A new Deloitte report highlights that women spend $15 billion more out-of-pocket annually than men on health care. This report, “Hiding in Plain Sight: The Gender Toll in Health Care,” makes no effort to hide the obvious, main reason why women spend more: exploitation. Women consume more health services than men and therefore spend more. This is true even when we separate out the costs associated with pregnancy, which Deloitte did.
In order to address the “gender toll in health care,” Deloitte’s Andy Davis suggests that insurance plans should cover more services and reduce women’s out-of-pocket costs. Shifting costs into insurance pools—the primary goal of the Affordable Care Act—isn’t exactly “socialized medicine” (it’s not Medicare for all), but rather a way to socialize or redistribute costs.
Some equity advocates may see this as a noble goal, but when it comes to health economics, it is misguided. It actually leads to higher costs all around. In other words, this report will be used to recommend the wrong drug… for the wrong diagnosis.
Women use the health care system more, including for more preventive care, more therapy of all kinds (physical, occupational, mental health), and more emergency care. Part of this is due to our biology: women suffer more minor injuries like stress fractures, seek care for menopause-related symptoms, and suffer higher rates of breast cancer, an expensive cancer to treat.
However, some of women’s higher health service use is behavioral: women are more likely to receive regular checkups and more services. Even the Deloitte report admits that men are twice as likely as women to wait two years or more between doctor visits.
So what do women get for all this extra health care? Ripped off? Maybe. Or maybe not. There may be some benefit to self-care. How about… an extra six years of life? The average life expectancy for women in the United States is 79.3 years, compared to 73.5 for men. It may be men who end up paying a “gender toll” for their failure (or inability) to seek regular care.
Life expectancy is not the best metric for the quality of health care available because it can have confounding variables. Another contributor to the longevity gap is the sad fact that more men die young doing dangerous things (sometimes work-related, sometimes brave, and sometimes dumb). Many men die young because of violence, including much higher suicide rates. However, this may also be related to health care; women use more mental health services, which may reduce suicide.
Deloitte is careful to argue that the utilization gap does not explain all of women’s higher health care costs. It’s also tied to the actuarial value of employer-sponsored insurance for women, which is $1.34 billion less than for men. In other words, women may have, on average, less health care benefits at work.
Deloitte compares the “gender toll in health care” to other economic disparities, such as the wage gap and the pink tax. There are indeed similarities. For example, women are less likely to have workplace health coverage (or comprehensive health coverage) because more women work in low-wage jobs, part-time jobs, or for smaller employers.
But the common thread (between the wage gap, the pink tax, and the health “gender toll”) is not a society or economy that is antagonistic or discriminatory toward women. This is a wrong diagnosis. Rather, the common thread in these differences is that men and women are different and make different choices about work, benefits and spending.
The worst thing about the misframing of the “gender health care toll” is how it will be used to argue for worse health policy. More third-party payments (to pay the insurance for more benefits) leads to more unavoidable costs for everyone. A recent example of this, with particular consequences for women, is how the Affordable Care Act’s no-cost birth control mandate backfired and only led to higher out-of-pocket prices for contraception.
While socializing health care costs may make them fairer, it certainly will not reduce costs. As PJ O’Rourke once said, “If you think health care is expensive now, wait until you see how much it costs when it’s free.”
Women would do well to see the “gender health care toll” for what it is: Another economic disparity rooted in gender differences, not sex-based discrimination. And another economic disparity where the proposed cure is definitely worse than the disease.
Hadley Heath Manning is vice president of policy at the Independent Women’s Forum (iwf.org).
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