Why single payer is best for women
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.