The much-politicized consumer-directed health care (CDHC) initiative has recently taken heat from critics calling it uncompassionate, unfair, and even sexist. See, for example, “Consumer Directed Healthcare: Except for the Healthy and Wealthy It’s Unwise,” Journal of General Internal Medicine, March 15. The new free-market approach seeks to lower costs by giving individuals more financial freedom and control of their health care, but Dr. Stephie Woolhandler and David Himmelstein are trying to scare women away from it.

Americans need to know more about cost and quality for the best health and financial results, and consumer-centered health reforms drive this change, by impelling patients to become savvy consumers of health care. Dr. Woolhander and Mr. Himmelstein call women the “losers” in such a system, but the truth is that women are no different from any group of consumers: their desire for superior quality and lower prices will significantly improve communication between patients and providers, creating a more transparent and competitive health-care “marketplace.”

Woolhander and Himmelstein’s rhetoric of victimhood maintains that health care amounts to “bad luck and bad choices” and is ultimately the responsibility of the state. In attacking CDHC, they lower themselves to divisive, “group specific” tactics, setting women against men, poor against rich, and young against old. This is nothing but a distracting emotional plea, and has nothing to do with practical health-care reform.

CDHC restores the true meaning of health insurance, with some increased cost-sharing so that patients pay out of pocket for more routine health services and extra benefits, like massage therapy or acupuncture treatment. Then insurance can do its job of covering unexpected health problems. Thirty years ago, the RAND health insurance experiment demonstrated that for middle-class Americans, paying higher co-payments and using slightly less health care had no negative effect on their health or finances.

Bear in mind that high deductible health plans don’t actually require that all non-urgent services be paid out of pocket. They do encourage Americans to start saving for health expenses at a young age, so that their life-long, non-taxable savings accounts (HSAs) will be useful in the future.

HSAs are ideal for women. As Woolhander and Himmelstein aptly note, women get the short end of the stick with routine pap smears, mammograms, and the pain of childbirth. Physiologically, women have more to manage, and starting at a younger age than men, and it costs us money no matter what kind of health-care system we have. We can debate “unfair” differences to no significant end — or we can help future generations of women take charge of their health and finances with their own tax-deductible savings accounts. 

According to U.S. Treasury rules, minimum high deductibles for HSAs are $1,050 for individuals and $2,100 for families, which average out to $3 and $5 a day, respectively. Even at the high end, a family’s $10,000 maximum out-of-pocket limit averages out to about $27 a day. Only a small fraction of families incur such expenses, for which they can put money aside in a tax-free HSA to go toward high deductible payments.

Woolhandler and Himmelstein argue that tax-free accounts are “unfair,” but their grievance is really with the tax system, not HSAs. Wealthier Americans will have greater tax deductions so long as they pay more taxes, so Woolhandler and Himmelstein ought to promote a flat tax first, and have equal tax cuts across the board.

As of January 2007, about 4.5 million Americans were covered by HSAs and high deductible health plans. The U.S. Treasury Department estimates that 30 million people could have HSAs by 2010, but consumer-directed health care is already warding off jabs from right and left that health care is not a commodity like other goods. Certainly, a legitimate fear of critics is that it threatens those who can’t afford care, causing them to put off important preventive services to avoid out-of-pocket payments. States can introduce health-tax credits and vouchers for these more vulnerable patients, which subsidize their health care and also preserve their valued choice to select private care if they want it.

Emotional pleas on behalf of women, however, especially those who are poor and chronically ill, are not productive if they result in enrollment in government programs. The federally-funded Medicaid provides relatively second-rate care, and underpays so many physicians that increasingly fewer accept Medicaid patients. More Medicaid and SCHIP beneficiaries are going to emergency rooms for non-emergencies.

Medicare benefits for the elderly will total $454 billion by 2008, an increase of $28 billion over last year. These overgrown programs contribute immensely to Americans’ dependence on the government, and government’s increasing wastefulness of taxpayers’ hard-earned money.

Ladies, you aren’t losers in a consumer directed system. You too can take control of your health care. The approach seeks to revolutionize the industry over time, giving individuals the resources and financial independence they need to make good choices. Women’s health is different from men’s but that is no reason to expand government in health care. Rather, it provides more reason to expand individual freedom, for women and all Americans.