Gender discrimination in insurance

In CA, as in most states, the State says it's okay for insurers to charge more to women, as long as the determination is backed with statistics. This is known as "gender rating." In San Francisco, the city attorney's office has brought suit against state insurance regulators for this practice.

Market says: gender discrimination is legit, state sanctioned, and
makes financial sense.

Rights advocates say: discrimination is bad, m'kay?

The fact that women generally pay more than men for the same insurance is a great illustration of dichotomy between free market health care solutions and more equality-based health-care-as-a-right, universal ("socialist")-types of solutions.

Industry people say that the reason for the discrimination is that women are more likely to use health services. Blue Shield spokesman Tom Epstein put it this way:

"women [are] more accident-prone than men and more likely to break bones or get
sick"

Okay, I'll buy that women use health services more, but Tom sounds like an abusive husband. And funny, Tom doesn't mention that women are more likely to get pregnant than men, which also requires some doctor care.

There is a comparison made to auto insurance: on the whole, men pay more than women because they're more likely to file claims (wait, who's more accident prone?). But, as the same article points out, this is a faulty comparison. Utilization of the health care insurance product is preventative (saving money in the long run), while utilization on the auto side is catastrophic and reactionary (only spending money).

Here's the deal. Insurance is a business. Business has the privilege to incorporate when a State says so. States (not the federal government) regulate insurance. The State is society's mouthpiece. As a member of society, what do you want your State to say to this business that has the privilege of taking your money, and your neighbor's money with the State's blessing? What do you want your State to say to the nation (and beyond) about your value system as reflected in this regulation?

Currently, what States are saying is that it's okay to charge more (and in health care speak this means "make less accessible") to people that utilize care more. But the State is actually saying more. It's saying

"It's okay to charge more for people that utilize the care more no matter
what the reason."

Even if that reason is prevention, which creates a healthy, more productive society on the whole. Even if that reason is specific to 50% of the population but not the other (though the other half certainly benefits).

Is that what you want to say? Balance it with a free market (if that's important to you). One could make the argument that allowing more preventative care would be better for the economy (see above argument on more healthy, productive society), even though it may restrict insurers in the immediate sense.

Any Friedman-ites out there wanna chime in? I'm all ears.

the frankenstein analogy

I'm not the only one that associates Frankenstein with health care.

Capitalism Magazine published an article called The Medicare Bureaucracy is a Frankenstein Monster That is Destroying American Medicine.

And there's apparently something called the "Frankenstein Syndrome" in health care, "caracterized by an excessive reliance upon high technology medicine to compensate for healthy lifestyle."

Health Care as a Right

I recently wrote a paper about the MA health plan. Part of that paper included exploring whether health care is a right... It's a topic I've struggled with because while I'm all for everyone having health care, I don't necessarily believe that it is a right, given certain legal arguments that will be traced out below. It's a tough one to resolve, so here's the start of an argument..............

Some proponents of Massachusetts’ health care reform claim that health care is a right, and therefore Chapter 58 is appropriate and justified, despite any economic issues. There are two points of contention with this assertion: Is health care a right, and if it is, has the Massachusetts legislature protected this right with Chapter 58? Some proponents further argue that regardless of rights language, we have a moral obligation to provide health care to those who cannot afford it. Whether health care is a right or moral obligation is a long-fought and storied debate. For purposes of discussion of Chapter 58, I will simply highlight some arguments.

First, a distinction must be made: human or civil rights are not necessarily the same as legal rights. In the American legal system, rights are treated with great deference, and therefore, a statutory or judicial declaration that health care is a right carries tremendous weight and imposes a duty on the government for protection and support. In his seminal work on the right to health care, Mortal Peril: Our Inalienable Right to Health Care?, Richard Epstein described the countervailing view against health care as a right. Negative rights are those that require noninterference, whereas positive rights require a duty from another individual. Health care is a positive right, and as such, is not fundamental.

There is an argument that health care should not be a right because it is not justiciable.[1] However, courts have looked at similar issues, which could shed light on the judicial analysis in recognizing a health care as a fundamental right. In Washington v. Glucksburg, 521 U.S. 702 (1997) the Supreme Court articulates a test to determine if a right is fundamental. The right must be “carefully described,” deeply rooted in this Nation’s history and tradition, and implicit in the concept of liberty.[2] In Abigail Alliance v. von Eschenbach, 378 U.S. App. D.C. 33 (2007), cert. denied, ­­­­­­­­­­­­­­­128 S.Ct. 1069 (2008), the District of Columbia Circuit court sitting en banc relied on Glucksburg to strike down arguments that terminally ill patients had a fundamental right to experimental drugs. The dissenting judge attempted to root the right in the due process clause of the Fifth Amendment. The court declined to address whether “access to medicine might ever implicate fundamental rights,” and the Supreme Court denied certiorari on the case.
Regardless of whether health care is a right, people argue that there is a moral obligation for the United States to provide health care to all residents. This argument is usually supported by pointing to international declarations, laws of other countries, inferences from American history, and emotional appeals.

