Health Care "Reform" Is Not Enough
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.
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