Girls Have Cooties

The NYT has a front page article, Women Buying Health Policies Pay a Penalty, on the significantly higher premiums private health insurance carriers charge woman. It appears that trying to remain healthy is a reason to charge higher premiums because the users "consume" more of the "product".

Striking new evidence has emerged of a widespread gap in the cost of health insurance, as women pay much more than men of the same age for individual insurance policies providing identical coverage, according to new data from insurance companies and online brokers.

Some insurance executives expressed surprise at the size and prevalence of the disparities, which can make a woman’s insurance cost hundreds of dollars a year more than a man’s. Women’s advocacy groups have raised concerns about the differences, and members of Congress have begun to question the justification for them. ...

In general, insurers say, they charge women more than men of the same age because claims experience shows that women use more health care services. They are more likely to visit doctors, to get regular checkups, to take prescription medications and to have certain chronic illnesses.

Marcia D. Greenberger, co-president of the National Women’s Law Center, an advocacy group that has examined hundreds of individual policies, said: “The wide variation in premiums could not possibly be justified by actuarial principles. We should not tolerate women having to pay more for health insurance, just as we do not tolerate the practice of using race as a factor in setting rates.”

The women most likely to be purchasing individual health care are those least likely to be employed and/or married to someone who has employer based health care. The women most likely to have lower household incomes and greater health risks due to the demands of work (possibly needing to do two jobs, leaving little time for self-care) and the structure of food pricing, where the least nutritious is the cheapest. This group of women is also likely to have dependents who are also significant "consumers" of health care.

One of my first thoughts was childbirth and attendant medical complications were factored into the premiums. After seeing what a friend of mine went through to have an "uncomplicated" ceasarian, I can see there would be some significant expenses involved. But that's not necessarily the case:

Insurers say they have a sound reason for charging different premiums: Women ages 19 to 55 tend to cost more than men because they typically use more health care, especially in the childbearing years.

But women still pay more than men for insurance that does not cover maternity care. In the individual market, maternity coverage may be offered as an optional benefit, or rider, for a hefty additional premium.

Crystal D. Kilpatrick, a healthy 33-year-old real estate agent in Austin, Tex., said: “I’ve delayed having a baby because my insurance policy does not cover maternity care. If I have a baby, I’ll have to pay at least $8,000 out of pocket.”

So, it's not because the dames are popping out sproglets. That would be an additional expense. The "but you might get pregnant" argument is the same as what was used for years to deny access to education and good paying jobs. Your biology isn't male, thus, we're going to charge you. How big are these disparities?

Humana, for example, says its Portrait plan offers “ideal coverage for people who want benefits like those provided by big employers.” For a Portrait plan with a $2,500 deductible, a 30-year-old woman pays 31 percent more than a man of the same age in Denver or Chicago and 32 percent more in Tallahassee, Fla.

In Columbus, Ohio, a 30-year-old woman pays 49 percent more than a man of the same age for Anthem’s Blue Access Economy plan. The woman’s monthly premium is $92.87, while a man pays $62.30. At age 40, the gap is somewhat smaller, with Anthem charging women 38 percent more than men for that policy. ...

Thomas T. Noland Jr., a senior vice president of Humana, said: “Premiums for our individual health insurance plans reflect claims experience — the use of medical services — which varies by gender and age. Females use more medical services than males, and this difference is most pronounced in young adults.”

In addition, Mr. Noland said, “Bearing children increases other health risks later in life, such as urinary incontinence, which may require treatment with medication or surgery.” ...

In Iowa, a 30-year-old woman pays $49 a month more than a man of the same age for one of Wellmark’s Select Enhanced plans. Her premium, at $151, is 48 percent higher than the man’s.

So, women and men engage in sex, but women get pregnant and might have complications. That men, statistically more likely to have more partners, are at a higher level of risk for STDs and (since they are less likely to seek treatment) are more likely to suffer the long term effects of a disease like herpes and to spread that disease to other partners doesn't come up. Can we also talk about the propensity for male "young adults" to engage in risky behavior and end up requiring extremely expensive treatment for injuries? A friend of mine is recently out of ICU because of bashing in his own skull in a fall while trying to skateboard while drunk, for example. Are these accidents being factored in to male insurance premiums? Is it really the case that a woman is 48% more expensive to insure, or is it that the insurers know that men don't use medical services enough to make any money off them?

