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The Politics of Women's Health

Our Bodies Ourselves Endorses Single Payer Health Care

June 15, 2009

Summary: Single-payer healthcare plans offer the best chance to reduce payment incentives that lead to overuse and misuse of drugs and medical procedures, which translates into an enormous problem for women of all ages. With resources better allocated and women's needs more effectively addressed, a single-payer plan would improve women's health more than any other system under consideration.

Our Bodies Ourselves supports the single-payer model as the most effective approach for solving the United States' health and medical care crisis.

The single-payer model creates a system that will best control costs, thus allowing existing resources to be allocated most equitably. First, it eliminates the $300-400 billion insurance companies spend on administrative overhead and waste. Second, it is best positioned to take on the enormous challenge of reducing or eliminating financial incentives that have led to both over-treatment and under-treatment.

Maternity care illustrates this phenomenon: We spend far more per capita than any other industrialized nation and yet do worse on many key indicators of maternal and newborn health.

So-called best practices – medical practices demonstrated to improve outcomes – are well-documented (e.g., "Evidence-Based Maternity Care: What It Is and What We Can Achieve," co-published by Childbirth Connection, the Reforming States Group, and the Milbank Memorial Fund). But they are not widely implemented in many care settings, even though doing so would lower costs and improve the health of mothers and babies.

For example, despite the World Health Organization’s recommendation of optimal cesarean section rates between 5% and 15%, nearly one-third of all women in the U.S. deliver their babies by cesarean section. One of the reasons is that most obstetricians and hospitals are paid more for a surgical delivery than for a vaginal birth. One national estimate found that in 2004, on average, hospitals got $2,090 more and health professionals got $723 more for a cesarean delivery.1  Such incentives not only raise costs, but ironically often produce worse health outcomes as more healthy women experience the risks of surgery without any benefits.

By reducing the ability of for-profit companies to siphon off huge sums of money for private gain, a single payer system is better able to expand best practices. The motivations to over-treat those who are well-insured, and to under-treat those with limited or no insurance coverage, will no longer be built into the medical care system.   

Why Single Payer is the Best Option for Women

Women in particular have much to gain from single-payer health care -- and not just because there are many areas where women experience the harms of both excessive and inadequate treatment.

Our country has an excess of medical specialists and is in desperate need of more primary care clinicians -- such as general internists, family practice physicians, physician assistants, nurse practitioners and licensed midwives -- who are often more aptly trained than specialists to provide the comprehensive services women need. A single-payer plan would eliminate the financial incentives that have been obstacles to investing in training more primary care professionals.

Here are other specific advantages of a single-payer system: 

The only national plan for health care reform that explicitly includes women's reproductive health services, including abortion, is HR-3000, sponsored by Rep. Barbara Lee (D-CA). Other sponsors of single-payer plans are also amenable to altering their language to be more explicit about women's reproductive health services.

Coverage is independent from employment. Because women are more likely to be self-employed, to work part-time, and to move in and out of employment outside the home (to reserve flexible schedules for family care-taking), they are now more likely either to lack coverage through work or to lose insurance when changing jobs. Should a plan with a “public insurance option” be passed by Congress and ultimately fail, women will be hit harder.

Coverage is independent from marriage. When their only option for health care coverage is through their spouse, women face additional risks for becoming uninsured as a result of divorce or a spouse's loss of employment. Again, should a plan with a “public insurance option” be passed by Congress and ultimately not work, women will be hit harder.

Single-payer system would encourage better care for chronic illnesses. Women utilize chronic care services far more than men. Because caring for people with chronic disease now accounts for more than 75% of all health care spending, women will benefit substantially from more efficient and effective ways to deal with severe chronic illnesses.

A third of Medicare dollars each year are now spent on chronically ill patients during their last two years of life. Alternative approaches to end-of-life care, such as hospice, work better for most people than expensive, hospital-based treatments. Numerous studies show that hospitals that treat patients more intensively and spend more Medicare dollars do not achieve better results. Only a system that eliminates the current financial incentives would encourage and promote these approaches.

Single-payer system would eliminate the need for Medicaid. Women who are unemployed and have functional limitations that exclude them from the private health insurance market would receive health and medical care on a par with women in general.

The percentage of women covered by Medicaid is higher than that for men for all levels of disability. Care available with Medicaid funding is now substandard in terms of access, quality and its bias toward funding institutionalization instead of home-based services. It also carries with it strict income eligibility requirements that force recipients to maintain their status as unemployed and live in poverty or else risk losing health care coverage altogether.

