Writing in the Times, Denise Grady explains that before reform, insurance companies charged women higher premiums than men — between 4 and 48% higher — because women "used the health care system more than men." Policies could also exclude maternity care. But the new healthcare bill bars sex discrimination in insurance practices, and also designates maternity care as "an essential health benefit." Women could see changes immediately — the rule against discrimination in premium prices (called "gender rating") takes effect right away.
But not everyone agrees that premiums should be equal. While probably few would argue that women should pay more, Sandeep Jauhur (also in the Times) writes that the majority of Americans think those with "unhealthy lifestyles" should shell out more for insurance. However, Jauhur argues that those who hold this view "presuppose more control over health and sickness than really exists." He writes,
Unhealthy habits are one factor in disease, but so are social status, income, family dynamics, education and genetics. Patient noncompliance with medical recommendations undoubtedly contributes to poor health, but it is as much a function of poor communication, medication costs and side effects, cultural barriers and inadequate resources as it is of willful disregard of a doctor's advice.
Just as any bike-riding, greens-eating person who's been diagnosed with high cholesterol can tell you, "healthy habits" don't necessarily protect you from disease. And as Jauhur points out, "unhealthy habits" are far more complicated than simply choosing to eat cheeseburgers all the time. In fact, Jauhur argues that calls for "personal responsibility" in healthcare are motivated by a fundamentally anti-communitarian principle, a belief that sick people themselves should bear the financial burden of their illness:
When people inveigh against the lack of personal responsibility in health care, they are really demanding a different model, one based on actual risk, not just on spreading costs evenly through society. Sick people, they are really saying, should pay more. Which model we eventually adopt in this country will say a lot about the kind of society we want to live in.
I'd like to live in a society where being sick doesn't mean going bankrupt, and where lacking reliable transportation to the doctor's office doesn't stick you in a lesser insurance program for non-compliant patients (as happened in West Virginia). And I'd like to live in one where having a uterus isn't a pre-existing condition. Luckily, we're moving closer — at least to the latter. The point's been made before, but it's worth making again — worries that healthcare reform will lead to "rationing" of care are a little ridiculous, given how much rationing was going on before. Insurance companies have been deciding who gets care for years now, deeming some people simply too sick, or too female. They're the real "death panels," and reform will lessen their influence over our lives, but unfortunately not remove it.