May 28, 2024

Equality in Fact, Law, and Medicine

Dennis Prager’s comment that equality is not an American value stirred up a few left-wingers like Ali at ThinkProgress.  His aghast reaction, like those of many TP commenters, was based on a superficial reading of the Declaration of Independence and the Constitution.  Neither document guarantees equality in fact, merely in law.  We come into this world with equal legal standing but what we make of it may, does, and should result in very different outcomes. 

For some, certain results can be negative when costs, as in the health care business, are apportioned.  The NY Times says that women are charged more for health insurance.  But must our health care premiums be identical because all men (and women) are created equal under the law?

Prager, whose "right-wing" radio show I have never heard, said this about America’s founding principles:

The French Revolution is not the American Revolution. The French Revolution said Liberty, Fraternity, Equality. The American Revolution said Life, Liberty, and the Pursuit of Happiness.

The differences aren’t that subtle.  Life vs. Fraternity, Pursuit of Happiness vs. Equality.  America’s version of human rights is that we have the right to pursue our own successes whereas the French promote homogeneity.  Capitalism vs. Socialism, just as it’s played out.

Part of chasing after success in America is the earning of wealth.  There are certainly other, better things in life than money, but financial success is near the top of most people’s list.  We achieve success by working harder and smarter than the other guy, and by managing our investments and risks.  Freedom demands that we make our choices and live with the consequences.  For business owners and stockholders, that means setting prices for goods and services at profitable, sustainable levels.

It necessarily follows that a company providing services to a demographic that demands more than another group must charge the former more to obtain the same level of profitability across the groups.  So does it cost more to provide health care services to women than men?

The Times:

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.”

If Noland is correct, Humana and others are entirely justified in charging women higher premiums for health insurance than they charge men.  The only valid counter-argument that doesn’t rely on a derivative of social engineering would be that he’s wrong.

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.”

Not everyone agrees:

Elizabeth J. Leif, a health insurance actuary in Denver who helps calculate rates for Nebraska and other states, said: “Under the age of 55, women tend to be higher utilizers of health care than men. I am more conscious of my health than my husband, who will avoid going to the doctor at all costs.”

That may say something about the long-term health prospects of men who are often unable or unwilling to get time off work to visit the doctor or recuperate during an illness or injury.  The facts support that claim:  men die earlier than women in the U.S. and, to spoof the old joke, it’s not entirely because they want to.  Regardless, women who use more services should pay for doing so.

Recognizing this basic truth, others make the suggestion that women’s health care should be subsidized by men because of the high cost of pregnancy care and baby’s delivery.

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.”

Kofman has a point.  However, women do not in fact bear the entire expense of maternity care, etc. 

The CDC says that 63% of childbirths in the U.S. are to married couples, meaning that these women’s health care costs have effectively already been averaged with their husbands.  This leaves 37% of women do pay higher medical costs because of pregnancy and related complications.

Given that society wants to continue to try to hold down the number of out-of-wedlock births – a bold assumption in these troubled times, but still a safe one, I think – simply allowing the market apportion costs per the consumption of medical services would put financial constraints on single women and achieve some of the desired result.

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.”

I can certainly see why women believe that this is unfair.  But is it?  Saying men and women should pay the same rates for health care is equivalent to saying that the government should transfer wealth from married couples and single men to single women in order to allow them to pay below-market prices for health insurance. 

Nice as such a thing would be to some women, that’s not the purpose of government.


Marc is a software developer, writer, and part-time political know-it-all who currently resides in Texas in the good ol' U.S.A.

View all posts by marc →