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Tuesday 4 November 2008

Women, Health Insurance, and Health System Ethics

17:44
The recent report that women pay much more than men of the same age for individual health insurance has led to a spate of outraged articles about unfairness and gouging.

The outrage and indignation are directed at the wrong target.

In the 1965 film classic "The Battle of Algiers," Colonel Mathieu, the French military leader (modeled on General Massu, the actual army leader) tells reporters who object to his brutal methods that they have a choice. If they want France to win they're by necessity endorsing his methods. If they reject his methods they relinquish French rule in Algeria. (If you haven't seen the video you're missing a masterpiece.)

Almost certainly some insurers are gouging. But if we choose to have a health system that dis aggregates the population into ever smaller units - ultimately to individuals - and ask that each unit pay in accord with its own utilization of health care, we'll get just what the study showed. So let's not blame insurers.

To quote another masterpiece - Pogo Possum, in Walt Kelly's comic strip - "we have met the enemy and he is us." As we have seen in the election campaign, policies based on collective interests, in which one party (such as the healthy) subsidize others (such as the sick) are "socialism." And in the U.S. lexicon, that's very bad.

Charging individuals different premiums because of different health needs is wrong. Whether or not we see health care as a "right," health is a basic human good. As a civilized society we have a collective obligation to each other to protect health to the extent our resources allow.

But we've been on a steady path of dis-integrating our human fellowship. One result is the insurance differential for women that leaves us shocked, shocked. But like Colonel Mathieu, the insurers who are being vilified are doing exactly what we, the body politic, are asking them to do.

Let's hope that after the election this piece of news about insurance differentials leads us to look into the mirror and place the blame where it belongs.

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