At the same time as women are being charged more because of they might get pregnant and they might make more use of the doctor, the fundamentalists are trying to remove access to effective birth control (in part by trying to force states to drop requirements that birth control be covered by insurance) and discourage use of health care that is aimed at reproductive health, such as pap smears, vaccines and and non-hormonal birth control, especially if provided by clinics that also provide abortion services. Where are the men of the Left in this battle?

Then there is the argument of health care over time. Women use health care earlier in their lives when it will pay out greater benefits in long term health. Men do not. The article did not offer a comparison of health care consumption after 40. Are men actually costing more long-term? The actuarial people warn against sharing the risk:

Cecil D. Bykerk, president of the Society of Actuaries, a professional organization, said that if male and female premiums were equalized, women would pay less but “rates for men would go up.”

Mr. Bykerk, a former executive vice president of Mutual of Omaha, said, “If maternity care is included as a benefit, it drives up rates for everybody, making the whole policy less affordable.”

Um, wouldn't it make the whole policy more affordable to the people most likely to need the health care? Instead of women, and the most vulnerable groups of women, having to bear a premium for the ordinary health needs of life, why don't we spread it around and make it a little more expensive here but a lot less expensive there? In short, why don't we use insurance the way it is supposed to be used, to reduce cost by recognizing the social benefits as well as the individual risks? Some people have their heads on straight:

Mila Kofman, the insurance superintendent in Maine, said: “There’s a strong public policy reason to prohibit gender-based rates. Only women can bear children. There’s an expense to that. But having babies benefits communities and society as a whole. Women should not have to bear the entire expense.”

The cost of poor maternal health as a whole is greater than just the considerable burden on the mother and her children. Of course, one answer I hear even on the Left is that women who can't take care of themselves (i.e., cannot afford health insurance plus the maternity rider) have no business bearing children anyhow. And they shouldn't expect to have contraception to save them, either. They can just keep their knees together and stop being such welfare queens and trailer park trash. Besides, the world is overpopulated and we don't need more people who are just going to reproduce their pathological culture as well as extraneous children.

Hmm, what's familiar about that picture? If you view women primarily as breeders, and then you divide them into the well mannered breeders who limit their reproduction and deserve to be treated like men and the undeserving breeders who have babies to stay on welfare or who are just sluts who fuck until they "have" to get married, well, you don't really have to look at the social benefit that accrues to men whose medical needs are no less than women's, but which follow a different pattern.

There is something profoundly wrong treating human reproduction as a disease peculiar to women.

Anglachel

A Room of One's Own

If you have not yet read Echidne's post, The Right to Go Out, go there at once and read it. It's brief and I'll wait. Back now? Good.

The line from the post that sticks with me is this one (my emphasis): "My second reaction [to a statement quoted in the post] was the realization that people mostly don't see that female fear of the outside as a civil rights issue or a human rights issue. It's just How Things Are."

Without disagreeing with Echidne, I think the argument can be applied more broadly – the problem is that there are almost no physical spaces women may safely occupy and that the home may be even more dangerous than the street. Echidne’s observation that, “In most societies women who go out alone at night are at greater risk than men who go out alone, because women have to deal not only with the risk of getting mugged but also with the risk of getting raped. They are seen as prey,” can be applied to any location. A workplace, a parking lot, a path or sidewalk are places where women are stalked as prey, but so are homes, both in and out of buildings.

The percentage varies with the study being done, but it is the majority of violent assaults on women are by someone they know, a partner, a relative, a family friend. The most common place for this violence is the home. Where the hell do you go if nowhere is safe?

I have been raped more than once, always in my own home, always by someone I knew. I am lucky that the only man who threatened to kill me decided to batter holes in the wall beside my head while screaming how he would kill me instead of doing the deed. I am also lucky that I was able to leave that situation behind.

What of women who cannot? What if you lack the money and the support to get a room of one’s own?

