Wednesday, October 29, 2008

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.



Sarah said...

Thanks Anglachel -
A good friend of mine is a high-level VP at Cigna and we at times discuss these things. I am an advocate of single-payer which he calls 'socialized medicine'. I am a cancer survivor and one of the reasons I Stayed in my job so long was to keep benefits. I had an opp to be my own boss and researched coverage - even as part of a high-tech consultant group which I was joining. $600-900 per month just for me. I explain to him that if I went to Cigna and asked for an individual policy they'd say NO because of my history, and I try to frame this to him, as you do - as a moral failing of our own society. (I think he agrees. AT least he says something needs to be done.)

I'm more an idealist, and what I think needs to be done is the CIgnas of the world need to disappear altogether. Ins Cos are profit-oriented middle-men.

Strictly speaking, we don't need health 'insurance', we need health 'care'. So I'm an advocate of Single-Payer....but since Clinton got taken out of the game, I guess that will remain a pipe dream.

Historiann said...

Great post--I've got a response up at

Vast Left-Wing Conspiracy said...

O/T, sort-of:

Tim Murray said...

You make some good points, but I've got the same beef re: auto insurance. The insurance industry is not known for gender sensitivity. If you have a 17-year-old son who is the picture of responsibility, you will pay a lot more for his auto insurance than for his wild and irresponsible sister who is the same age. Real fairness goes out the window anytime you start stereotyping individuals based on the fact that they were born into a group.

Sarah said...

I hear you Judge - but I have some Underwriting background and sadly, your very responsible 17-yr-old has to prove it before his rates will come down. Actuarials do not have his past history, only his group's. Once he's logged a few years of spot-less driving, his rates "should" come down. Emphasis on "should"....

Koshem Bos said...

Our society is based on exploitation. Women are a prime target. Health care is more expensive for women because they have never organized to fight health care cost nor is there a universal health care. Teachers, mostly women, are paid badly compared to other professions where men are more numerous.

Engineers, women and men, work extra hours without being paid. They, simply are supposed to do. Vacations start from 10 days a year, an insulting short time. Europeans start from a month and go on to at least a month and a half.

The belief that everyone has to bow to business needs, real or invented, causes massive abuse of the work force; the people who work for salaries or ourly rate.