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PPACA: The Divide Just Gets Wider

Last Friday, the Commonwealth Fund, a private foundation that works to promote improved health care, released a report detailing its findings about health insurance and women, the uninsured, minority Americans, children, the elderly and low-income people.  The picture it paints is not pretty.  Some of the highlights include the following:

  • Twenty percent of American women had no health insurance at all in 2010, up from 15 percent in 2000.  That’s about 19 million women.
  • In addition to the uninsured women, some 17 million were underinsured in 2010.
  • US women had serious problems paying their medical bills, at double the rate of women in any of the other countries studied: Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland and the UK.  All of these countries, by the way, have universal health coverage.
  • In the US, 26 percent of women had medical bill problems, as compared with 12 percent in France, 13 percent in Australia and 4 percent in Germany.
  • 39 percent of American women spent $1,000 or more for out-of-pocket medical costs during 2009-2010.  Compare this with 24 percent of women in Switzerland, 1 percent in Sweden and 0 percent in the UK.
  • 52 percent of American women were confident they could afford their health care if they became seriously ill.  91 percent of women in the UK, 77 percent in the Netherlands and 76 percent in Switzerland echoed that sentiment.
  • 43 percent of American women went without recommended care, did not see a doctor when they were sick or did not fill prescriptions because of cost, compared with 8 percent in the Netherlands, 7 percent in the UK and 28 percent in Germany and Australia.
  • 51 percent of uninsured American women had difficulties paying their medical bills.
  • A shocking 77 percent of these uninsured women went without needed health care due to costs — more than twice the rates of women in other countries.

The Commonwealth Fund report ends by suggesting that the full implementation of the Affordable Care Act will help solve many of these very troubling problems.

Not so fast!” say the critics of these findings.  Greg Scandlen, director of the Health Benefits Group Inc., which sells group and individual health and life insurance products, was quick to weigh in.  As far as he’s concerned, “This report is a wonderful example of how you can prove anything if you cherry-pick the data carefully enough”.  In his opinion, women are not at all underserved or disadvantaged in the health insurance marketplace: “In fact, women are far more likely to be covered than are men at nearly every age”.

Scandlen doesn’t deny that there are sex-based differences in the health insurance market.  There are the same differences in all insurance markets.  He offers an interesting explanation for the disparities:

Women pay more for health insurance than men because they consume far more services than men.  In the life and auto insurance markets, women pay far less than men because they drive safer and live longer.

Hmmm.  Women drive more safely and are rewarded for it.  Women take better care of themselves and are punished for it.  What point was he trying to make there, exactly?

He further criticizes the report for not taking into account the long waits for care in other countries, along with the so-called rationing of care in other parts of the world.  One could argue, however, that a woman’s inability to afford care period is a very effective form of rationing already.  Scandlen concludes his critique:

The Affordable Care Act may very well remove price obstacles to care, although that remains to be seen.  But if it floods the system with new patients without increasing the supply of providers, it may result in less actual care for everyone.

And there you have it.  Versions of this debate are taking place everywhere.  Here’s the thing.  Women follow the recommendations and suggestions of their physicians, get the care they’re supposed to, then are rewarded for this by paying much high premiums.  A good deal of the care they seek involves maternity, a perfectly normal, natural part of a woman’s life, and, medically, a very risky undertaking.  We may be in the 21st century, but carrying a baby to term and then delivering it remains a dangerous, complex process.  And the challenges and after effects of pregnancy don’t vanish the moment a baby is born.  Women may be charged for this, but they don’t get themselves there alone – a point far too often overlooked when talking about the perils of insuring women during their reproductive years.  And while we’re on the subject, men often don’t use the services they should use until it’s too late.  They are far more expensive to insurance healthcare-wise than women when they are older.  Deferring health care may make men look good on a balance sheet at 40, but the price by the time they reach 65 is really, really high.  Lucky for them there’s Medicare, right?  Good timing!

And just think.  It’s only the beginning.  Where, oh where, will all these suits and countersuits, thrusts and parries, pros and cons, yay’s and nay’s take us over the next few months?  Wouldn’t it be lovely if we actually got access to decent, affordable  health care as we needed it?  Wouldn’t it be lovely if the human(e) model drove the business model rather than the other way around?

As ever, we will keep you posted!

Special thanks HealthDay, US Dept. of Health and Human Services, and womenshealth.gov.

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One response to “PPACA: The Divide Just Gets Wider

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