POWIP Piece of Work In Progress

21Nov/0937

Women and Health Care “Reform”

Recently, a couple of advisory boards altered recommendations for cancer screening for women: breast cancer screening and cervical cancer screening. But for women, it's going to go well beyond screening.

Here is something that has not brought up in many of these health care debates: women use health care a lot more than men do.

First, there are the obvious costs of pregnancy and childbirth. I've done that three times, and it's not cheap, especially if you get a C-section. C-sections are real surgery with all the costs that go with that [and anyone who goes for elective C-sections are freaking nuts! Ladies, the vagina is built to let kids out, it does bounce back a lot better than do your abdominal muscles being sliced through. Okay, no more graphic mommy talk. In this post.]

Another thing is that women are more likely to go to the doctor regularly, and part of that are those annual Pap smears [at younger ages] and mammograms [at older ages]. These aren't free, though much cheaper than surgery.

All of this health care "reform" is about money. Who is paying for what and how much, and who is getting paid and how much. The federal and state governments already have a very heavy hand in this stuff. Only a few health-related industries escape much of the onerous government funding and regulation: LASIK surgery, plastic surgery, and abortion to name a few. There are already a bunch of price distortions due to Medicare, Medicaid, S-CHIP, and state insurance regulations; but the octopus has decided that level of power is not enough. The people who are going to be most impacted by federal government control of health care are those who use the most health care. The biggest groups: the elderly and women.

But wait, women make up half the elderly, so they're being double-counted, right? No, it's worse than that. Women make up a lot more than half the elderly. Here's where life expectancy comes into play. I'm going to use the 2000 calendar year Social Security tables [without mortality improvement] to calculate differences. And I'm going to measure life expectancy from different points, not birth. I'm going to check from age 21, and from age 65 [when Medicare coverage begins].

[A quick aside: absent abortion or other artificial conception methods, more males are born than females. Males in the U.S. have higher mortality rates at all ages than do women. I will explain this another time.]

Here are the age at death stats starting from age 21:

Male Female
Percentile Age 21 Age 21
50th 78 83
70th 84 88
90th 91 94

And here they are starting from age 65

Male Female
Percentile Age 65 Age 65
50th 81 85
70th 86 89
90th 92 95

Let's pretend there are a whole bunch of actuarial caveats here. The point is not the exact numbers, though, but the relative numbers, the gaps between men and women.

Let's start with the from age 21. I'm not using life expectancy, because I want to look at actual probabilities - the 50th percentile [the median] is a good starting point. Using the mortality table numbers, half will die before this age and half after this age -- note there is a 5-year gap here. If we want to get more specific, at the median death age for women is close to the 70th percentile for men. If there are the same amount of men and women are alive at age 21, then at age 83, you will have half the women left, but only 30% of the men [this is not exact, but it's close] -- that means there will be 5/3 - 1 = 66% more women than men at that age. Of the age 83 people, 63% will be women. It gets worse at higher ages.

This is going to come up again when I look at public pensions - especially when the men are married to women who are already younger than they are.

You're going to find, even without the bias for women to go to the doctor more often than men, women simply live longer to require more medical care. If you drop dead of a heart attack at age 75, that's a heck of a lot cheaper than living past age 90 in a nursing home. If we look at the stats starting at age 65 [thus ignoring all the people who died during middle age], you will see using this mortality table almost 30 percent of women will make it to age 90.

But let's go back to the mortality table I'm using: a calendar year table with no mortality improvement. That table is based on actual deaths at certain ages in calendar year 2000; so you count up how many people are age 21 at begin of year 2000, see how many make it to the end of the year alive, and put down the mortality rate [it's a little more complicated than that, but not by much]. The group of people you're looking at for mortality at 21 are different from the group you're looking at for mortality at 65.

A better table to use would be a cohort table, meaning you follow a group of people who are born in a particular year, from age to age. But there's a problem with this - you can't get a full table until they all die. And not even all the people from 1900 cohort are dead yet. But actuaries don't wait until everyone is dead; all sorts of projection techniques are used, including mortality improvement from earlier mortality tables. I don't have a cohort table loaded up right now [I'll have to get back to you on that], but the qualitative results I discuss above aren't going to be much different: women outlive men, and you'll see this especially at advanced ages where senility and general systemic failure mean there's a heavy usage of health care at this point.

