KAI RYSSDAL: One of the issues at the heart of the health care debate has been who's paying. Critics of the status quo say consumers are less cautious than they ought to be when they're spending insurance company money. So one of the hot new trends is something called consumer-directed plans. Also known high-deductible options. Where patients or their parents pay out a lot out-of-pocket before insurance kicks in.
Employers like them because the premiums are lower. And the Bush Administration has been pushing them as a way to cut costs. But a new study points out that these plans penalize part of the population — 51 percent of it, in fact. From the Marketplace health desk at WGBH, Helen Palmer has the story.
HELEN PALMER: You can blame biology.
STEFFIE WOOLHANDLER: We women have breasts, we have uteruses, we're the ones who have the babies.
Harvard's Steffie Woolhandler is an author of the Journal of General Internal Medicine study. She says those biological facts add up to big differences in the health costs men and women face.
STEFFIE For people under the age of 45, men would average just under $500, wheras women average closer to $1,500 a year.
So, she says, if your boss decides to shift to a high deductible plan, it's like giving female employees a $1,000 pay-cut — because the first $2,000 or so of health costs come directly out of your pocket.
But Melinda Beewkes Buntin of the Rand Corporation takes issue with Woolhandler's figures. They come from medical expenditure data for 2003 — not the costs people are actually paying under these plans.
Buntin says large employers are designing them carefully.
MELINDA BEEWKES BUNTIN: Ninety-two percent of those large employers are offering preventive care coverage before those higher deductibles are met.
The health insurers trade group says the same — over 90 percent of the plans cover preventive services without making the consumer pay upfront.
And Mike Tuffin of America's Health Insurance Plans says women like high deductible plans just as much as men.
MIKE TUFFIN: People buying these plans are split almost perfectly evenly between men and women — it's 51 percent men and 49 percent women.
Woolhandler isn't impressed though. She says even if, say, a preventive screening's covered, any follow-up wouldn't be. That means higher bills for women and the sick.
But of course, it's those higher bills that advocates say will help consumer-directed plans control health costs. If we have to pay more, we'll go to the doctor less.
In Boston, I'm Helen Palmer for Marketplace.