October 30, 2008

Health Insurance Premiums Cheaper for Men

THE NEW YORK TIMES has published a fascinating article looking at the considerable difference between what men and women pay for health coverage on the individual insurance market. As it happens, women pay a lot more -- as in 30 pc to 50 pc more -- for health insurance compared to men. This has perhaps understandably alarmed women's groups, and now people in Congress are looking at it, and the Times accordingly wrings its hands about the whole matter. Indeed, as reporter Robert Pear writes in one line, the new findings "are not easily explained away."

If I wanted your opinion, Bob, I'd have asked for it. But I digress.

Anyway, the insurance companies argue that they charge more for two key reasons: one, women get pregnant and have children, which men cannot do; and two, women use more health care services than men. As one executive told Mr Pear:

“Premiums for our individual health insurance plans reflect claims experience — the use of medical services — which varies by gender and age. Females use more medical services than males, and this difference is most pronounced in young adults. ... Bearing children increases other health risks later in life, such as urinary incontinence, which may require treatment with medication or surgery."

One health insurance actuary was a bit more blunt:

"Under the age of 55, women tend to be higher utilizers of health care than men. I am more conscious of my health than my husband, who will avoid going to the doctor at all costs.”

Based on these quotes, it certainly seems as if the insurance business has its own Industrial Laundry Conundrum. That's the iron rule of economics that says men pay less at the dry cleaners because our orders largely consist of easily-washed button-down shirts, while female customers must ensure their good outfits receive special care and get dry cleaned and what not. Also, generally speaking, men are less fastidious than women and so some may seek to reduce their outlays through austerity measures (see the Looks Clean, Smells Clean Corollary).

Now, I do not have the expertise to say whether this justifies a 50 pc differential in insurance costs. But I do think most women use health care services more than men, if only because men generally hate going to the doctor. For instance, I hate going to the doctor, hate going to the hospital for pretty much any reason, and hate dealing with the paperwork and inefficiency that go along with those things. I daresay men look at the health care system somewhat like this (go about 30 seconds in):

Ren And Stimpy-In The Army | Funny Jokes at JibJab

For instance, just recently I called my GP's office to schedule a checkup -- it has been a while since I have seen the man, and it was time that I did so. So I called the office to schedule a consultation. Why, I was asked, did I want to see my GP? Well, said I, I wanted to go over my treatments for certain continuing health care issues.

This was not enough for the receptionist, who said she couldn't schedule an appointment for me unless she knew exactly why I wanted one. I responded by asking to get penciled in for 15 minutes to discuss my diabetes, among other things. After a bit more back and forth, I got set up for some lab work, after which I would then get an appointment to see my GP. Why this couldn't have been set up at all once, I don't know, but I went in for my lab work yesterday. Perhaps I will get my appointment next week.

The diagnostics lab at my GP's clinic has all the charm of waiting at an airport. Yesterday, as I sat waiting serenely to have my blood drawn, I looked around and saw six or eight people all looking rather annoyed. In the back, people wearing lab coats went about their work, which appeared to require a lot of record-handling. The minutes ticked on, and none of the people waiting were called. An elderly man walked into the lab, clutching a pamphlet about an unpleasant disease. He proceeded to read aloud from it to his companion. The waiting continued. Finally the dam gates burst and people were called in rapid succession. Things proceeded quickly from there, but what should have taken five or ten minutes took closer to thirty. Thank goodness I didn't have to work.

I suppose what bothers me the most about the health care system is that so much of it is inherently infantilizing. It is not, of course, always this way -- I really like my GP, who actually treats me like an adult, and I've had some good doctors that also actually treated me like an adult, but I'm really not into the do-this do-that or else mindset that seems to pervade the lower ranks of the medical establishment. This doesn't work on me. I'm stubborn and I'm cheap. I don't have to do jack shit.

I don't think this mindset is intentional on the staff's part; it's just the culture and that's not something that changes overnight. But it can really be aggravating. I mean, my God, I'm an independent adult and one with not too bad of a brain. Give me facts I can analyze, opinions I can weigh, decisions I can make -- don't launch into a lecture about how I'm not doing something right. Don't you think I know that already? Here's an idea: if I need to eat more vegetables or something, tell me how I can work that into a rather frenetic daily life.

I also don't like this idea that I'm supposed to surrender my life to some stupid medical condition. In my case, one of my medical conditions is that I'm a Type 2 diabetic. Oops. Anyway, as a result of this, I limit my intake of refined sugar and save dessert for special occasions. When I eat, I try to focus on protein and vegetables as opposed to carbohydrates. I take care of my feet. OK, fine.

All that does not mean that I am going to obsess over the fact my body decided it hates my pancreas and will only politely pick at its peace offerings of insulin. This also does not mean I'm going to act like I have something really bad -- like coronary disease or cancer -- and bemoan my state. It's diabetes. It is not like my typing hands got caught in a blender.

Anyway, the point to all this is that the medical establishment could perhaps do a better job at reaching out to its male patients, particularly the young, sullen, angry, passive-aggressive ones with issues. Here's an example of how they can do this:

I mean, if Taco Bell can figure it out, the medical establishment should too. Notice how this ad is extremely direct, extremely quick, proposes a reasonable and cost-effective solution, and then leaves the matter for the consumer to decide. That's what you've got to sell. Given the price of the Taco Bell box meal, you could do the same thing for a prescription of metformin. Have Adam Carolla stand up and declare, "EAT LIKE A DIABETIC!" and mention how eating right and a couple pills each day improves one's mood, improves one's sex life, gives one more energy, and a month's supply of the pills will run you $4. OK, I'm sold.

Which leads me to my last point -- I wonder if one reason women use more health-care services is because the marketers have aimed their messages in a way that is particularly receptive to women. Women are better about talking about these types of things, and more open about discussing them, and as such better at dealing with them. With men, on the other hand -- well, oftentimes we're stubborn and cheap and impatient and not good at dealing with emotions. We are also (perhaps too) confident in our own innate ability to solve health care issues; and marketers hoping to improve men's engagement in terms of their own health care might want to consider such aspects of masculinity when drawing up their campaigns. Part of me wonders if a campaign that simply said, "LOSE WEIGHT -- HAVE BETTER SEX" would do more to solve the obesity epidemic than ten billion spent on pharmaceuticals.

Posted by Benjamin Kepple at October 30, 2008 03:33 AM | TrackBack
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