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Midlife and Menopause

Reforming the Health Care System

With the skyrocketing costs of our medical care, limited medical insurance coverage, disparities in health care services, and discriminating attitudes, our health care system is in crisis and needs reform. The debate centers on whether government should provide universal health insurance for all (called a single-payer system); employers should offer insurance as a benefit, with private insurance companies continuing to manage the cost of care through market-based competition; or individuals should be left to choose their own health care and insurance and bear most of the burden of paying for it themselves. Market competition and employer-based health insurance are not more cost-effective than government-funded insurance. The rhetoric of choice in the marketplace masks the reality that many people, including many women at midlife, have no realistic options to pay for health care. The current U.S. system seems to be leading to higher costs, huge discrepancies between rich and poor, and lower-quality health care.17

Universal health insurance could lower health care costs.18 We would no longer have to depend on our work status or our savings for insurance, and we could have continuous access to health care, whether we change jobs, work for small companies, take time off for caregiving, work part-time or at home, or are unemployed. The savings could exceed $200 billion a year, far more than the cost of covering all the uninsured.19 Although a 2003 poll showed that two-thirds of the public is in favor of the U.S. government guaranteeing medical insurance for all citizens,20 the power and organization of the medical establishment, the private insurance industry, and drug companies together have thus far successfully opposed reform. Local, state, and federal legislators continue to propose single-payer laws that would be financed like Medicare. Indeed, the Medicare program offers a model that could be expanded into a national health insurance system.

Universal single-payer coverage is probably not going to happen right away, but there are some improvements that could be made right now. Increased coverage could be offered through employer-based insurance, including job-based coverage for part-time workers. Medicaid eligibility requirements could be broadened on the state and federal level to cover women with earnings up to 200 percent of poverty level. Medicare could offer buy-ins for uninsured women ages fifty-five to sixty-four (13 percent of uninsured women). Hospitals and doctors could accept payments from uninsured patients on a sliding scale adjusted to income.  The states could subsidize health insurance plans that would cover basic care, at rates that working people who earn too much to qualify for Medicaid could afford, or the states could set up programs to cover the uninsured.

Women's health care activists have developed a list of features required for health-care reform policy to reduce disparities in increased access to all: 23


  • Finance health care through government insurance to achieve universal coverage.

  • Control costs through streamlined administration, elimination of profits, control over fraud and advertising, and price limits on health-care providers.

  • Reduce profits on prescription drugs and focus drug industry research on new treatments instead of profitable copies of existing drugs.

Fair treatment

  • Eliminate discrimination against women and all populations confronting geographic, physical, cultural, language, and other barriers to service.


  • Involve health care users, women, and communities in administration and policy decision making in health care administration and policy making.

  • Guarantee provider accountability and the right to sue for grievances.

  • Assure confidentiality of medical records.

  • Establish our right of ownership over our genetic material and control over who has access to our genetic information.

Comprehensive benefits

  • Provide a package responsive to women’s needs, including coverage for wellness visits, gynecological/reproductive health, occupational and environmental health, prescription drugs, mental health, dental care, and long-term care.

Effective planning

  • Require consumer participation with ongoing evaluation and planning of the delivery of health services.

  • Support for public health

  • Invest in and recognize public health programs.

High quality of care

  • Improve the quality of medical care for all of us.

  • Train health professionals in the economic, cultural, psychological, and social (race/gen-der/age, etc.) determinants of health and effective caregiving for different populations.

  • Assess and evaluate medical technology and make results available to the public.

  • Provide access to high-quality, unbiased women’s health information.

Support for health care workers

  • Support education, training, employment, and promotion of professional and other health care workers. Assure advancement of female workers and clinicians who represent diverse communities and provide quality care at all levels.

Social/economic policies

  • Direct health institutes to research and implement social and economic policies that improve women’s health, including protection of occupational safety and health.

End of excerpt
Excerpted from Chapter 20: The Politics of Women's Health in
Our Bodies, Ourselves: Menopause  © 2006 Boston Women's Health Book Collective


17. NIH State-of-the-Science Panel, "National Institutes of Health State-of-the-Science Conference Statement: Management of Menopause-Related Symptoms." Annals of Internal Medicine 142 (2005):1003. [back to text]

18. Sherry Sherman, Heather Miller, Lata Nerukar, and Isaac Schiff, "Research Opportunities for Reducing the Burden of Menopause-Related Symptoms." American Journal of Medicine (in press). [back to text]

19. Gerard F. Anderson, Peter S. Hussey, Bianca K. Frogner, and Hugh R. Waters," Health Spending in the United States and the Rest of the World," Health Affairs 24, no. 4 (July/August 2005):912. [back to text]

20. Kenneth E. Thorpe, "Impacts of Health Care Reform: Projections of Costs and Savings, " National Coalition on Health Care, 2005. [back to text]

23. Boston Women's Health Collective, Our Bodies, Ourselves: A New Edition for a New Era (New York: Simon & Schuster, 2005), 728-29. [back to text]

Excerpted from Our Bodies, Ourselves: Menopause, © 2006, Boston Women's Health Book Collective.

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