Wednesday, April 18, 2007

How HSAs Help Women (and Men)

In an April 16 blog, John Goodman writes that Steffie Woolhandler produced a forthcoming study claiming that "women are punished by high-deductible, Health Savings Account plans because they have expenses men don't have: mammograms, pap smears, prenatal care, etc." While the study itself was not yet available, an AP story that Goodman cites discusses the study and quotes Woolhandler.

Goodman writes: "A glaring omission in the AP article: most HSA plans make preventive care a first-dollar coverage exception to the high deductible, and/or deposit funds in the HSA so that women can purchase care on their own."

In accordance with the freedom to contract, insurance companies and their customers have the right to mutually agree on a policy that both sides find agreeable. In a truly free market, likely some insurance policies would make "preventive care a first-dollar coverage exception to the high deductible," and some wouldn't. The government's proper role is to protect the right to contract, not force either insurance companies or their customers to accept particular sorts of policies.

My wife and I can attest to the value of HSAs for women. My wife and I were uninsured for several years, and only in recent weeks have we applied for high-deductible insurance in conjunction with an HSA. We simply couldn't afford broader-coverage insurance, at something like $4,000 per year. However, the high-deductible insurance costs us only around $1,600 per year. So, because of HSAs and high-deductible insurance, my wife and I have health insurance, when otherwise we would not. And that is a benefit to one woman whom I care about very much indeed.

The unaffordable, broader-coverage insurance wasn't that broad, anyway. It still required relatively high co-pays. It didn't cover my wife's single most expensive health cost, birth control. And it covered only 80 percent of costs, even after the deductible, without limit. So, for us, the expensive insurance was a terrible deal. (This is not surprising, given that employer-paid insurance is particularly rigged by federal and state controls to force people like my wife and me to subsidize others in the pool.)

Now that we have an HSA, we can purchase birth control with pre-tax money. Thus, my wife will now be spending less on her health care than she would have spent with the more expensive insurance.

Goodman writes that Woolhandler wants "Americans to adopt Canada's healthcare system." But that's not so great for women, Goodman points out: "The organization Cancer Ontario reports an average wait time of more than five months between the first abnormal mammogram and a diagnosis of breast cancer." He cites a Fraser study to the effect that, in Canada, women are forced to wait for treatment, and they have less access to machines such as MRIs, sonograms, and ultrasounds.

The situation of my wife and me reveals a few more facts. Many women are married, in which case medical bills for women impact the husband just as much. However, judging from the AP story, apparently Woolhandler just looked at male vs. female expenses, without separating out the women whose medical expenses are already pooled with those of men (their husbands). (Whether or not the study mentions this fact, the AP story does not.)

In addition, averages say nothing about individuals. Last year, for example, I suffered a cracked tooth that cost more than all of my wife's medical expenses for the entire year, combined. The AP notes the statistical averages found by Woolhandler: "The median expense for men under 45 in these plans was less than $500, but for women it was more than $1,200... [O]nly a third of insured men in that age group spent more than $1,050 in annual medical costs, while 55 percent of women did." Of course, if women over 45 were included, the median for women would go down, because pregnancy is fairly expensive (and it's also something that often happens within a marriage, in which expenses are shared).

This raises a much broader issue. Why is gender the relevant distinction? To rephrase the statistics cited by the AP, 66 percent of men in the age group and 45 percent of women spent less than "$1,050 in annual medical costs." That's quite an overlap. Obviously, gender is hardly the most important factor in health-care costs. The express intent of forcing everyone into collective pools is to force the less-costly people in the pool to subsidize the more costly people. Woolhandler wants to forcibly confiscate the wealth of some women (and men) in order to subsidize other women (and men). People such as my wife (who approved this line) who neither equate themselves with statistical averages nor approve of egalitarianism, but instead view themselves as individuals, will find such an outcome to be profoundly unjust.