When Sarah Palin said "death panels", she was on point... but what she really should point out is that women really will be hardest hit by these death panels. She has written on the recent cancer screening recommendations, but I don't see anything in there that it was inevitable that this sort of thing would happen. It's not just a matter of screening and prevention; the actual healthcare of women will be cut more than that of men under government-run health care, just because there's more to cut.

But hey, perhaps under the new regime, life expectancies and survival probabilities will be equalized between the sexes. But I don't think that's what feminists were shooting for.

More stuff on childbirth health care costs: This is from an actuarial meeting, but the speakers are a nurse and a doctor. Births of a Nation [pdf of Powerpoint slides]. I want to point out the following on page 39 - the very last page:

Though hospital and physician fees
are still the main obstetric costs, lab
tests make up a growing portion of
costs.

These enhancements to care over the
last 20 years have clearly added to
costs but have debatable health
benefits.

So expect the pregnancy and childbirth lab tests and OB visits to be the next on the chopping block from government advisory panels.

RELATED POSTS: Instapundit linking to Althouse.

Discussion at the Actuarial Outpost on mammograms.

Meep

Meep is a member of the Irish Catholic mafia, having a suspiciously high number of green-eyed, red-haired friends. While she doesn’t have red hair herself [except when she goes into the sun (rare for any vampire)], she does have green eyes. She’s a raving Papist and is a life actuary on the side [i.e., she counts dead people]. An amateur pain-in-the-ass [willing to go pro!], she likes covering retirement, mortality, math, and education issues.

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  1. Lump Conner
    November 21st, 2009 - 08:52

    Medicare takes care of our elderly without regard to their costs.

    Fuck you, you’re a cheap lying un-American piece of shit for implying otherwise, and so is Parah Salin.

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  2. Meep
    November 21st, 2009 - 09:13

    And Canadian Medicare and UK’s NHS take care of people with
    regard to cost, too, right?

    That works for only so long, and Medicare’s cracks are already beginning to show. Even with underpaying for certain treatments, the Medicare costs are getting well out of hand. And when everybody is under that system as per in UK and Canada? You get rationing whether explicit means [approved treatments via advisory panels... no deviation allowed] or implicit means [waiting lists and times]

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    • Meep
      November 21st, 2009 - 09:18

      I meant “without regard to cost”

      People forget that Medicare doesn’t cover everything, either. There’s Medicare Part A that covers hospital charges, but it doesn’t cover long-term care like nursing homes. They tried to add something in called CLASS act [oh, so subtle] about long-term care.

      Let’s see what the actuaries had to say about that:
      http://actuary.org/pdf/health/class_nov09.pdf

      Excerpts: Q: Why is broad participation in the
      CLASS Act program not likely?
      A: Given the proposed benefit structure of
      the CLASS Act long-term care (LTC) program,
      the required “actuarially sound” premiums
      are likely to be unaffordable for much of the
      intended population.

      You can use “other people’s money” for only so many things; it does run out eventually.

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    • Klem Moore
      November 21st, 2009 - 23:01

      Those are single payer systems, Meep troll. And guess what, Meep troll, those are better systems than the U.S.’s, and do you know why, Meep troll, because they cover all their citizens with better quality care at a fraction of the cost.

      Meep troll, do you work for an insurwance compwany?

      You seem to have a tinge of fear in your lies.

      HAhahahaha, what fuckin’ twinky lie-bot you are.

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      • Klem Moore
        November 22nd, 2009 - 23:51

        Duly noted: Meep didn’t answer the question as to whether she works for a insurance company.

        Maybe it’s because a whore don’t like revealing her pimp!

        Who can really say for sure.

        Meep can.

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        • Bob Reed
          November 23rd, 2009 - 00:25

          Perhaps she wishes to retain some anonymity; you know, like people who use names from Norse mythology, or change their handles, IP’s, and e-mail addys regularly…

          Hmmmmmmm?

          Sounds like the pot calling the kettle black, you RAAAAAACIST!

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        • Klem Moore
          November 23rd, 2009 - 00:56

          Put the moonshine down, Floatin’ Bob.

