Chix cost more for everything, as any fule kno.

I think it is actuarially justified by higher medical usage and costs for young and middle-aged women -- the article doesn't present any proof against that, it just claims it's not true. The deeper question is whether we should be varying health insurance payments by health care use at all. To me, the answer is: only for truly optional procedures (cosmetic surgery, etc.). Not for the great majority of health costs, and certainly not for childbearing.

As long as we run health insurance as a for-profit business, insurers will try to charge more to people who use more medical care. They would do this in the group market if they could, but for the most part they can't.

I loved Sam Bee's thing on the Daily Show about women's "health." McCain has showed a disturbing lack of knowledge about or interest in women's health care. Remember when he simply couldn't answer a question about why birth control often isn't covered by prescription drug plans, but Viagra is? He sort of looked like he was laughing.

As long as we run health insurance as a for-profit business, the health care system will in all likelihood continue to suck.

As the article points out, utilization is the underlying actuarial principle for the differing premiums. Most guys just don't go to the doctor. For a variety of reasons, even healthy women will go at least once a year.

4 should have had a [* compared to many reasonable alternatives] in there somewhere. Compared globally, we're doing pretty well. Compared to the best systems around, not so much.

Pardon me for being silly, but isn't the point of insurance to spread the risks and costs around? In that respect is it proper to even distinguish between gender?

Oh, and just this year I heard that they are no longer endorsing routine prostrate tests for men over 50 and I think they are no longer endorsing breast self-exams for women either. So medical knowledge seems to change over time.

If pregnancy is such a factor, would a woman's premiums decrease if she had a hysterectomy?

6: Compared to the Democratic Republic of Congo we have great health care!

If they differentiate on gender what about the trans-gender and other cases that aren't so clear cut? Do they want to open the same can of worms some of the marriage laws are trying to do?

10: They're just running a business, not laying down impartial laws, so they can let a random bureaucrat make arbitrary decisions on the occasional case that doesn't fit their categories. It won't effect the bottom line.

Most guys just don't go to the doctor.

This is indeed the key. I've only been to a doctor a couple of times in the past ten years. I'm cheap as hell to insure.

isn't the point of insurance to spread the risks and costs around?

No, the point of insurance is to create profits for insurance companies and their shareholders. Few things in this world would make me happier than seeing the health insurance industry ground into dust.

No, the point of insurance is to create profits for insurance companies and their shareholders

Oh. As I said then, silly me. What was I thinking?

My friend works for a small nonprofit agency. Their insurance company raised their premiums a few years ago because their employees were largely young women, and said that young women cost more to insure due to GYN visits, birth control, and pregnancy. The management at the nonprofit was told this flat out.

No, the point of insurance is to create profits for insurance companies and their shareholders.

One could take the wind out of this proverbial sail by decreeing that all insurance companies be mutuals, thus aligning two out of the three actors.

Yeah, we need single payer. Germany has a better health care system than the US, but it is a complicated mish-mash like all of the health care reforms currently on the table in the US so it just costs more than france, england or canada. Obama just needs to bite the bullet.

How come people don't complain about the cases where men pay more for insurance?

To the degree that this happens, James (and systemically, it's mostly the other way around) that's not good either. It's at best 2nd order though.

re; 18

I'm fairly sure auto insurance is generally (and consistently) more expensive for men. That's just the result of actuarial calculation, though. Men are more likely to crash.

Like some of the comments above there's no way round it if the private insurance model is the one you take.

19: I'm actually kind of surprised that the actuarial results work out the way they do -- women get more routine care, but I have the anecdotal impression that men are more likely to get injured. It seems as if I know a bunch of under 40 men who have had knee surgery or similar, and more women who haven't ever been to a doctor for anything non-routine (which it's my understanding is pretty cheap.)

Was there a link somewhere to a study of total cost of health care usage broken down by gender under 40? Or does anyone have a good idea of where to look?

re: 20

http://www.ingentaconnect.com/content/bpl/hesr/2004/00000039/00000003/art00013

"Per capita lifetime expenditure is $316,600, a third higher for females ($361,200) than males ($268,700). Two-fifths of this difference owes to women's longer life expectancy."

I heard that they are no longer endorsing routine prostrate tests for men over 50

They will have to make do with exams in the conventional supine position.

but isn't the point of insurance to spread the risks and costs around

Well, it depends very strongly on what the insurance is for. Insurance for most things is only meant to spread around the risk of the policyholder's potential futures (as best as they can be determined by the actuaries), so that each additional policyholder will have their expected future costs covered by their premiums. This has the effect of spreading a fair amount of risk for accidents or unlikely conditions, but screws over anyone with a particuarly nasty risk factor.