International declarations, which the United States have supported, assert every individual’s human right to health care. For example, the 1948 Universal Declaration of Human Rights, drafted by a committed chaired by UN ambassador Eleanor Roosevelt states:

Everyone has the right to a standard of living adequate for the health and well-being of himself and of his family, including food, clothing, housing, and medical care and necessary social services, and the right to security in the event of unemployment, sickness, disability, widowhood, old age or other lack of livelihood in circumstances beyond his control.[3]

The 1996 International Covenant on Economic, Social and Political Rights states:

1. The States Parties to the present Covenant recognize the right of everyone to the enjoyment of the highest attainable standard of physical and mental health.

2. The steps to be taken by the States Parties to the present Covenant to achieve the full realization of this right shall include those necessary for:
(a) The provision for the reduction of the stillbirth-rate and of infant mortality and for the healthy development of the child; (b) The improvement of all aspects of environmental and industrial hygiene; (c) The prevention, treatment and control of epidemic, endemic, occupational and other diseases; (d) The creation of conditions which would assure to all medical service and medical attention in the event of sickness.[4]

Each of these documents was accepted by the United Nations General Assembly, and each has been signed by the United States.[5]Proponents of the provision of health care as a moral obligation or right also frequently point out that the United States is the only industrialized country that does not offer universal care of some sort to its citizens, despite public support for a century.[6] Proponents rely on the moral values, justice, and equality upon which our society was built to support their claim.[7] Following this moral compass, there have been a number of U.S. presidents and lawmakers who have tried to implement health care reform on a federal level. Among them are Franklin D. Roosevelt, Harry S. Truman, John F. Kennedy, Lyndon B. Johnson , Edward Kennedy, and Bill and Hillary Clinton.


[1] Puneet K. Sandhu, A Legal Right to Health Care: What Can the United States Learn from Foreign Models of Health Rights Jurisprudence? 95 Calif. L. Rev. 1151, (2007)
[2] Roy G. Spece, A Fundamental Constitutional Right of the Monied to “Buy Out Of” Universal Health Care Program Restrictions Versus the Moral Claim of Everyone Else to Decent Health Care: An Unremitting Paradox of Health Care Reform? 3 J. Health & Biomed. Law. 1, (2007).
[3] Universal Declaration of Human Rights, G.A. Res. 217A, at 71, U.N. GAOR, 3d Sess., 1st plen. Mtg., U.N. Doc A/810 (Dec. 12, 1948).
[4] International Covenant on Economic, Social, and Political Rights, G.A. res. 2200A, 21 U.N. GOAR Supp. (No. 16) at 52, U.N. Doc. A/6316 (1966), 999 U.N.T.S. 171, (Mar. 23, 1976).
[5] http://www2.ohchr.org/english/bodies/ratification/3.htm
[6] Tom Daschle, Critical: What We Can Do About the Health-Care Crisis (Thomas Dunne Books 2008) (2008).
[7] Tamara Friesen, The Right to Health Care, 9 Health L.J. 205 (2001).

Soda Tax

A recent Business Week article discusses "A Tobacco-Style Tax on Fattening Drinks." I'm for it.

Let's bypass the libertarianesque arguments about taxes for right now (I'll save that bigger picture for my political blog, but in fairness, here's an argument against a soda tax) and assume it's a legit way for governments to act. The government uses taxes to create incentives/disincentives to do things. All. The. Time. It's the way things get done. Want to encourage creation of nonprofit entities? tax breaks. want to tie health care to employment? allow use of pretax dollars. i'm not a tax wiz, but you get the point.

Public health issues are hard to deal with. Unhealthy behaviors are very hard for the government to control, yet we deal with the consequences ...not surprisingly, tax money is one of the ways. But the bigger picture is that unhealthy choices translates to an unhealthy population. And when a person is unhealthy, it's harder to do things that life calls for & they enjoy (pay bills, vote, pay attention to job & school & family). It takes a toll on an individual and on a society. But what is a government to do? We've got this little thing called a "Bill of Rights..." and a capitalist society.


"Opponents say such a tax would disproportionately fall on the poor, punish thin people who merely happen to like soda and candy, and fail to address the many complex factors that contribute to obesity."



Okay, let's knock that shit down.