          I’m about Hope and Change.

          Me thinks you need a hug.

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  3. Dan Collins
    November 21st, 2009 - 09:19

    The proposed legislation will cut Medicare by $490 billion over ten years.

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    • Meep
      November 21st, 2009 - 09:34

      Well, that’s what they say.

      I went to a talk by a Social Security Administration actuary recently, where he was talking about scheduled cuts in Social Security payments. And I said “Really? When the ones getting payments have nothing better to do other than show up to every minor election, do you really think politicians will cut those payments? It’s just a ploy to make the program look cheaper than it is”

      So either they’re going to have to say “well, yeah, of course we’re cutting coverage for the elderly… otherwise the bill will cost too much for people to swallow” or they’re going to have to admit that they don’t really intend to make these cuts, and the bill will look even more expensive.

      In the short term, the elderly aren’t going to become less numerous unless we go the Soylent Green route.

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  4. Joe
    November 21st, 2009 - 09:22

    Dr. Utopia says he might not run again in 2012.

    Meanwhile Darleen at PW has the agenda for “health care” and it is a wee bit broader than signing up the uninsured:

    •An income surtax on taxpayers earning more than $500,000 a year,[1]
    •An excise tax on high-cost “Cadillac” health insurance plans that cost more than $8,500 a year for individuals or $21,000 for families,[2]
    •An excise tax on medical devices such as wheelchairs, breast pumps, and syringes used by diabetics for insulin injections,[3]
    •A cap on the exclusion of employer-provided health insurance without offsetting tax cuts,[4]
    •A limit on itemized deductions for taxpayers with a top income tax rate greater than 28 percent,[5]
    •A windfall profits tax on health insurance companies,[6]
    •A value-added tax, which would tax the value added to a product at each stage of production,[7]
    •An increase in the Medicare portion of the payroll tax to 3.4 percent for incomes great than $200,000 a year ($250,000 for married filers),[8]
    •An excise tax on sugar-sweetened beverages including non-diet soda and sports drinks,[9]
    •Higher taxes on alcoholic beverages including beer, wine, and spirits,[10]
    •A tax on individuals without acceptable health care coverage of up to 2.5 percent of their adjusted gross income,[11]
    •A limit on contributions to health savings accounts,[12]
    •An 8 percent tax on all wages paid by employers that do not provide their employees health insurance that satisfies the requirements defined by the Secretary of Health and Human Services,[13]
    •A limit on contributions to flexible spending arrangements,[14]
    •Elimination of the deduction for expenses associated with Medicare Part D subsidies,[15]
    •An increase in taxes on international businesses,[16]
    •Elimination of the tax credits paper companies take for biofuels they create in their production process–the so-called “Black Liquor credit,”[17]
    •Fees on insured and self-insured health plans,[18]
    •A limit or repeal of the itemized deduction for medical expenses,[19]
    •A limit on the Qualified Medical Expense definition,[20]
    •An increase in the payroll taxes on students,[21]
    •An extension of the Medicare payroll tax to all state and local government employees,[22]
    •An increase in taxes on hospitals,[23]
    •An increase in the estate tax,[24]
    •Increased efforts to close the mythical “tax gap,”[25]
    •A 5 percent tax on cosmetic surgery and similar procedures such as Botox treatments, tummy tucks, and face lifts,[26]
    •A tax on drug companies,[27]
    •An increase in the corporate tax on providers of health insurance,[28] and
    •A $500,000 deduction limitation for the compensation paid by health insurance companies to their officers, employees, and directors.[29]

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  5. Dan Collins
    November 21st, 2009 - 09:36

    And as Congresscritters, they won’t have to use it.

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    • Meep
      November 21st, 2009 - 10:32

      Well, as long as they’re congresscritters. Some may find they’re having a hard time holding onto their jobs. That should make for some interesting behavior.

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  6. Wellescent Health Blog
    November 21st, 2009 - 12:06

    That’s an interesting analysis on how much women cost vs men. It does indicate where the costs are, but drawing the conclusion that the cuts will be there next is more of a leap. Though much has been said about rationing and other systems in other countries starting to crack, systems in other countries have been around for quite some time so the fact that they are starting to crack after 40-50 years isn’t that bad. The citizens of these countries have used the same system and been provided good health care for quite a while despite the medical field having advanced by leaps and bounds. What this means is that they have to refine their systems as opposed to figuring out a brand new system as is being done here in the US.

