So I was reading this article about how the repeal of the ACA would particularly harm women, and came across this little pearl at the end of the article. It's a statement by an organization which opposes giving women "free stuff:"
The Commonwealth Foundation, a free-market think tank in Harrisburg, said the ACA is forcing benefits, and extra costs, on people who may not want them.Very interesting. Let's take a few sentences out of that quote for closer perusal:
Elizabeth Stelle, the foundation's policy analysis director, said the organization wants people to have more choices so they don't have to pay for services they're not going to use.
For example, she thinks women should be allowed to choose if they want preventive services and birth control covered under their plans.
She noted the cost for services haven't declined, but have been spread to other areas. She said the reason women were paying more for health care before the ACA is because they require more health care.
"The alternative, under the ACA, which I think is extremely unfair, is we then asked single men, for example, to essentially pay for maternity coverage that they had no intention of ever using. I don't think it's fair to ask somebody to pay for coverage they're never going to use," Stelle said.
She said the reason women were paying more for health care before the ACA is because they require more health care.Stelle's statement is about the individual health insurance market, not about employer-based group health insurance. In the former women indeed were usually quoted higher prices for the coverage packet, and that higher quote was justified in the way Stelle does here.
But there's a flaw in the basic assumption. Well, two flaws:
First, much of the greater health care use by women is not for themselves but for the infants they give birth to*. Pregnancy and birth-related expenses shouldn't be assigned to just the mother. Perhaps they shouldn't be assigned to her at all, with the exception of the costs of caring for any complications to her health. An alternative view would be that those health care costs are the first expense of the new person who is born.
Second, women tend to see the health care sector more for routine visits, checkups and preventive care, all of which drive up their usage figures. But to the extent such care prevents more expensive treatments later, their overall lifetime costs might be lowered, right?
And there is evidence that the average annual cost of men's care begins to exceed the costs of women's care later in life. Why that doesn't raise men's premia in the individual markets is because the age at which this becomes visible is also the age at which individuals begin to qualify for Medicare, the federal health insurance system for old age. Thus, from one angle men's higher health care use in older age is subsidized by the society.
The other paragraph in the above quote that is worth closer scrutiny is this one:
"The alternative, under the ACA, which I think is extremely unfair, is we then asked single men, for example, to essentially pay for maternity coverage that they had no intention of ever using. I don't think it's fair to ask somebody to pay for coverage they're never going to use,"
Great! I will from now on refuse to pay for anyone's vasectomies, testicular cancer care, impotency treatments, prostate cancer or the treatment after accidents which were caused by skydiving, downhill skiing, boating or race driving. I will also refuse to pay for the care of any congenital disease that doesn't affect my genetic group.
Note, also, that the "single man" in Stelle's example was once born and most likely used medical care in that context, and that the only reason he could now view maternity benefits as not having anything to do with him is because his birth is in the past. Things are different for future "single men."
The wider problems in those opinions are a) that the more we slice-and-dice the insurable pool of people into smaller sub-groups, the lower will the benefits of insurance ultimately be, and b) that the opinion fails to understand the public benefits of, say, subsidized contraception for the poor.
It helps to reduce unintended pregnancies, helps to reduce abortions and helps to reduce the costs associated with the avoided pregnancies and deliveries. Many of those costs would have to be paid from public sector subsidies. It's quite possible that the net savings to some imaginary (and celibate) single man would be greater if the ACA contraceptive benefits were retained. In other words, he would pay less for the IUDs in his insurance premium than he would later have to pay in taxes under the alternative repeal-the-benefits scenario.
* And these infants have fathers. Those fathers should bear some responsibility for the costs, I would think.
The same blindness is common when free contraception is discussed. That the male partner of a woman receives 100% of the benefit, assuming he doesn't want to become a father, and 0% of the possible medical side-effects of, say, the contraceptive pill, sounds to me like a deal not to be sneezed at. But the Rush Limbaughs of this world think the situation is the unfairest one can imagine: Sluts being subsidized for sluttery.