The Healthcare Debate Is a Variant On The Gender War?

So says Malcolm Gladwell in a 2000 debate with Adam Gopnik in The Washington Monthly. I’m not sure if I agree but it’s an interesting point that I’ve never heard anyone make before.

MG: Let me reframe the argument for a moment. It’s clear that these systems mean different things to different people at different stages in their lives. I think it’s very useful to think of them… If I might offer one sort of reductive way of looking at these questions, let’s think about this in gender terms. Women and men use health care in profoundly different ways. Women and small children use… The most important thing that they need is a personal relationship with a doctor. They use the health-care system chronically, that is to say, from the age of… From the moment that they reach reproductive health, from the moment of menarche through to the end of their lives, they go to the doctor, need to go to the doctor about every month, every couple of months. 

AG: Regularly. Certainly systematically.

MG: Systematically. And the kind of health care that women need up to middle age is, by and large, relatively low tech. It is, by and large, things that we know how to do, and the real critical questions for women are almost always solved by: Have you seen your doctor recently? Are you getting a check-up?

AG: A Pap smear. A breast exam. Whatever.

MG: If you look at patterns of mortality for women, and morbidity, there are many, many more things that can go wrong in a 30-year-old woman than there are in a 30-year-old man.

Look at the way that men use the health-care system. They use it not chronically, but acutely. The problems that strike them, strike them well into middle age. A 30-year-old guy does not need to go to the doctor ever unless there is something obviously wrong with him, and, in fact, many 30-year-old men, 40-year-old men do not go to the doctor. The pattern of male illness…

AG: Not to interrupt, but Dave Barry has a whole thing about the doctors for guys. He just looks at you and says, “You look fine!” And then you go home.

MG: And if you look at the reasons why men get sick as opposed to reasons why women get sick, men, up until their 60s, essentially, they either get shot or they die in car accidents. Women do not get shot or die in car accidents. It’s actually quite striking. Women die of cancer, or they die of very, very different things until you get up into the late 60s and 70s.

AG: When they’ll start dying of heart attacks.

MG: They go boom and it’s over. That suggests to me that the ideal health-care system for a man is very different from the ideal health-care system for a woman. In fact, what a man wants from a health-care system is a health-care system that is acutely oriented, not chronically oriented, that is much more interested in quality of care, much less interested in access. A man doesn’t need access to care until he’s very old. He wants a high end, super-specialized system that when he has something seriously wrong with him fixes it right away. A woman, on the other hand, wants a system that’s low tech, that sacrifices quality for a kind of presence. She can go to the doctor three times a month if she wants to and get a personal relationship with that doctor.

The Canadian health-care system is a health-care system for women. The American health-care system is a health-care system that is perfectly situated for men. It’s the male health-care system. This whole debate about what is better, the American system or the Canadian system, is essentially a variant on the gender war. As a man, I am infinitely better off in America than I am in Canada. Were I a woman, I would be much happier with the Canadian system, where I can go and see my ob/gyn for free, day in and day out if I wanted to, than I would be in America. I think once you think about those systems that way it sort of clarifies what’s wrong with each. The Canadian system is not a good system for men.

There are two things that America developed that would not have been developed without Americans: trauma care. The idea of sending in a helicopter to pick up someone who was in a car accident and getting him back to a helipad at a hospital, rushing him downstairs and dealing with him right away. That comes out of the Vietnam War. That is an American invention, and it has saved thousands of lives. It has saved male lives.

AG: Women don’t get in accidents or get shot in bars, right?

MG: Right. They don’t get shot, and they’re not involved in multi-car pile-ups at 2 a.m.

The other great thing that Americans have discovered is, of course, organ transplants. If you look at the gender breakdown in organ transplants, organ transplants are all about men. Women don’t need liver transplants because they’re not drinking the same way men are drinking. It’s not women who need heart transplants at 45, or have kidney failure. Liver transplant is precisely the kind of incredibly expensive, incredibly high end, incredibly complex health-care intervention that is really important if you’re a guy. Transplant in Canada and trauma care lag behind America by 15 years, so I don’t even know what the numbers are.

MRIs and the whole medical technology thing is another example. Canadians were incredibly slow to adopt this kind of cutting edge. Why? Because women don’t need MRIs! It’s a female health-care system. So, if you look at it that way… I don’t mean to sort of completely rag on the Canadian system. I think it’s good. I think it’s perfectly designed for feminine care.