    Given the relative success of their systems at a much lower cost per capita (10% of GDP vs 16%), lawmakers simply need to determine how to make any of their moderately successful models work in the US.

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    • meep
      November 21st, 2009 - 14:09

      It’s all about tradeoffs.

      I can understand people wanting single payer systems for various reasons, but they need to be honest what will be given up. And not all people are going to be hit the same amount… that also should be acknowledged.

      I’ve seen some interesting systems – Israel for instance. The universal health care part in Israel is an HMO program, and really very basic [as opposed to the larded-up insurance requirements here in New York state]. Then you can buy supplemental private insurance for stuff above and beyond the basic HMO.

      Thing is, can one get Americans to admit that a universal healthcare system will cover only extremely basic stuff? That any universal part is going to have to limit benefits explicitly, like no hip replacements for people over eighty.

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      • Klem Moore
        November 21st, 2009 - 23:17

        You’ve never seen any system other the America’s, that’s why you’re a flag-pin-stupid dishonest demagogue.

        There’s already limited availability for full hip replacements for persons who reach their mid-70′s, but the decision lies ultimately with the ortho-surgeon. The operation requires a patient with the ability to lose a lot of blood. It has nothing to do with teh ebol gubmint fantasies, Meep troll.

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        • Bob Reed
          November 22nd, 2009 - 10:46

          Why don’t you just post some more Russian non-sequitors, like the Limanov drivel you put in the Palin thread?

          I guess that’s what happens when you run out of valid arguments and have overused all of the usual and customary talking points…

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        • Klem Moore
          November 22nd, 2009 - 11:22

          Why don’t you read the words of a populist Russian politician and compare them to Sarah the Quitter’s?

          Limonov’s book, It’s Me. Eddie, was his first written while he lived in New York City. It’s sales were pretty good in the U.S., maybe a 100K, I dunno. Shortly thereafter It’s Me, Eddie was re-printed in Russian and re-published by a Russian publisher. Estimates are that it sales have exceeded 10-million copies there.

          Bwahahahahahaha!

          Rocket Boobs, why do you think Russian youths take to the streets and die in the name of Eduard Limonov all while fat white cow-people in America politely stand in line for Sarah the Quitter to sign her ghost-written book?

          Compare the real versus the poseur.

          Ooops, sorry, I forgot you don’t read books, Bob. My bad.

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        • Bob Reed
          November 22nd, 2009 - 12:06

          Did “Eddie” sell 300K copies on opening day?

          “A HarperCollins insider told The Daily Beast that the book sold a staggering 300,000 copies on the first day alone, which was Tuesday. “Sales are phenomenal, and we are convinced that the book will continue to sell phenomenally for some time to come,” says the insider. They’re not prevaricating: As of 2:30pm today, the book was #1 on Amazon, ahead of both Stephen King’s new novel, Under the Dome, and Dan Brown’s The Lost Symbol.”

          300K in one day-selling better than popular writers long awaited sequels and new offerings…

          Hillary didn’t sell that well, nor Billy Jeff…Nor Obama!

          So remind me again of the relevance of Limanov to our discussions..? Oh, that’s right, there is none…

          Just more pointless blustering to cover a lack of anything to add in the way of facts to the discussion…

          Have you read Palin’s book? No? Why, don’t you read books..?

          Two can play the “cartoon reality game” thor; I’ve read and written plenty-enough to be able to tell when, “something is wrotten in Denmark”, or spot the phoniness of a zero like Obama. The phoniness of an inept, inexperienced politician who confuses talking about something with, you know, actually doing something-constructive…

          As opposed to single-mindedly pursuing the obamacare swindle, which will not only establish de-facto “death panels”, institutionalizing the eugenicist mindset of that goul Zeke Emmanuel, and the eventuality of care rationing; but it will also remove all incentive for innovation, invention, research, development, and professional participation from the medical industry.