For stuff that we see as a right, such as healthcare, we go one step even further and insist that the costs are also spread interpersonally, since no one should be deprived of a certain minimal standard of care due to a terrible risk factor.

For stuff that we see as a privilege, and especially stuff with a higher percieved element of personal control, such as driving, we're fine with people covering their own underwriting costs. After all, it can have some influence on behavior if they can change something to save themselves money (which is why people who don't think healthcare's a responsibility of a rich and fair society want everyone to cover their own costs, since they think this can be a big effect). And besides that, well, if it's really costly for you to drive, why should society help you do so when it's just a privilege?

This ignores the attempts in some ways to separate risk factors under individual control from those which are due to luck (like many pre-existing conditions) and only declaring the former to be valid risk factors for insurance pricing, but that's also a pretty damn difficult and faulty exercise. It would eliminate the price difference between men and women for health insurance, though.

This ignores the attempts in some ways to separate risk factors under individual control from those which are due to luck (like many pre-existing conditions) and only declaring the former to be valid risk factors for insurance pricing, but that's also a pretty damn difficult and faulty exercise. It would eliminate the price difference between men and women for health insurance, though.

We could just mandate that women kill themselves at age 73. To even out the lifetime cost.

21: Thanks, that was exactly what I was looking for and was too lazy to Google.

I can't really get worried about this as a gender inequity. As PoMo says, there's a real equity problem with charging people for health insurance on the basis of their actuarial risk, but once you're doing that, I can't see it as any worse differentiating on gender than on age, or any other demographic subgroup.

24: Ice floes, ttaM, ice floes. Have you no sense of history?

24: Fair's fair.

Now, does 21 account for pregnancy? Because the insurance gap persists is health care which does not cover pregnancy.

Because the insurance gap persists is health care which does not cover pregnancy.

Does that cover abortions, then?

rE: 28

I think it includes all life-time expenditures -- they state that they didn't break down the expenditure by medical code so can't factor in and out things like pregnancy. Their study is specific to total expenditure broken down by age cohort and gender.

However, I'd be very surprised if the 60% difference in costs not explained by life-expectancy was solely due to pregnancy.

I'd bet that the fact that men tend to keel over dead with all kinds of terminal shit rather than hanging about for years probably factors in. It's noticeable in their breakdown that men incur far less nursing home/facility costs even adjusted for life expectancy.

If you have the appropriate access, the full text is here:

http://www3.interscience.wiley.com/cgi-bin/fulltext/118752963/HTMLSTART

However, I'd be very surprised if the 60% difference in costs not explained by life-expectancy was solely due to pregnancy.

Reading the article again, they point to one study that suggests that the combination of child-birth related costs and longer life-expectancy accounts for most of the expenditure gap.

I'm actually kind of surprised that the actuarial results work out the way they do -- women get more routine care, but I have the anecdotal impression that men are more likely to get injured. It seems as if I know a bunch of under 40 men who have had knee surgery or similar, and more women who haven't ever been to a doctor for anything non-routine (which it's my understanding is pretty cheap.)

My understanding from reading various medical novels and such is that physical injuries (broken limb, blown out knee) aren't mindnumbingly expensive in the way that spending the last two months of your life in the hospital are.

But as people say, if you're in a system of private insurance where you get to pick your risk pool, this kind of shit is inevitable.

What apostropher said. I saw the article linked around yesterday, and this is just actuarial tables as far as I can tell. It's like the NYT never looked at the private insurance market before.

Thing is, that's problem enough. I don't think I could afford private insurance that would cover pregnancy. If I go for barebones insurance that doesn't cover doctor's visits at all, my basic rate is cheaper than shiv's.

If it helps the discussion I will share that a broken fingers cost little (xrays are not that expensive), the same, surprisingly, for a dislocated shoulder or a badly sprained ankle (have you heard of a Robert Jones dressing), the various cuts may actually be more expensive, especially if they require a plastic surgeon, like a lacerated eyelid sliced clean through, then removing torn knee cartilage cost even more, much of that for the mri (darn soft tissue injuries) and the big ticket item was spinal surgery, removing a slipped disk in my neck.

Everything else almost falls in the 'noise' category.