The current financial meltdown will produce an upsurge in violence against women because the opportunity to engage in this violence without repercussions to the abuser will also increase.
If you have no health insurance except what your spouse or domestic partner gets through work, you have to calculate the costs of losing that coverage. If you kick out an abusive partner, will you be able to pay your mortgage or sell the house at any price? Shelters are closing for lack of funds – would there be a place to go to? If you have children who need to be protected, how might homelessness affect them (PDF)? Will rents be affordable even if you have your own income? Will employers hire you if they know you have a restraining order against a violent partner? Will you be targeted to be let go if your home life threatens to spill over into the workplace?

What about community programs that try to combat violence? The Family Justice Center of San Diego provides a one-stop-shop to help victims of domestic violence to work their way through the legal and social service tangle and get help. It both is and is not a part of the city and relies on volunteers, grants and donations to keep running. How will it be affected when corporate donor budgets are cut to the bone, charitable groups have less to give, and volunteers may need that time to work for wages? City of San Diego Police Department has one of the best domestic violence response units in the country, and works closely with the Family Justice Center (FJC). The City is also looking at a 10% cut across the board budget cut. What will happen to this unit? To similar units in other cities? What about emergency medical services? What about undocumented aliens? Will they protest if it might mean a visit from the INS? FJC won’t ask about your residency or citizenship, but will legal and social service agencies that use public funds be required to report suspected illegals?

Given a political and cultural environment awash in misogynistic imagery and sentiments, where the leader of the majority party is openly courting cultural conservatives and saying privately to the money men that social programs and services will be cut, we can expect to see policy and funding choices biased towards “family values” and increasing privatization of the risks of ordinary life. If misogyny and violence against women are not seen as civil rights or human rights violations, then the home becomes that much more dangerous a place because it is just a private matter, just that bitch getting in his face, you know, so you can understand why he had to give her a smack to make her calm down. Or maybe more than that. Whatever it takes to reassure the abuser that order has been restored.

In the current political environment, how difficult will it be to secure a room of one’s own?

Anglachel

Update - I have received some incredible comments from a number of people, some who said they've never posted a comment before to a blog. They are almost all stories about a woman's encounter with violence in her home. After consideration, I will not post these, even if the writer did not specifically say "don't publish", though most of you did say that. Thank you for trusting me enough to tell me these things.

A Bitter Pill

This post has been stewing a few days while I waited for the Senate web site to get its brains unscrambled, but it looks like that won't happen anytime soon.

Senators Hillary Rodham Clinton (NY) and Patty Murray (WA) have been at the forefront of a battle with the Secretary of HHS, Michael O. Leavitt, to prevent the Bush adminsitration from categorizing contraceptive pills and IUDs as abortifacients. Melissa McEwan wrote this up on Shakesville in July. Hillary co-wrote an op-ed for the NYT on this matter, Blocking Care for Women.

Sens. Clinton and Murray on July 16, 2008
Sens. Clinton and Murray on September 23, 2008

A few days ago, French Doc posted Punishing The Poorest Women, which uses a Nicholas Kristof column to talk about what the deliberate refusal of the Bush administration to provide effective contraception means to the poorest and most vulnerable people in these societies - more impoverishment, worse health, sick children and increases in infant and maternal death.

Oral contraceptives are the single most socially transformative invention of the 20th century, something that fundamentally altered how half of the species could act in the world. Women could now control their fertility with a great degreee of precision and without the assitance of men. Until this invention, all forms of contraception had to be some type of barrier method - a condom, a diaphragm, a cervical cap - or else sterilization. (I set aside IUDs for now, but consider them a variation on a barrier) If the barrier wasn't present, pregnancy could take place. Barriers were prone to high rates of failure, condoms required the cooperation of the male, and all required planning. With the pill, women could proactively protect themselves from pregnancy and could regulate their occurance with a minimum of effort.

The pill removed male agency and control from reproduction in a way no other contraceptive ever could. It was a direct assault on the male privilege of impregnating (and incapacitating) women as it suited them, and using the threat of rape and unsanctioned pregnancy to profoundly limit where women could go and what they could do. In the absence of modern medicine, every pregnancy was a life threatening event, and the most common cause of death for a fertile women. It also removed a great deal of power over lower status men who could now engage in sex without the fear of "ruining" a woman or having to forego sexual activity until they were able to afford a wife and children.

