Susan Feiner

(WOMENSENEWS)–So who’s got the most women-friendly health care plan?

Is it Hillary, Obama or Edwards?

Answer: none of the above.

Only Dennis Kucinich offers what women really need: single-payer, universal health care.

To the others I have one question: Why are you ignoring over 50 years of experience in our peer nations, which show that the public provision of health care delivers far better results at far lower costs?

The national disparities in women’s deaths between the United States and countries such as Canada, France and Germany are horrendous.

In the United States there are 77 female deaths from heart disease per 100,000 women, according to current World Health Organization data. In Germany that first key number is 68; in Canada 54; in France 21. For pulmonary disease the U.S. performance is even worse. The rate per 100,000 in the United States is 33; in Canada 13. In France and Germany it’s 7.

But universal health insurance does more than fight the diseases that afflict women. By extending better coverage and care to everyone it goes to the heart of women’s major inequity: our lower work-force participation due to the time we spend taking care of the preschoolers, sick kids, elderly parents and disabled spouses.

Women’s wages are often reported to be about 80 percent of men’s. But that figure seriously understates the actual loss of earnings due to gender and caretaking. The 2004 report “Still a Man’s Labor Market” by the Women’s Institute for Policy Research puts the gap closer to 60 percent.

But the proposals by the Big 3 will not stop women from being the ones to leave work–or not even attempt it at all–when the health care system breaks down.

Nice Features

All three plans have some nice features. All call for a ban on the insurer practice of “adverse risk selection,” which means enrolling healthy people and rejecting those more likely to require doctors, hospitals and medicine. All allow Medicare to negotiate for lower prescription drug prices.

But each plan shortchanges women in some similar ways.

For starters, each relies on tax credits to help people buy health insurance–the purchase of which will be mandatory–from existing private, mostly for-profit, insurers.

Do tax credits really help women, given that women earn considerably less than men? No. The value of tax credits decline as income falls so the more generous the tax credit the greater the benefit to the highest earners: men.

The trio of plans by Hillary, Obama and Edwards are also equally hard on women by requiring some level of out-of-pocket payments.

Even when women have insurance coverage their economic insecurity means they are more likely than men to economize on their medications and minimize follow-up treatment. All of this was first reported by the Kaiser Family Foundation and confirmed earlier this year by a study published in the Journal of the American Medical Association.

Caretakers Need a Real Break

The three private insurer-based plans are also identically stingy toward caretakers.

Some plans–Hillary’s and Edwards’–would cover respite care to help caregivers. Edwards offers up flextime, longer leave periods and paid leaves to help “parents” balance work and family.

Although well intentioned these policies reinforce the social expectation that women will be able to meet the daily needs of those who cannot help themselves.

If, for example, federal legislation required employers to grant flextime to help care for the elderly, our social expectations of women would mean that any one of them who didn’t use this option–who didn’t toss aside her paying job to assume this role–would be subject to criticism.

And the news media wouldn’t shy from broadcasting every report–however marginal or questionable its methodology–that showed how much better it is for the elderly to be in the care of a daughter than a professional attendant.

The U.S. health care crisis–which left 47 million uninsured in 2006–is driven by escalating costs, high co-payments, skyrocketing drug prices, minimal preventive care and over-hospitalization (combined, ironically, with such short stays that the families of discharged patients must learn advanced nursing skills overnight).

None of the Big 3 addresses the fundamental cause of this crisis, which is not consumer behavior, employer stinginess or insufficient competition.

Instead, the high costs are traceable to the for-profit organization of the medical-industrial complex.

One need not have an MBA–or even to have viewed Michael Moore’s diatribe against the U.S. system in “Sicko”–to know that insurance company profits rise with every claim that is denied, or delayed, delayed again and then processed incorrectly.

Eventually some customers give up thinking, “It’s only $25,” “It’s only $50” and “It’s only $1,000.”



Total Spending on Health as a % GDP

Total Spending on Health per capita

Public Expenditures on Health as a % of Total Health Spending

Female Life Expectancy at Age 65

Maternal and Infant Mortality
Deaths per
1,000 live births

Practicing Nurses per
1,000 population*

Female Respiratory Deaths per

















































Source: OECD Health Data 2007 – Version July 07.
All data for 2005 except as noted.

* 2004 data
** 2002 data
*** 2003 data

If you’re having trouble viewing the chart,click here.

Keeping Industry CEOs Happy

Multiply all those amounts by the millions currently covered by for-profit plans–and adding on the millions more who will be required to buy them if the Big 3 have their way–helps explain why CEOs in the medical-industrial complex should be pleased by the so-called reforms offered by our so-called leading progressive candidates. In August, Reuters reported that profits in the health care industry are expected to be the strongest in the economy.

As long ago as 1991, the General Accounting Office pointed out that if the United States adopted the Canadian model we could expect to save enough–by eliminating the costs of insurance, duplication and the insane nightmare of provider forms–to cover everyone who is uninsured.

A 2006 study funded by the Robert Wood Johnson Foundation and conducted by the Cambridge Medical Care Foundation found that administrative costs per capita were $1,059 in the United States versus $307 in Canada.

All the candidates–even progressive John Edwards–are also in denial about household purchasing power. The U.S. savings rate is negative because households spend more than they earn. What are people supposed to stop buying so they can pay for health insurance? Setting premiums as a percent of income is no help when many paychecks are fully committed.

The idea that people have a right to health care is hardly new, even in the United States.

President Franklin D. Roosevelt made the point in 1944.

For women–who tend to need more health care and to use it longer, who live longer and are poorer–it’s an important right that goes to the heart of our ability to close the gender wage gap.

The personal is still political. Tell the candidate of your choice that your vote depends on their support for universal, single-payer health care.

Susan Feiner is professor of women’s studies and economics at the University of Southern Maine in Portland.

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