All told, though, I think the cost for four routine childbirths was more than all that. Remember, both the mother and newborn spend at least one day in the hospital.

Men collectively driving worse & getting in more accidents than women is: (1) a result of behavior they control (2) doesn't benefit women. Women being the ones who get pregnant & give birth is: (1) not something they control (2) does benefit men. Hardly comparable. But it is comparable to all sorts of involuntary other biological conditions, of course.

Also, any expense due to women living longer seems like it's NOT going to be a legitimate factor--if anything, a man's more likely to be dying on a private insurer at age 50; by age 78 a woman's probably going to be on Medicare.

Childbirth is really expensive. (well, it looks like it to me, at least.) If we compare a 30-year-old guy and his 30-year-old wife with two small kids, her medical expenses are kinda like his would be if he'd had two minor surgeries in the past few years.

re 19/17: I misread James (sorry!) as speaking to specific pools where mens health insurance is higher (which iirc, can happen, but is more rare). Of course if you look at all forms of insurance, that's different.

On the other hand, I think it is a fundamental mistake to think of or provide health insurance as the same thing as other forms of insurance.

Also, any expense due to women living longer seems like it's NOT going to be a legitimate factor

Right. It should make her lifetime expenditures accumulate to more, but it shouldn't be factored into yearly rates, should it?

It depends on how you die, doesn't it? A heart attack that takes a guy out when he's 54 is going to cost less than years of cancer treatment.

21, 36 -- This reminds me of when the tobacco companies were sued by states for the costs of treating people with lung cancer and claimed that lung cancer saved the states money. The argument was that all of the premature deaths due to people dying of lung cancer saved the states money on long term health care costs.

Kip Viscusi, formerly of Harvard, now probably the highest paid professor at Vanderbilt, was one of the prime movers behind this ethically awesome argument, and would be a decent candidate for the pig farm.

a lacerated eyelid sliced clean through

AAAAAiiiiiiiieeeeeee!

42: the kids learn it from movies, you know. A dangerous influence.

However, I'd be very surprised if the 60% difference in costs not explained by life-expectancy was solely due to pregnancy.

It's more than explained by that. If not for childbirth-related claims, women would be substantially cheaper than men (adjusted for life expectancy). Premature babies are the high cost claimants. Everything else is noise.

Premature babies are the high cost claimants. Everything else is noise.

There is no sensible reason to think of these particular expenses as exclusively the woman's, though.

They aren't they? Maybe it depends on the insurer, but I thought that some of the expenses were billed as to the baby itself. I remember a friend scrambling to put the baby on the insurance within the window.

And if it is all childbirth and longer life expectancy, both should drop out of insurance for younger women that doesn't cover pregnancy.

Only loosely related, but I took Cassidy to the doctor this morning to determine whether she'd broken her nose falling face-first onto the side of the sandbox at the daycare. It had bled off and on that evening, then she woke up yesterday with her nose all swollen and a big, UFC-style, black bruise across the bridge and under both eyes. No break, as it turns out, but it sure looks funny paired with the princess costume she's wearing today.

Just minutes after I dropped her off at the daycare and got to work, the woman who sits next to me had to leave to go pick up *her* daughter, who had fallen off playground equipment at her school and broken her wrist. The playgrounds are turning on our children, it appears.

It's official: Sarah Palin is an Internet troll.

47: absolutely.

41: It takes a lot of work to give tobacco companies the moral upper hand in a situation, but the states managed to do it in that lawsuit. Not only was it a crude shakedown, but it managed to make the states dependent on tobacco companies staying in business and continuing to sell cigarettes, giving the tobacco companies much more political power than they had before. All of this is being financed by a hugely regressive tax on cigarettes.

all of the premature deaths due to people dying of lung cancer saved the states money on long term health care costs

And the Social Security savings for the national government. The couple studies I've seen (though unfortunately I can't remember any names) suggest that smokers help us balance the budget.

49: I just posted about that over at my site. Jesus, but that woman is a full-steam moron.

49, 53: I actually find that statement more scary than funny. She's saying she would like to enforce the constitution in a manner that prohibits criticism of her by others. That's laughable intellectually, but as a statement by someone not that far from the Presidency it's not laughable at all.

I've always thought that if the right stayed in power Bush could be a transitional figure to a more real authoritarianism, sort of blazing the trail. It would take someone more independent from tradition, the memory of older ways of doing things to finish the journey. Palin sort of shows how that could work -- she didn't come up through the system, and her common sense about how it should work is completely shaped by the propaganda from Rush L. and so forth. It makes visceral sense to her that freedom = the freedom from nasty liberals.

