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OTI Online
Winter 2009

Health Care ‘Reform’ Is Not Enough
by Susan Yanow

We asked leading thinkers to describe New Revolutions We Need for a feminist and progressive future. Here's one response.


At a conference on women's health care needs in fall 2008, a woman whom Ill identify as Marcia said: "Massachusetts requires me to buy health insurance. I had an ovarian cyst and some other health issues last year and the high co-pays for doctors visits, surgery, and medications left me so deep in debt that I had to declare personal bankruptcy. And every month, I still have to pay the health insurance bill."

Marcia's story is one of many, and illustrates how, despite healthcare reform adopted in Massachusetts, much more needs to be done to address the health concerns of women.Most current health care reform initiatives, including those of Barack Obama, focus on providing wider access to health insurance. They do little to address the underlying problems with our health care system.

Our existing system allows insurance companies to decide who gets care, what kind of provider we can use and what services will be covered. The basis for these decisions is to create financial profit, not to create health.

Additionally, many insurers make decisions about what will be covered based on moral values. As a result, many will not cover abortion and coverage of contraception had to be mandated by the states in many cases. Insurance companies run by the government also set limits based on political motivations. For example, the Hyde Amendment, passed by Congress in 1976 and renewed each year, bans the use of federal Medicaid funds for abortion care. (Although 17 states allow state Medicaid funds to cover abortion, even in these states many women are denied coverage: federal employees, including the military, women in the Indian Health Service and women in prison.)

Our Current System Is Not Healthy

Our insurance-driven health system is rife with problems. Five top problem areas for women are:

1. Overhead Costs Deplete Funds for Services: Billing for insurance and supporting insurance companies overhead eats our health dollars. A significant part of the money that is put into the system by individuals, employers and the government goes to support insurance companies and high-priced hospital executives. For example, in 1999, U.S. private insurers retained $46.9 billion of the $401.2 billion they collected in premiums. Their average overhead (11.7 percent) exceeded that of Medicare (3.6 percent) and Medicaid (6.8 percent), according to a study on the costs of health care administration published in the New England Journal of Medicine in 2003.

If the United States had a single-payer system with administrative costs similar to Medicaid, $20 billion health care dollars per year would be saved and could be redirected into services.

2. Hospitals Are Driven By The Bottom Line: Hospitals negotiate directly with insurance companies or have well-paid lobbyists who advocate for set rates, resulting in an abundance of highly specialized services that are well-reimbursed, while preventative services are under-reimbursed. There is a growing shortage of primary care physicians, who provide the preventive services that keep us healthy.

The astronomical cost of medical education and training is driving future physicians out of primary care and geriatrics, which are lower paid, and into specialties that will pay back their investments in their education. This system contributes to rising health care costs, which means rising health insurance premiums and co-pays that many Americans simply cant afford.

I am skipping the $400/month injections recommended by my doctor to treat my endometriosis. Instead Im taking hormones. They are less expensive but have harsher side effects Im losing my hair- but I cant afford to exceed the $1500 cap on prescription drugs in my student health plan, Heather Knauer told a Boston Globe reporter in December 2008

3. Malpractice Policies Drive Healthcare Decisions: Fear of a lawsuit contaminates physicians decision-making. For example, the United States has one of the worlds highest rates of C-section births, both because it is easier to train physicians in the skill of surgery rather than the art of birth, and because doctors fear the malpractice claims that can come with a difficult vaginal delivery. Some doctors are leaving obstetrics and gynecology altogether because of high premiums. If women want a range of birth options that include the possibility of using a midwife or home birth, the malpractice system will need to be overhauled.

4. Hospitals With Religious Agendas Restrict Services: Approximately 18 percent of all hospitals and 20 percent of all hospital beds are owned or controlled by the Catholic church. These hospitals have broad restrictions on the types of services provided to women. They routinely deny the provision of abortion, contraceptive services, infertility treatments and patient-directed end-of-life care, although they receive as much public funding as do nondenominational hospitals.

5. Healthiness Is Not A Central Value: Our health care system is focused on treating disease, not on keeping people healthy. Half of all American adults do not receive recommended preventive care, including vaccinations, blood-pressure checks and cancer screenings. The U.S. rate of preventable deaths ranks at the bottom among industrialized nations.

Creating A Future For Womens Health

Revolutionizing our health care system is complex yet critical. Our starting place must be a proactive and comprehensive vision of what we women need from a healthcare system.

What does a vision of womens health care look like? To start with, our vision recognizes the basic human right to quality healthcare for all individuals and families. This right must not be dependent on employment status and cannot be denied based on a pre-existing health condition or religiously-imposed moral values.

It includes holistic preventive services including dental health care, mental health care, alternative therapies, and the option to choose the type of provider we feel can best care for us, such as midwives. A comprehensive health care system would provide services that are culturally competent, establish quality standards that ensure timely access to needed services and work to eliminate the current pervasive racial disparities in health outcomes.
It would also include support services for women who are caring for sick children, partners and parents.

Preventive services would be a priority, and those who provide these services, whether in the home, clinic or hospital, would be fairly reimbursed. We would be able to choose midwives or obstetricians, hospital or in-home births. The health care system we need would allow us to make choices about end-of-life care, including hospice and home services. And of course, womens health care must ensure the provision of the full range of reproductive health services, explicitly including abortion and contraceptive services.

Health on the Activist Agenda

Women must mobilize to make sure that we are at the table when health care reform is being discussed at the local, state and national levels, or our issues will be off the table. The many powerful forces involved in the current debate, including the Catholic Health Association, the pharmaceutical company lobbyists and the insurance companies, do not make womens issues a priority.

The work of bringing reproductive health activists and health care reform activists together as a force for change has been started by groups like Raising Womens Voices (RWV) In the proud tradition of Our Bodies Ourselves and the National Black Womens Health Project, Raising Womens Voices is a grassroots efforts working to transform our health care system so that it meets OUR needs.

As a reproductive rights activist, I call on everyone who cares about womens health to come together in this effort. There will be major changes to the health care system in the coming years. Abortion and contraception will be bargained away unless we are an organized presence in the health care debates. Women have transformed the way the health care system responds to breast cancer, to domestic violence and so much more. Now we must mobilize to change the system itself.


Susan Yanow, MSW - A long-time reproductive rights activist, Ms. Yanow is the founding Executive Director of the Abortion Access Project. Ms. Yanow is currently a consultant to a number of reproductive rights and health organizations, including the Advancing New Standards in Reproductive Health (ANSIRH) program at the Dept. of Ob/Gyn at UCSF, Planned Parenthood New York City, the Reproductive Health Access Project (RHAP), and Women on Web. She has also consulted to the Byllye Avery Institute for Social Change, the International Consortium on Medical Abortion (ICMA), and SisterSong.

Also see: Theater Arts: A Menace to Society by Alexis Greene in this edition of On The Issues Magazine.

See In the U.S., AIDS Spreads Rapid-FireAnd Crosses the Gender Divide by Molly Ginty in the Spring 2008 edition of On The Issues Magazine

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