating young mothers and increasing their standard of living so they have the time to breast feed would be a better use of government money.

  3. This is really interesting to think about and consider. I don't have any children but when I do I would like to be able to feed my baby breast milk versus formula. Breast pumps do help women that have to go back to work and cannot be there to feed their baby. However, I've worked with women who work around their schedule to feed their baby at the daycare in person.
    As a woman who has just lost insurance coverage I have seen some of the benefits of the new health care act. However I am still figuring out how health insurance and our economy work so this opinion could change. I have had my moments where I have definitely despised our health care system but hopefully with more knowledge I will understand how the system works and why it works the way it does.

  4. The topic is incredibly interesting! I Can't relate to women who have children that go through the decision on whether to use the breast pump or not, but If i had to decide I would choose natural breast feeding.
    Natural Breast feeding is inexpensive point blank.
    The government can promise you that a breast pump will stop different causes, but they are not 100% sure that these things wont happen. So I say the healthiest choice would be the natural way.