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Are Breasts Unfair?

April 11th, 2007 · 2 Comments

Here’s the AP today:

High-deductible health insurance plans favored by many employers often wind up being an unfair burden to women, a new study says, largely because women need many routine medical exams that quickly add up. [….]

“High-deductible plans punish women for having breasts and uteruses and having babies,” said Dr. Steffie Woolhandler, the study’s lead author.

“When an employer switches all his employees into a consumer-driven health plan, it’s the same as giving all the women a $1,000 pay cut, on average, because women on average have $1,000 more in health costs than men,” she said.

Insofar as the U.S. labor market isn’t exactly rigged in favor of women, I feel a bit churlish quibbling about this, but wouldn’t an equally reasonable frame here be that the more common low-deductible* traditional plans amount to a $1,000 cross-subsidy to women? (Birth control, of course, is something of a special case, since it’s typically purchased by women but equally benefiting a male partner.) There are all sorts of differences between people’s expenses. Some are a matter of choice, some less so. Some are idiosyncratic, some vary reliably and systematically from one subgroup to another. And we don’t normally think it’s “unfair” of employers not to, in effect, index compensation to the different costs faced by all the different people working in the same office. And gender isn’t really the most salient dimension here, is it? Young healthy people generally aren’t going to hit their deductible, and people with serious chronic ailments always are.

The unequal burden the lede of this article talks about is imposed by biology, not employers’ insurance packages. Pace Alanis, “rain on your wedding day” isn’t ironic, it’s just sort of crappy. Similarly, I don’t think it makes sense to characterize as “unfair” brute biological differences that end up cashing out as unequal medical costs—they just sort of suck. Fairness and unfairness are properties of intentional allocations, not blind nature.

Or, put in a slightly more ideology-neutral fashion: If there’s a sense of “fairness” or “justice” that requires trying to smooth out morally arbitrary differences in our natural endowments, it seems like it ought to fall at the level of the “basic structure of society,” not individual employers’ healthcare policies.

* My initial clumsy wordy appears to have misled Ezra, so I’ve just clarified that I’m comparing “consumer driven” plans involving, for instance, HSAs, with more conventional insurance. Though since I note Ezra mentions the gender pay gap in the previous post, I wonder: Do estimates of the size of that gap incorporate the fact that the same (traditional) health benefit plan is apparently worth about $1,000 more to women? I assume some of you out there pay close attention to this issue & can enlighten me.

Tags: Libertarian Theory



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