Single-payer system would address the cost issues that send women into debt and bankruptcy. Medical debt is an enormous concern for many women. A 2009 Commonwealth Fund study found that 45% of women accrued medical debt or reported problems with medical bills in 2007 compared to 36% of men.

Under one single-payer bill introduced to Congress (HR 676), a family of four making the median income of $56,200 would pay about $2,700 in payroll tax for all health care costs. There would be no deductibles, no co-pays, and no worrying about catastrophic coverage.

Single-payer system would reduce the number of medical malpractice lawsuits. Because people would not have to worry about paying for medical care whenever they experienced bad medical outcomes, they would be less likely to sue for compensation.

Single-payer system would enhance the working environment for health care professionals. There would be less need to spend hours on pointless documentation in order to justify billing for services.

A Public Insurance Option is Not Enough

Although many progressive members of Congress now support a proposal that includes a "public insurance option" as an alternative to private insurance industry plans, numerous critiques demonstrate how this approach could fail.

Unless designed to mirror the effective Medicare system -- by automatically enrolling the majority of the population and using Medicare's cost control levers -- the public option will not be affordable for all. And this approach foregoes at least 84% (more than $300 billion per year) of the administrative savings available through single payer.

It is unclear if regulation of the private insurance industry could ever be effective enough to avoid the ultimate demise of the public health insurance option. As Dr. David Himmelstein and Dr. Steffie Woolhandler wrote (3/26/09):

"A quarter century of experience with public/private competition in the Medicare program demonstrates that the private plans will not allow a level playing field. Despite strict regulation, private insurers have successfully cherry picked healthier seniors, and have exploited regional health spending differences to their advantage. They have progressively undermined the public plan -- which started as the single payer for seniors and has now become a funding mechanism for HMOs -- and a place to dump the unprofitably ill. A public plan option does not lead toward single payer, but toward the segregation of patients -- with profitable ones in private plans and unprofitable ones in the public plan."

Support Grows for Single Payer

A growing chorus of voices is now rising from the ranks of physicians, a majority of whom have repeatedly indicated their preference for a single-payer system in numerous surveys and polls.

These individuals on the front-lines will be harder to ignore, especially as the media provide more in-depth and accurate coverage of single-payer proposals. Recent examples include discussions on "Bill Moyers Journal" (PBS, 5/22/09) and "The Diane Rehm Show" (NPR, 5/18/09); Dr. Marcia Angell's Boston Globe op-ed (5/23/09); and Victor R. Fuch's "Perspective" in the New England Journal of Medicine (5/28/09).

Other signs support for single payer is building:

  • Following a recent meeting with single-payer advocates, Senate Finance Committee Chair Max Baucus admitted that he was wrong to exclude single payer from full hearings. A vocal citizenry can make a difference.

  • A new report from the National Economic and Social Rights Initiative, "A Human Rights Assessment of Single Payer Plans" (pdf), makes a strong case for how specific single-payer proposals would both vastly increase equitable access to high-quality care as well as secure long-term financial sustainability.

  • Polls indicate that a substantial majority of Americans would support a universal health insurance system based on Medicare. For example, a 2007 AP-Yahoo poll asked respondents whether they agreed with this statement: "The United States should adopt a universal health insurance program in which everyone is covered under a program like Medicare that is run by the government and financed by taxpayers." A whopping 65 percent said yes to that question. By political standards, this is a landslide.

That this option has been so categorically rejected or ignored by most legislators in Washington, when the majority of the public clearly supports this approach, is reflective of a weakened democratic process that should be great cause for concern.

Take Action

We must remember that we already pay for national health insurance -- we just do not get it. Single payer deserves serious consideration, and we must insist that Congress get the Congressional Budget Office to analyze the cost of HR 676, the single-payer bill introduced by Rep. John Conyers. Visit Physicians for a National Health Program for immediate actions you can take.

Concerned citizens may lack the resources to oppose powerful and well-funded insurance industry interests, but we must at least raise our voices and be heard. Join us in keeping apprised of the latest developments. Single Payer Action is a good source for updates.

Additional Reading


1.  Sakala, C and Maureen Corry. The Milbank Report: Evidence-Based Maternity Care: What It Is and What It Can Achieve. The Milbank Memorial Fund, 2008, p. 14. Available online at http://www.milbank.org/reports/0809MaternityCare/0809MaternityCare.html. [back to text]

Written by: Our Bodies Ourselves
Last revised: June 15, 2009

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