The Corner

Politics & Policy

Why Shouldn’t Women Pay More for Health Insurance?

The Democrats, and progressives in general, like to boast of being the partisans of science.


Most of them, like most people, do not know the first thing about science, but they enjoy the preening. They are, they insist, “reality-based,” empiricists who follow the evidence wherever it may lead . . . until they figure out that it sometimes leads them in directions they’d rather not think too much about.

“For Republicans, being a woman is a preexisting condition!” This is the Democratic talking point of the week as Republicans work on trying to fix the mess of a health-care program created by Democrats. A typical example of this stupidity is this column by Slate’s Christina Cauterucci, who dutifully repeats the formula: “Read closely, the American Health Care Act, or Trumpcare, also reveals the basic theory that underlies the GOP’s entire legislative wishlist on health care: the idea that being a woman is a chronic medical condition and a liability.”

(Did she read it closely? When, I wonder?)

Her complaints are familiar: The Affordable Care Act enacted pricing rules that largely prohibited charging women higher health-insurance premiums than men, and the Republican plan would relax some of those restrictions, which probably would result in women’s paying higher premiums.

But nowhere in the piece does she consider the actual facts of the case: Women have radically higher lifetime medical expenses than men do, about one-third higher, on average.

(At the risk of committing hate crime, I’ll be using “women” in the old-fashioned sense, the way Bill Nye used to before the Minitrue men at Netflix memory-holed all that chromosome talk.)

According to “The Lifetime Distribution of Health Care Costs,” (published in Health Services Research and made available online by the National Institutes of Health) per-capita lifetime health-care expenditures for women run $361,200, or nearly $100,000 more than per-capita lifetime health-care expenditures for men. Part of that is related to the fact that women live longer on average, but that does not account for the majority of the difference. If you want to call yourselves “reality-based,” how about taking a little reality into account? You don’t necessarily have to interpret the facts in any particular way, but you ought at least to take note of them.

The usual rhetorical strategy is at work here: Ignore the relevant facts and, if someone forces them into the conversation, retreat into high dudgeon. “Harrumph! Sexism! Harrumph!” 

But maybe the dudgeon here ought not be too high. Yes, you could make a very persuasive argument that women ought not be expected to bear the burden of their higher medical expenses, or at least not the entire burden. But you could also make a pretty compelling case that poor working people in the South Bronx ought not be forced to subsidize the lifestyles of the multi-millionaire vanden Heuvels out in the Hamptons or the multi-millionaire Clintons in Chappaqua (does Mrs. Clinton still pretend to live in Chappaqua?) just to satisfy some gender-studies graduate from Bryn Mawr. 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?

Which is not to say that we can’t or shouldn’t subsidize some health-insurance consumers. Of course we can, and will. But why subsidize them based on biological sex (seriously, call the hate-crime hotline!) rather than on some other more subsidy-relevant metric such as income or wealth?

I know it is a downer to start thinking about the facts when you’re right in the middle of a very pleasurable episode of moral grandstanding, but the facts will still be there when you’re done.

Correction: The original version of this post misstated the original source of “The Lifetime Distribution of Health Care Costs.” 

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