A new report from Deloitte highlights that women spend $15 billion more out-of-pocket than men annually on health care. This report, “Hiding in Plain Sight: The Health Care Gender Toll” makes no effort to hide the obvious, main reason women spend more: utilization. Women consume more healthcare services than men, and therefore spend more. This is true even when we set aside pregnancy-related costs, which Deloitte did.
In order to address the “health care gender toll,” Deloitte’s Andy Davis suggests that insurance plans should cover more services and reduce women’s out-of-pocket costs. Moving costs onto insurance pools—a primary goal of the Affordable Care Act—isn’t exactly “socialized medicine” (it’s not Medicare for All), but it is a way to socialize, or redistribute, costs.
Some equity advocates might see this as a noble goal, but when it comes to health economics, it’s misguided. It actually leads to higher costs all around. In other words, this report will be used to recommend the wrong cure… for a wrongful diagnosis.
Women use the healthcare system more, including for more preventive care, more therapy of all kinds (physical, occupational, mental health), and more emergency room care. Some of this is due to our biology: Women suffer more minor injuries like stress fractures, seek care for symptoms related to menopause, and suffer higher rates of breast cancer, an expensive cancer to treat.
However, some of women’s higher healthcare utilization is behavioral: women are more likely to get regular screenings and more services. Even Deloitte’s report acknowledges that men are twice as likely as women to wait two or more years between doctor visits.
So what do women get for all this additional health care? Ripped off? Maybe. Or maybe not. There may be some benefit to taking care of ourselves. How about… an extra six years of life? Women’s average life expectancy in the U.S. is 79.3 years, compared to 73.5 for men. Maybe it’s men who ultimately pay a “gender toll” for their failure (or inability) to seek regular care.
Life expectancy isn’t the best metric for the quality of health care available, because there can be confounding variables. Another contributor to the longevity gap is the sad fact that more men die young doing dangerous things (sometimes work-related, sometimes valiant, and sometimes dumb). Many men die young because of violence, including much higher rates of suicide. However, this too could be related to health care; women use more mental health services, which may reduce suicidality.
Deloitte is careful to argue that the utilization gap doesn’t explain everything about women’s higher healthcare costs. It also has to do with 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, inferior healthcare benefits at work.
Deloitte compares the “health care gender toll” to other economic disparities like the wage gap and the pink tax. Indeed there are similarities. For example, women are less likely to have on-the-job 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 (among the wage gap, pink tax, and health care “gender toll”) is not a society or economy that is antagonistic or discriminatory toward women. This is the wrong diagnosis. Instead, the common thread in these disparities is that men and women are different and make different choices about work, benefits, and consumption.
The worst thing about the wrongful framing of the “health care gender toll” is how it will be used to argue for more bad healthcare policy. More third-party payment (having insurance pay for more benefits) leads to more runaway costs for everyone. A recent example of this, with particular ramifications for women, is how the Affordable Care Act’s mandate of no-copay birth control backfired and led only to higher raw prices for contraception.
While socializing health costs might make them more equitable, it certainly won’t make costs lower. As PJ O’Rourke once said, “If you think health care is expensive now, wait until you see what it costs when it’s free.”
Women would do well to see the “health care gender toll” for what it is: Another economic disparity rooted in sex differences, not sex-based discrimination. And another economic disparity where the proposed cure is decidedly worse than the disease.