Tuesday, November 4, 2008

Women, Health Insurance, and Health System Ethics

The recent report that women pay much more than men of the same age for individual health insurance has led to a spate of outraged articles about unfairness and gouging.

The outrage and indignation are directed at the wrong target.

In the 1965 film classic "The Battle of Algiers," Colonel Mathieu, the French military leader (modeled on General Massu, the actual army leader) tells reporters who object to his brutal methods that they have a choice. If they want France to win they're by necessity endorsing his methods. If they reject his methods they relinquish French rule in Algeria. (If you haven't seen the video you're missing a masterpiece.)

Almost certainly some insurers are gouging. But if we choose to have a health system that dis aggregates the population into ever smaller units - ultimately to individuals - and ask that each unit pay in accord with its own utilization of health care, we'll get just what the study showed. So let's not blame insurers.

To quote another masterpiece - Pogo Possum, in Walt Kelly's comic strip - "we have met the enemy and he is us." As we have seen in the election campaign, policies based on collective interests, in which one party (such as the healthy) subsidize others (such as the sick) are "socialism." And in the U.S. lexicon, that's very bad.

Charging individuals different premiums because of different health needs is wrong. Whether or not we see health care as a "right," health is a basic human good. As a civilized society we have a collective obligation to each other to protect health to the extent our resources allow.

But we've been on a steady path of dis-integrating our human fellowship. One result is the insurance differential for women that leaves us shocked, shocked. But like Colonel Mathieu, the insurers who are being vilified are doing exactly what we, the body politic, are asking them to do.

Let's hope that after the election this piece of news about insurance differentials leads us to look into the mirror and place the blame where it belongs.


Anonymous said...

The source of most of the information on the way insurance companies discriminate against women is from a report of the National Women's Law Center:
Nowhere to Turn: How the Individual Health Insurance Market Fails Women at:

This and other information can be found in the newsletters of the Women's Universal Health Initiative. To receive the latest issue you can send a request to: Info@wuhi.org

You can become a member for a donation of any ammount at www.wuhi.org.

Jim Sabin said...

Dear anonymous -

Thanks for the information on how to get the important report. The insurance differential for women is so stark that it just may move political opinion and public understanding towards recognizing that no man or woman is an island. We in the U.S. should structure our health system around universal coverage as virtually every civilized society does. I hope the model of treating the population as a collection of individuals, each of whom should be maximally responsible for her or his health care costs, is on its way out.



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Jim Sabin said...

Hi Alina

I'm glad that your hard work on the insurance problem is working out for you!



bhargava said...
This comment has been removed by a blog administrator.
HelpLine said...

It is really shocking to know about this practice of the insurance companies. I feel that it is absolutely unacceptable that in a civilized and progressive society there should be any discrimination on the amount of the premium on the basis of the potentiality of health hazards…

Jim Sabin said...

Dear HelpLine -

I agree that a civilized society should ensure that its citizens receive basic health care without penalizing people who need more care. Our health "system" is a national disgrace.

I fault our body politic for this failing. We've created the ground rules for the system we have. Insurance companies play by those rules. As Pogo Possum said 50 years ago - "we have met the enemy and he is us."



Hannah said...

I do think that women are getting a raw deal when it comes to health insurance and hopefully things will improve. I always like to be prepared for what life throws at me and as a precaution I have recently took out a health policy with AIG wellwoman insurance which provides me with financial support should I ever be diagnosed with cancer. It is something no one wants to think about, but I would rather not have to worry about money should the unexpected happen.

Health Advocate said...

I think women are not at all getting good deals where health insurance is concerned. And there is no doubt that this situation needs to improve immediately. :(

Jim Sabin said...

Dear Health Advocate -

I hope that the health reform process will address the issue you raise. The larger principle is that a just health system will not penalize individuals for "legitimate" health costs. The fact that women deliver babies and men don't shouldn't make women pay more for health insurance! Similarly, the fact that some people have cancer, heart failure or other conditions shouldn't make them pay more.



Nurse Practitioner said...

I really hope that the health reform process address the issue of an unbiased health system in which no one gets a raw deal. I believe that the health care system is such a system where equality and transparency is most required.

Jim Sabin said...

Dear Nurse Practitioner -

Your comment about fair treatment for all is in the best traditions of the nursing profession! Nurses have been special custodians of humane values at least since the time of Florence Nightingale. Your emphasis on equality and freedom from bias is central for an ethical health system.