Medical Segregation: A Coming Coup in American Medical Care?

Forbes calls it “the $20 billion question.” Should women’s health be approached on the basis of women’s clear biological differences from men—for example, by obstetricians and gynecologists—or on the far broader basis of assuming that biology informs every aspect of women’s health, and they should be addressed separately across the board? Should the federal government address health care at all? 

The question was pushed forward on July 15 when the American College of Obstetricians & Gynecologists, along with the Society for Women’s Health Research and the Women First Research Coalition announced a massive new program: the National Strategy to Close the Women’s Health Gap. 

This is a proposed federal advocacy framework that calls for Congress to invest $20 billion over 10 years in women’s health. It states amorphous goals such as funding research, workforce, and public awareness through “strategies like campaigns, partnerships and workshops.” The stated purpose is “to transform women’s health research, care, and outcomes.” 

Federalizing Women’s Health Care

Federalization leads medicine down a very bad path toward bureaucracy and away from competitive markets, which are the best hope to deliver quality at reasonable cost. Remember Covid? Remember President Ronald Reagan’s famous comment, “The nine most terrifying words in the English language are ‘I’m from the government and I’m here to help’?” Bureaucrats helped us good and hard with Covid; now they want to help with women’s health. They make no pretense of ‘helping’ men good and hard, of course.

To men, the program offers a medical segregation that is as medically unfair as it would be to medically segregate blacks along racial lines. Clearly, medical differences between women and men sometimes require totally different hands-on care; but medical differences, like breast cancer rates, is not what is being discussed. Political and economic power is under discussion. Spending billions on “strategies like campaigns, partnerships, and workshops” is such a vague agenda that it does not break down according to genitalia. Yet, this redistribution of dollars from one category of taxpayers to another is being suggested.

The two words used most often to justify medically privileging one sex over the other are “understudied” and “underserved;” that is, women are said to have been ignored by the medical establishment for decades, and they must now be privileged in order to catch up to men. Is this true?

Strong indicators say ‘no.’ Men’s health researcher James L. Nuzzo conducted a study entitled “NIH Funding of Men’s and Women’s Health Research, 1988-2022.” The data was drawn from the US National Institutes for Health (NIH), which is currently the primary federal agency responsible for biomedical and public health research. (Nuzzo includes charts to provide easy visuals that are linked to original data.)  

Other of Nuzzo’s findings from NIH research include:

Averaged across all years from 1998 to 2019, 81% of the NIH’s research budget has been invested in research that is not sex-specific. Of NIH funding that has been allocated to sex-specific research, significantly more funds have been allocated to women’s than men’s health. Between 1998 and 2019, 10% to 16% of the NIH’s research budget was invested in women’s health, whereas 4.5% to 7.5% was invested in men’s health. Averaged across all years from 1998 to 2019, 13% of the NIH’s research budget was invested in women’s health, whereas 6% was invested in men’s health.

The free market adds its own confirmation of women’s better health; life insurance rates trend higher for men than for women, and insurance companies are not prone to cutting humanitarian price breaks. Life expectancy is a key reason for this. In 2023, female life expectancy in the US was 81.1 years compared to males at 75.8 years—a difference of 5.3 years. This is called the morbidity-mortality or gender paradox in medicine; women report higher rates of chronic illness or disability and, yet, they live longer than men. The longevity gap continues even when circumstantial factors, such as war, are eliminated. It is driven by significantly higher rates of preventable disease or health conditions, including coronary problems, substance overdoses, a higher suicide rate, as well as a tendency to delay routine medical care. 

Slighting Men’s Health

And, yet, health care workers are being asked to slight those who are dying earlier from preventable causes as opposed to women. It is inexcusable for the medical establishment to adopt a policy of discriminating against taxpayers because they are black or white, male or female. And, yet, my husband is more likely to be dismissed by doctors or die from lack of treatment than I am. 

These sort of discrepancies were not mentioned at the July 15 announcement. In fact, and considering the huge ‘ask’ that was made, very few specifics were provided. Most of the language of the National Strategy to Close the Women’s Health Gap is vague and bureaucratic, with specifics left to the amounts of funding being requested. For example, $7 billion is slated for “research and innovation across federal agencies that ‘will unlock new scientific discoveries to inform our understanding of sex differences and women’s health’ through strategies like establishing a national Women’s Health Centers of Excellence that would speed up the implementation of research into clinical practice.” In short, a new national bureaucracy. 

Elsewhere, the plan explains “$4 billion [will go] into data and evidence infrastructure, which would go toward establishing a private partnership for women’s midlife health data and a public workshop on women’s health research data.” 

Imprecision Favors Bureaucracy

The lack of precise plans or accountability serves several purposes, none of them good. It masks the incredible amount of money that would be directed into women’s health as opposed to men’s. It allows mountains of tax dollars to get lost in the bureaucracy. It makes administrators, experts, and activists powerful. When billions of dollars are spent, some individuals have immense incentives to be as nebulous as possible. And it seems easy to do. These are tax dollars—money that many people view as free money to be wasted and poorly untracked. 

No wonder clear explanations of health care expenditures are difficult to come by. For example, the academic paper “Gender Disparity in the Funding of Diseases by the U.S. National Institutes of Health” from Sage Journals self-describes its own program as, “We normalize funding level to disease burden, as measured by the Disability Adjusted Life Year, and we specifically consider diseases for which both disease burden and funding level are provided. We apply a power-law regression analysis to model funding commensurate with disease burden.” Medical language surrounding ‘gender’ usually seems designed to obfuscate. I hasten to add that the preceding quotation was not selected as the worst example available, or even an atypical one.

Vagueness also allows objectionable policies to fly in under the radar. The new proposed program describes itself as comprehensive but public information about it is so scant that it is difficult to assess. But some of what is published should cause alarm. Part of “Public Awareness and Education,” for instance, would be to combat social media on so-called unproven health claims and predatory medical misinformation. Often, this is code for censorship.

The National Strategy to Close the Women’s Health Gap has hit Capitol Hill and, although lawmakers are reviewing it, no date has been set for it to go before Congress. No one knows what will happen, if anything. The proposal could be chop-shopped with sections of it receiving approval. Or the drive behind the entire plan could succeed. Whatever happens, people should educate themselves and others about a major change that could be imposed on American medicine.

Health care needs to be privatized as quickly as possible so that individuals can control their own bodies rather than depend upon bureaucrats or experts who act in their own self-interest. This change will not happen any time soon, however, because few areas of life are as tightly tied up with red tape as health care. It is difficult to get even basic antibiotics without jumping through hoops. But demanding fairness in this area is a matter of life and death—perhaps your life or your death–and men may soon have a harder time getting quality treatment. 

I celebrate attention given to women’s health, although it should be private, not governmental. But I’m not willing to have my husband’s life be taken less seriously than my own.