July 25 2011
Women's groups are applauding the Institute of Medicine's recent recommendations that all health insurers cover preventive services like contraception and annual visits at no cost. This overtly political "determination" goes hand in hand with the Affordable Care Act, which requires health plans to cover a wide variety of women's services, determined by the Department of Health and Human Services.
It's interesting that 40 years after the feminist movement, women on the left are the only ones still talking about women's bodies. They are entirely focused on negotiating healthcare policies that address a woman's reproductive tract and nothing else. Left out of the conversation is what these recommendations mean for our economy - and what that means for women.
It's true women have unique healthcare needs - especially during their childbearing years. Women account for two-thirds of the dollars spent on healthcare and take more prescription drugs than men. What's more, women make the majority of decisions pertaining to their families' healthcare needs. So we might say women often have the most at stake in preserving high-quality medical treatment centered on patient choice.
But I disagree strongly with the recent determinations made by the Institute of Medicine and supported by our new healthcare policy. A successful healthcare system is one that allows for the greatest freedom of choice. Unfortunately, these recommendations do just the opposite, namely, discouraging individual involvement and control over healthcare decisions.
Any system that provides a good or service for free for everyone - or, in this case, for all women - cannot sustain itself. Ultimately, policies like this will result in patients having fewer choices, a decline in quality of care and an increase in costs for all. By forcing an insurance company to cover contraception, maternity care, breast-feeding support, domestic-violence counseling (and on and on), companies will simply shift the cost of doing business. Instead of having women who use those specific services pay for the coverage, companies will ask someone else to pay for it. Of course, this is why the Affordable Care Act had to be coupled with the individual mandate.
I've had this debate with women like Marcia Greenberger of the National Women's Law Center before. Gender-based pricing makes people uncomfortable. But too often it's misunderstood. Objecting to the notion of providing all medical services for free to all women is not baseless gender discrimination; it's an attempt to deal with an economic reality.
Gender-based pricing exists in other insurance areas. For instance, young men pay higher car insurance premiums because of their gender and risk pool. It might not seem fair, but it's not spiteful discrimination.
Still, the question remains how best to help women who want greater access to birth control, for instance, but can't afford it. The Democrats' answer is to create a highly regulated health insurance industry, in which premiums will become more expensive for the average person. But some rational, market-based reforms could have gone a long way to expanding health services in an affordable way.
When women try to negotiate specific advantages for themselves, they lose sight of the bigger picture. Perhaps women ought to be asking what's more important: that the government subsidizes birth control or that they bankrupt the nation?