Jesus, but that woman is a full-steam moron.

who's the moron when she puts you in jail for "violating her first amendment rights"? She gets the last laugh, is what I'm saying.

51 -- You're totally right. The tobacco companies are more powerful than ever, sin taxes on harmful substances are a bad idea, and we should never have used a "crude shakedown" to raise the price of cigarettes or obtain some more money for public ends.

PGD, check your email (the "guy" one).

56: I'm all in favor of sin taxes. I'm not in favor of paying lawyers billions of dollars to launder a sin tax, nor am I in favor of levying a sin tax on cigarettes, giving up the ability to change it in the future, and spending the next 25 years of tax receipts immediately. But this is in fact what the states did.

However, I'd be very surprised if the 60% difference in costs not explained by life-expectancy was solely due to pregnancy.

Lots of the "women get routine care, men don't" stuff would also go by the wayside if you weren't required to have a yearly exam for the doc to prescribe BCPs.

58 -- As long as those evil lawyers don't get money for "laundering" the system, it's all good!

Look, this is a classic optimal v. real world regulation debate. In the fantasy world, we'd have had insightful and well-intentioned regulation of the tobacco industry (and everything else) by competent bureaucrats since the health risks became clear in the 1960s. In the real world, the states and federal governments did nothing for years until prompted to do so by the trial lawyers, and you got a result that wasn't perfect, but a lot better than the status quo. Killing decent but imperfect regulation because it doesn't meet some ideal standard or benefits an undeserving party is a fools game and a cause of a lot of the mess that we're currently in. Yglesias had a pretty decent post on this point recently.

Lots of the "women get routine care, men don't" stuff would also go by the wayside if you weren't required to have a yearly exam for the doc to prescribe BCPs.

Given that routine preventive care is massively underconsumed in this country, the net impact on public health might actually be positive, though. I wonder if the requirement for a doctor's prescription for boner pills has boosted the % of men who make an annual visit to the GP.

Given that routine preventive care is massively underconsumed in this country

Indeed. The thought that if only women weren't required to have a yearly exam for BCPs, they wouldn't visit the doctor either -- just like men -- seems odd (to the extent that I'm not sure I'm reading it correctly). It's not clear why men's use of health care should be a baseline; men should, in fact, have annual physicals, at least after a certain age.

They aren't they? Maybe it depends on the insurer, but I thought that some of the expenses were billed as to the baby itself. I remember a friend scrambling to put the baby on the insurance within the window.

I know for a fact that after a birth there were definitely itemized bills in the child's name. I also know that my particular insurance charges a premium for every person on the list but doesn't distinguish between gender or age and I had like two weeks to add a newborn onto the coverage.

My insurance price goes: Employee, x amount, spouse or partner, add y, eligible children, add z times the number of children.

They do not distinguish gender in any way.

And above I didn't mean to imply childbirth expenses are gender related. I mean (of course) woman birth the babies but my insurance does not distinguish between genders when determining rates and I hope any overall US coverage would not distinguish either.

64: Yes, I wasn't talking about how insurance is itemized, rather how this claim:

Premature babies are the high cost claimants. Everything else is noise.

Cannot sensibly apply to making womens lifetime claim levels higher.

My insurance price goes: Employee, x amount, spouse or partner, add y, eligible children, add z times the number of children.

Right, but you're buying yours through work. They don't care about your hypothetical pre-existing conditions, either.

OT: Fucking IRS. I thought I was free from having to interpret their dipshit let's-fix-what-ain't-broken pronouncements.

64: Cala's right in 66. Employer-provided coverage can't discriminate between men and women.

after a certain age
That's not for a while. At my age (early 30s), my PCP and her NP were discussing whether it made more sense for me to come back for another routine physical in two years or five. Certainly doesn't compare with women my age who are getting the annual exams required for BCPs, at a minimum.

discussions like this make me feel depressed about how sick I am; I go to the doctor like twice a month and am currently taking 5 kinds of medicine per day :( The idea that I might not go at all for an entire year is just laughable.

emoticon included to spite the absent ogged, PBUH.

70: I'm in the office w my therapist who happens to be a psychiatrist twice a week.

Plus the sleep doctor. Plus I went in again when I had the heart problem for an EKG. I am a leech on the health care system.