Last week, after a nearly all-male group of Republicans celebrated the passage of a House bill that would, they boast, enable men to stop having to pay for women’s health care, and as a completely male Senate Republican working group gets to work on the upper chamber’s bill, a Republican aide told CNN that gender is a nonissue: “We have no interest in playing the games of identity politics, that’s not what this is about; it’s about getting a job done.” Just a bunch of gender-neutral human beings making gender-neutral decisions about public policy!
Except there happens to be the coincidental factor that the policy in question is inextricably linked to gender. The health-care debate revolves around whether, and to what degree, the medically and economically fortunate should have to subsidize the medically and economically unfortunate. Women have, on average, higher lifetime medical costs than men, which means a market-based insurance system, where every individual plan is priced based on that person’s expected medical costs, will charge women on average higher premiums.
Republicans have been dancing around this implication for years with their argument that people who don’t need prenatal care should not have to buy insurance that covers it. (This means, of course, that the costs of prenatal care would be borne entirely by those who do need it, i.e., women of childbearing age.) National Review columnist Kevin Williamson comes right out and makes the case that charging women higher rates for insurance is the natural order of things. “Why Shouldn’t Women Pay More for Health Insurance?” asks his headline. Williamson’s answer turns out to be Science:
The higher premiums charged to women are not rooted in the malice of wicked insurance executives but in the thing that our progressive friends claim to love: science — in this case, actuarial science. The argument for charging women higher premiums may not be persuasive to you, but it has some basis in reality. The argument against doing so has no obvious basis in anything other than preference.We all support evidence-based medicine. Why not support evidence-based health insurance, too?
It’s worth noting that the vast majority of American health insurance operates on the principle of gender parity. If you get standard employer-based insurance, then your firm divides the cost of insurance among employees without regard to gender. Likewise, Medicare, Medicaid, and the VA are financed without regard to fact that women absorb more medical care. We certainly could change those systems to reflect actuarial science. Employer insurance could charge female employees higher premiums and deductibles than male ones, and Medicare could change its financing so that women pay more than men. Oddly, nobody — not even Williamson — is proposing these changes. The non-group insurance market is the only segment of American health care in which anybody proposes to make women pay proportionately more.
Conservatives have made all kinds of practical arguments for the Republican health-care bill. They have made a smattering of moral arguments, too, such as the principle that people with more expensive medical needs have failed to make healthy choices and deserve financial punishment for their failings. What is telling about the gender debate is that it lacks even the pretext of personal responsibility. There is no case to be made that women ought to pay more for insurance because they chose to be female. There is no principle at all except that people who have more ought to keep it.