Why women need single payer

Gary Lapon looks at a new study that details the gender inequality built into the U.S. health care system.

"WOMEN AT Risk: Why Many Women Are Forgoing Needed Health Care," an issue brief released this month by the Commonwealth Fund, reveals the gender inequality of the U.S. health care system and illustrates the gross inability of the current private health insurance system to meet the needs of working-class women and men.

Although the study doesn't call for it, it provides further evidence for the compelling case for "everybody in, nobody out" single-payer health reform as necessary both to provide universal access to health care and as a blow against sexism.

Report authors Sheila Rustgi, Michelle Doty and Sara Collings begin by placing their findings in the context of an economic crisis where millions of workers are losing their jobs (and with it their employer-provided health insurance) while "health care costs are rising at a rate of more than 6 percent per year...increasingly, health insurance and access to care are falling further out of reach for many working families."

Women are disproportionately affected because on average they "require more health care services [than men] during their reproductive years" and "have higher out-of-pocket medical costs." Considering that women are paid about 76 cents for every dollar a man makes, they face the triple burden of requiring more care, paying more each time they access care,and relying on less income to cover these costs.

Disturbingly, "in 2007, more than three of five adult women under age 65 reported a problem paying medical bills, a cost-related problem getting health care, or both." And this data, from before the onset of the current economic crisis, is likely much worse today.

While U.S. Census Bureau data shows that some 47 million (nearly 16 percent) of U.S. residents are uninsured, the inclusion of the underinsured--those who have insurance but "incur out-of-pocket health care costs" such as co-pays and premiums "that are high relative to their income"--reveals that health care woes are spread across a much broader section of the population.

According to the "Women at Risk" report, 75 percent of adults with yearly household income under $20,000 and 60 percent of those with household income between $20,000 and $39,999 "had gaps in their insurance coverage or were underinsured...in 2007, 45 percent of women and 39 percent of men were underinsured or uninsured for a time in the past year."

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THE FINANCIAL burden of health care costs for the underinsured can be crushing, especially for those living paycheck to paycheck, and it's growing at a rapid rate. In 2007, 55 percent of women with household income under $20,000 spent at least 10 percent of their income on health care, up from 29 percent of those women in 2001, an increase of nearly 90 percent in just six years. The underinsured have coverage, but financial barriers mean they must at times go without needed care or choose between paying for care and other necessities such as food, rent, or debt payments.

According to the "Women at Risk" study, 67 percent of low-income women and 65 percent of moderate-income women responded "yes" when asked if, during 2007, because of cost they'd "not filled a prescription; skipped a medical test, treatment or follow-up visit recommended by a doctor; not visited a doctor or clinic when they had a medical problem; or did not get needed specialist care." Working-class men fare better, but still face a crisis situation: for men in the same income brackets, the percentages forgoing needed care are 57 percent and 52 percent, respectively.

Frequently, the un- and underinsured skip preventive care, such as cancer-screening: according to the Commonwealth report, "only 67 percent of underinsured women over the age of 50 received a mammogram in the past two years, compared with 85 percent of adequately insured women." Going without preventive care has tragic consequences: patients with treatable but dangerous diseases such as cancer and diabetes may go years without a diagnosis, only finding out about their condition when it's too late to prevent serious complications or even premature death.

According to Urban Institute findings based on Institute of Medicine methodology, 137,000 people died in the U.S. from 2000 to 2006 from a lack of health insurance. To put this in perspective, that is over 28 times the number of U.S. soldiers who've died in the wars in Iraq and Afghanistan, and 23,702 more than the number of U.S. residents murdered during those same six years.

The United States spends more on health care than any other country in the world, yet is the only advanced industrialized nation that does not provide universal access to care and of thousands of poor and working-class residents die each year as a result.