The social conservative assault on women has focused on reproduction because it is pivotal in controlling female behavior. The political conservative attack on reproduction also wants to control female behavior, but is more interested in this as a wedge agisnt the formation of privacy rights for anyone. See my posts Privacy and Privacy Rights and Equal Treatment for my extended argument about the attack on privacy by the Right.

What I realized as I read French Doc's post and thought about Hillary and Sen. Murray's fight to make Sec. Leavitt back down (and I give a shout out to their defense of Plan B, too), is that the life I lead could not have occurred without that medication. I recently went off the pill, and the mental shock of knowing that I am now vulnerable to an unplanned pregnancy was greater than I had expected. I now know what pharmacies in the area stock Plan B and who is open 24 hours. When I read about Gov. Palin's youngest child having Down Syndrome, I realized that was something that could happen should I get pregnant. With the financial meltdown, I've spent some hours figuring out "What if..." scenarios should this or that calamity befall us, and I have to factor in an unplanned pregnancy as a possibility. It has made me focus on who is defending my rights.

What makes this a bitter reflection is that I do not hear the senators' defense coming from the mouths of the Party leadership. I hear general blandishments about a woman's right to chose, but not a rigorous defense of the right to contraception in the first place. Before this election season, I would have said that the Democratic Party was sqaurely behind women's rights, but given the misogyny and the kinds of assaults aimed at first Hillary and then Gov. Palin specifically about their sexuality, fecundity, and what their sexual histories "said" about them, I have lost most of that certainty.

Are women's reproductive rights going to be one of those subjects, like gay rights, the Unity Democrats are going to be all bi-partisan about? Maybe keeping the foreign policy stuff in place to placate the Right because it's only poor black and brown women in distant places who will die as a consequence? Maybe rescind requirements that insurance policies have to cover hormonal contraceptives, and state they cannot be used to cover Plan B at all, as a way to get some bipartisan support for health care? Allow conscience clauses everywhere to prevent pharmacists from having to provide this medication to any women? There are a lot of ways to effectively remove a right that fall short of legally dissolving it.

I have no confidence that men on the Left are interested in defending women's rights, starting first and foremost with the right to control their own fertility without unjust burdens and barriers. I will be blogging more on the political uses of misogyny over the next few days.

Anglachel

Turn Tables

I'm working on the party post which is proving difficult to pull together, so I thought I'd toss out something I said to the spousal unit while we were making dinner.

The problem with the Obamacan response to Palin is that it did nothing to bring the debate back to Democratic friendly ground. It wallowed in cultural class resentment. A more sophisticated response would have been personally sweet-as-pie to the entire Palin family while blasting holes in the Republican platform. Something like:

Bristol is expecting? Our best wishes for a healthy pregnancy and a safe delivery. By the way, how does Ms. Palin get her health insurance? Through her mother's coverage? That should be good coverage, considering all the great care Gov. Plain must have received while carrying a special needs child. What are the Republicans doing to ensure that all American mothers-to-be get the prenatal care they need? What is their stand on health insurance for all just as good as what Gov. Palin can provide to her family?

Oh, Ms. Palin is getting married to her child's father? Our congratulations to the young couple for their upcoming nuptials and bundle of joy. Being a young couple starting a new family is a very scary proposition in these bad economic times. What can Republicans offer young families trying to get established in careers, buy a house, start their family, and so forth? Aren't young couples facing reduced prospects compared to their parents? Reduced funding for education, a deregulated market that allowed insane toxic mortages to be made, reduced job opportunities for blue and pink collar workers, especially those new to the labor market. The Republicans have ruined a previously strong economy, and this hurts young families.

And after Ms. Palin has her baby, will she be continuing her education? Will she be employed outside the home? These are crucial needs that young families struggle to fill. Child care, women completing college degrees, flexible workplaces, paternal as well as maternal leaves - these are all things that can mean the difference between a comfortable life and a struggle to put food on the table. Just what are the Republican plans to provide these goods and services?

Lather, rinse, repeat. It's really not that hard to be both nice and politically tough. Of course, it's a lot easier to do if you actually defended women's rights, UHC, strengthening education, expanding workplace programs to be family friendly, subsidizing child care and so forth.

If you run on a platform of vague and generically liberal propositions, you rob yourself of tools to use to your advantage when specific situations arise.

Anglachel