Snatching Humiliation From the Jaws of Compromise

Much is being made of the apparent ‘concession’ from America’s Health Insurance Plans (AHIP) to drop gender as part of underwriting.

You can read Karen Ignagni’s statement here. On first read, the Disease Management Care Blog wouldn’t have caught the its significance, but on page 4, it says ‘We envision a rating system based on the following demographic factors: geography, age and [insurance] product type.’

That’s right, the word ‘gender’ as an underwriting factor is absent.

Massachusetts’ Senator John Kerry’s staff certainly picked up on it, which enabled some public puffery over the issue of gender discrimination in the follow-up Q&A. This in turn flushed Ms. Ignagni ‘s page 4 insurance industry ‘setback’ out into the open.

What has been absent from the press reports about this is how the commercial insurers are hanging tough over the linkage of an individual mandate to guaranteed issue and community rating as well as the non-necessity of the public plan option. It may be paying off. Senator Charles Schumer of New York is working hard to find a compromise that will allay the concerns of enough conservative democrats who are apparently willing to break ranks and vote ‘no’ against what could be shaping up to be a public-option poison pill. The optimistic and naïve DMCB believes compromise is in reach and will ultimately depend on how a ‘public’ plan is defined. A very regulated plan administered by a private insurer of last resort could fit the bill.

But how about that gender issue? As a physician, the DMCB is well aware that women are, well, built differently. That translates into different healthcare needs. To further research the issue, the DMCB went to many interesting web sites but ultimately headed on over the USPSF’s Guide to Clinical Preventive Services and searched on the word ‘women.’ It found things have not changed much since Senator Kerry’s wisdom was given such public display: women have considerable healthcare needs. What’s more, they deserve to access to the full range of services that will address them. It could be argued that insurers agree and charge women more in their premiums so that they can be assured that those services will be available to them.

Readers need to decide for themselves if the insurers are guilty of clandestine conscious and unconscious sexism or enlightened business practices aimed at doing the right thing for an important market segment. As for Senator Kerry’s comment about ‘the disparity between women and men in the individual marketplace is just plain wrong and it has to change,’ the DMCB is having trouble between the choosing between a) grandstanding for political advantage and b) showboating by beating up on a favorite whipping boy, er sorry, person. Compromise is one thing. Making it appear as if it's humilation is another.

Post script: By allowing rating based on age and geography, is the US Congress going to permit ageism and geographism? Don’t the elderly deserve the same consideration? Shouldn’t persons living in New York have the same low insurance costs available in Minnesota? Tsk tsk.