They die because health insurance giants maximize profits, which increased 170 percent from 2003-2007 to $12.6 billion for the industry leaders, by providing less care and passing more costs on to those who are insured, providing insufficient coverage to those who are underinsured, and refusing to cover those who cannot afford to pay enough in premiums for the insurance companies to make a profit.

Until the profit motive is removed and the insurance companies excluded by the introduction of a single-payer reform or system of socialized medicine, millions will continue to suffer from forgoing needed health care.

Proposed reforms that maintain a role for private insurance, such as the "health insurance mandate" reform (the Massachusetts model), under which everyone is required to purchase health insurance, even if they contain enough subsidies to insure everyone (and even in Massachusetts over 2 percent aren't covered) will amount to a massive public subsidy to the health insurance industry and fall short of providing universal health care.

As illustrated above, millions of the underinsured, those who have insurance but pay a prohibitively high percentage of their income in premiums and out-of-pocket costs, do not have access to the care they need. Having access to insurance is not the same as having access to care, and it is not enough to fill in the gaping cracks in the system.

Those who are oppressed and marginalized, such as low-income women, are more likely to fall through these cracks, or be "swept into them" (as described in Michael Moore's Sicko).

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REPRODUCTION IS one of the main reasons women as a whole require a greater amount of health care than men. Women must pay for birth control, abortion services, prenatal, maternity, and post-partum care (before during, and immediately after the time of birth), and other services associated with choosing whether or not to have children or ensuring the health of mother and child.

According to a 2007 Thomson report for the March of Dimes entitled "The Healthcare Costs of Having a Baby," for the insured, the average vaginal birth in 2004 cost $7,737 (inclusive of prenatal and other care) while the average Cesarean section cost $10,958, the overwhelming majority paid for by the insurance company.

However, for the uninsured and underinsured, disproportionately low-income women, these costs are prohibitive and can have a devastating impact on the health of the woman and child. According to Dr. Jennifer L. Howse, president of the March of Dimes, "it is well documented that a lack of prenatal care is associated with poor birth outcomes, including prematurity and low birth-weight, and high out-of-pocket expenditures may discourage women from obtaining the care they need."

Control over reproduction is essential to winning equality for women. Working-class women who cannot afford birth control or an abortion when they so desire, do not have full control over their bodies and therefore cannot enjoy equality with men.

Similarly, this control is denied women who would like to have children but are discouraged or go without proper care because they lack adequate health insurance and cannot afford the costs associated with the care necessary to minimize health risks to mother and child.

For working-class women especially and for the working class as a whole, health-care costs associated with reproduction are one of the ways the capitalist class passes the cost burden of raising the next generation of workers onto the working class. The capitalist class that wants workers to have more babies for the former to exploit for profits when the latter grow up, but would much rather the working class pay the costs and perform the unpaid labor to raise them.

The enactment of a system of universal health care, one that includes full funding for abortion (and a repeal of the Hyde Amendment restricting federal funding for abortion), would be a major victory for the women's rights movement, the labor movement (health care benefits are often used as a lever for employers to gain concessions from labor) and for the working class as a whole.

Today, according to a recent CBS/New York Times poll, 59 percent of Americans support government-provided national health insurance as opposed to 32 percent who think it should be left to the private sector. And numerous polls have shown that significant majorities of doctors support a single-payer system that eliminates the role of private health insurance.

Earlier this month, when nurses, doctors, and other "single-payer" advocates disrupted a Senate finance committee meeting on health care reform to ask why supporters of single-payer were not included and why committee chair Senator Max Baucus (D-Montana) refused to consider it, they were removed by police and arrested.

A government that would provide a seat at the table for health insurance executives who preside over a system that kills dozens every day by denying care, while arresting those who actually provide health care and speak for a majority of the population, is not going to pass single-payer unless pressured by a movement from below.

As Frederick Douglass wrote, "Without struggle, there is no progress." Supporters of women's and worker's rights should join the movement for single-payer health care, health care for all. Everybody in, nobody out!