By Wendy Staebler. Originally published at Talking Points Memo.
Few women in America -- even among the wingnuts -- would disagree with Nancy Ratzan, who wrote the following article about gender discrimination in health care that appeared in The Miami Herald this morning:
What women need from healthcare reform" by Nancy Ratzan "With healthcare reform efforts reaching a critical stage, the stakes couldn't be higher for women. Women are the victims of a healthcare system that treats people badly at one point or another, but that treats women badly all the time. Women suffer the double blow of both legalized insurance discrimination and lack of affordable access to needed healthcare. According to the National Women's Law Center, seven in 10 women are either uninsured or underinsured, struggling to pay a medical bill or experiencing another cost-related problem in accessing needed care. More than half have been unable to get care because of cost. They haven't filled a prescription; they skipped a medical test; or they failed to see a doctor when they had a medical problem. The situation is most dire for African-American, Hispanic, and Native-American women, who suffer such problems two to three times as often as white women....
Women are less likely than men to qualify for their employer's insurance program, because they are more likely to work part-time and to have lower-wage jobs. Instead, since they are more likely to depend on their spouse's policy than men, they are more susceptible to losing insurance because of divorce or widowhood.
In 38 states, it is legal to discriminate on the basis of gender when selling insurance. Policies sold to women or their employers can cost 40 percent more than insurance for men -- even when maternity benefits are excluded. Currently permissible practices, such as denying coverage for pre-existing conditions or charging more for those with a history of health problems, disproportionately affect women, who are more likely to seek help from a doctor and to need ongoing care. One of the most egregious current practices allows insurance companies in eight states and the District of Columbia to deem domestic violence a ``pre-existing condition'' and deny coverage to its victims.
For women, healthcare reform must embrace principles and practices that will end gender discrimination and provide affordable quality healthcare for all, including access to the full range of reproductive health options. Tinkering around the edges and adding stopgaps won't be enough. Relying on the insurance industry alone to accomplish what it has been unable or unwilling to do for the last 50 years will only prolong an untenable situation.
New solutions must involve innovation and imagination, including creation of a public health insurance plan option to lower costs and ensure universal affordable coverage. Such an innovation has the support of three-quarters of Americans according to a recent SurveyUSA report -- a result that hasn't changed since 2003. A new poll published in the New England Journal of Medicine finds that 73 percent of all doctors favor a public option. Yet the public option is repeatedly dismissed out of hand in the back rooms on Capitol Hill, even by supposed moderates.
It's up to us to ensure that our elected representatives understand that half-measures won't do. The dire consequences of our patchwork healthcare system are both morally and fiscally indefensible. The 2006 estimate of ``excess deaths'' attributed to being uninsured was between 22,000 and 27,000 among all adults age 25-64. Our system's failures earned us a ranking of 35th among countries with a national healthcare system, while we pay the most for poorer results.
Discrimination against women must be rooted out, and we must insist on a public option. Only then will all of us enjoy a standard of health care that Congress itself takes for granted."
I would add to those points Ms. Ratzan made that health care concerns for women are not only questions of accessibility and cost, but also the quality of care provided once inside the examining room and/or hospital door.
So engrained is the prejudicial, and therefore dangerous Freudian idea that women are "hysterical" that all of us could list dozens of instances in which -- regardless of ethnic or educational background -- the health issues of women were dismissed as psychosomatic. Conditions which later proved to be, among other things, herniated discs, a heart attack and fatal ovarian, bladder and kidney cancers.
But the gender bias does not stop there. Treatments, as well as observations made during them, can reflect engrained prejudices and therefore become abusive. Many of these abuses are definitely gender-specific in that they are age and appearance related. The elderly neighbor I cited with herniated discs -- the who had been telling her neighbors and friends that she was in so much pain she had not been able to sit or stand or lie down comfortably for days -- was actually accused by the male resident on duty in the ER as being nothing more than "an addict seeking painkillers." She was sent home without a proper diagnosis and without any pain relief; she alleged, later, that the resident had " alerted the authorities" (I don't know what authorities) that her name should be added to a list (I don't know what list) of potential drug abusers. When taken to task for his behavior by my neighbor's daughter, his initial response was: "Well, sorry. But we all know that women of that generation are prone to be pill poppers."
At the opposite end of the age spectrum, another neighbor -- a young, attractive woman -- learned, much later, that she had suffered nerve damage during uterine surgery for fibroids -- damage that was so severe that it created permanent red/ purple patches on her inner thighs. Nonetheless, she was told by her surgeon in a follow-up exam that "it must be an outbreak of Herpes." Despite the fact that the young woman swore she did not have, nor had she ever had Herpes and invited the surgeon to check with her Ob/Gyn, the surgeon insisted he was correct. So one is left to surmise that either the surgeon was attempting to cover his tracks, in the literal sense, or he made snap judgments based on her age and appearance.
Gender bias is an important point that has not been part of the healthcare reform discussion. For reform to be meaningful to women, it must include reforms in attitude as well as in accessibility and cost.