1. (1) That the poor would be disproportionately affected is a distraction because soda is not a necessity. This is the emotional argument. Further, it acknowledges the larger public health concern that healthy food is F*ing expensive and harder to get than bad-for-you food, and so makes me think we'd better address this. Also, if you want to talk in money and proportional representation, go back to the paragraph above about the use of tax dollars to "fix" what bad health choices bring, such as obesity-related diseases. the poor that are more likely to drink soda and smoke cigarettes are also more likely to use your tax dollars when they are sick. I'd really like to know who this "opponent" is that would make such an argument. It doesn't really benefit an advocate for the poor, who would probably have more important things to advocate for. Who else would be opposed to such a tax, I wonder?
2. (2) That the "thin" who "merely like soda" are punished is laughable--first, this is not punishment, it's prevention. Second, it's like saying those who "merely like cigarettes" but don't have heart disease or cancer (yet) are being punished with cigarette taxes, while those that are sick and pay the tax deserve it. thin does not necessarily equal healthy or invincible. argument fail.
3. (3) of course the tax does not "address the many complex factors that contribute to obesity." It addresses one. that's a pretty good start.

Apparently the tax would not include diet sodas, which is a bizarre and artificial distinction. (get it?). (Raises the spectre of the menthol exception in the recent cigarette bill.) Diet sodas are even worse than regular sodas. Artificial sweeteners make people more fat by messing with the way a body counts calories and leading to overconsumption!! Read about it here and here, for a start. (And of course, there are those that believe aspartame, a.k.a. nutrasweet, is much less healthy than the FDA and manufacturers would have you believe... that discussion is for another day).

I think the article author is correct in saying it's only a matter of time...

Daschle's Critical: Outlining the steps from the laboratory of MA to the Federal Government

Just finished reading Critical. Had to return the book to the library (late) so bear with me as I go from memory (& can't quote).

Any suspicion that Obama's health care plans are following the drumbeat of MA has been confirmed. Daschle had nothing but praise for the state's plan, especially the Pay-or-Play, the Connector, the "shared responsibility..." In recalling the failed Clinton plan, I saw Daschle outlining lessons learned that I would expect the new administration will try to avoid: (1) non-transparency, (2) document too detailed and lengthy (3) timing.

So here's my prediction for Obamareform in a nutshell: The new administration is already addressing non-transparency by having the public meetings and getting input on the website. The long document problem will likely be addressed by pushing off the details to a (MA) Connector-like agency proposed by Daschle to be called the Federal Health Board. This helps by (1) getting reform more quickly (2) being able to blame someone else (3) lessens policy arguments that will bog down passage of the bill, especially the line-drawing wrt what's covered and what is not. I expect fast action on health reform to avoid the Clinton-esque problem of allowing the opposing troops (doctors, insurance) to mobilize, and fearmongre. We've already heard about the medicare-like program with benefits the same as federal employees. Finally, I expect moral and emotional appeals. Not only is this the liberal thing to do, but Daschle illustrates the effectiveness by discussing an appeal from a rabbi in MA at a State House meeting saying everyone should join together to create a "coalition of compassion" to do the right thing & pass health reform. Daschle suspects moral appeals as such would work on all Americans. And of course, there will be an appeal for individuals to take more personal responsibility for their health.

health care problem solved.

Daschle wants to model the FHB on the Federal Reserve, so it can be an independent agency without political pressures. Daschle thinks this is a good idea because of the transparency of the Fed, and how well they've done with the American economy over the years. Really.

I have read some articles/blogs saying the Daschle/BO plan will be paving the way for "socialized medicine." I've also read articles/blogs warning that evil opponents of liberty will claim TD/BO are paving the way for socialized medicine. I will say there are some moments throughout the book where Daschle seems to be in favor of single payor, saying things like "since single payor is not an option right now...." or pointing out how efficient it is, but it wouldn't work in America... BO said he was in favor of single payor in 2003, and of course the context is that this is not an instantaneous solution for America. However, until we get special interests and corporations under control, I don't see this happening, no matter who loves socialized medicine. Daschle points out that the health care industry is the nation's biggest lobbyist by far, followed by insurance. (each out-lobby Big Oil, he points out.) ...I noticed the reform posited in Daschle's book does not say anything about reforming the insurance industry, other than disallowing discrimination against people with pre-existing conditions. Though he does discuss putting togther a board to evaluate the cost effectiveness of new technologies, as many other countries have.

This is a quick fix that will give relatively fast and good results but is ultimately unsustainable and will not grant universal access. The goal, as in MA, is to get people insurance, not to get people care. The MA government acknowledges that not everyone will get care. The ones that need it the most--those that are "not poor enough" for medicare/caid, but earn too much for other programs fall through the cracks yet again. And just like in MA, the pay-or-play will more entrench health care through employers which is a plan that does not work for America anymore and the Auto Crisis is the prime example.