          Stop worshiping the Russians long enough to consider might be good for the entire country, and not just for Obama’s ego and electoral prospects.

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        • Klem Moore
          November 22nd, 2009 - 12:33

          Britney Spears, too, sold a million copies of something.

          You don’t fuckin’ read books, Bob, and that’s but one reason you’re head is fat and ignorant.

          A comparison of Parah Salin to Limonov is all too relevant, we’re talking about non-office holding politicians with their names on books, no, but that obviousness makes you look like the fool so keep on play-pretending it’s not relevant, pretender.

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        • Bob Reed
          November 22nd, 2009 - 12:48

          Limonov is a crazy man who alternates between punk anarchy and tyrannical communism; completely unlike Palin…

          Britney spears,blah,blah,blah…more drivel…

          Keep on living in your cartoon reality where I don’t read books…

          I stick to facts, in the real world, and don’t take life lessons from self-styled poets or self-serving revolutionaries. I’m out to actually learn things and enhance my intellect, not impress baristas, with a variety of piercings, at peotry readings…

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    • Klem Moore
      November 21st, 2009 - 23:06

      Thank you, Sir/Madame, for your honest input.

      You’re a patriotic American from the more patriotic parts of American, no doubt.

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  7. Mike LaRoche
    November 22nd, 2009 - 00:46

    Thor seems quite determined to prove himself a maladjusted, misogynistic loser.

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  8. Klem Moore
    November 22nd, 2009 - 10:50

    Hi Meep troll! I’m thor!

    I’ll tell you what I expect, Meep troll, that way you’ll have a high expectations bar to shoot for. See the studies you cite at the bery-bery top of your failed screed? Read them. Read every page. Read every word.

    After you’re done reading, go look in the mirror. What do you see? Duuuuuh gooody person? An Ebooool person? If you answered affirmatively to either of the questions, punch yourself in the face, repeatedly if necessary.

    Most of your conclusion is based on two facts: that women live longer versus men and that women, due to childbirth and its necessary plumbing, require more health care monies versus men and therefore – stand back Nobel Prize Committee – any cutbacks in health care spending will fall moreso on women than men. Jeeenyus ballons were made especially for your pleasure, Meep troll.

    But before you can connect these Meep-dots, you have to make the necessary assumption that the two studies cited at the beginning were motivated solely to reduce health care spending – why the fuck else would Meep troll give us a 1500-word word salad without that assumption?

    Duh Ebol Gubbymint wants to reduce monies spent on precious Meep! But of course duh Ebols do!!! And duh Ebol Gubbymint wants to reduce monies spent on women in general! But of course duh Ebols Gubbys do!! Women will die, goody people!

    The study Meep troll cites on breast cancer isn’t really a study, it’s a summary of other studies … and it was written by both women and men who happen to be doctors, and yes, to the dismay of Dan Collins, on the council overseeing the study there are, indeed, oncologists and a breast-person!

    The biggest kick in the head to Meep troll failed conclusion is that much of the study she cites states that breast self-examines (BSE) draw too many false-positives as well as do mammograms.

    Breast Self-Exam.

    Read that slowly, Meep troll.

    How much does one of those cost?

    Knock, knock. Meep troll, is it possible that you might know less of breast cancer and studies thereof versus trained medical research doctors, even teh female ones?

    Is it possible that though these professionals who know umpteen-times more than you, Meep troll, drew the wrong conclusion from statistical data that they might have done so without regard to medical costs? Think hard Meep troll!

    Awwwwwww, the sound of the swirling blades from the black helicopters in Meep troll’s head might have been silenced momentarily.

    Here your audience isn’t made up of autistics. I expect you to know that.

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  9. Klem Moore
    November 22nd, 2009 - 13:04

    I hope I didn’t make Meep cry.

    Teletubbies don’t cry!

    Your chart was amazing, Meep troll, and your conclusion needed every bit of the empirical evidence provided.

    Women live longer than men and women have babies.

    Nobel Prize, I tell ya, Nobel Prize a-comin’!

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    • Bob Reed
      November 22nd, 2009 - 13:20

      If your ridicule is correct in any way, then at least she can take some solace in the fact that she deserves a Nobel as much, or even moreso, than Obama…

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