Universal Health Care: A Feminist Issue

Two great recent essays on why universal health care is a critical feminist issue. First, Natalie Shure:

One of the pervasive ways women are disadvantaged under the ACA is its reliance on employer-based coverage. In the United States, World War II–era wage freezes helped entrench a system of employer-provided health insurance, a perk meant to attract workers in a squeezed labor market.

Eventually, Medicare and Medicaid were devised as a safety net for those shut out of private plans, and the ACA expanded that safety net. Still, job-based plans remain the bedrock on which our insurance system is built.

Under this system, it’s harder for women to get health insurance in the first place. The strains of childrearing and elder care make women more likely to seek more flexible employment, like part-time, remote, or freelance work. These forms of employment tend not only to pay less, but are less likely to include health insurance benefits.

Those that do provide inferior ones: companies with majority-female workforces tend to offer less generous health-care coverage than those that are majority male. And less than one-third of low-income workers receive any health insurance through work. Jobs paying at or around the minimum wage are most often occupied by women, the majority of whom are women of color. Trans women face even higher levels of poverty than cis women, and are frequently saddled with impossibly high out of pocket costs.

Then there are the 25 percent of non-elderly adult women insured as dependents of a working spouse, which weakens their control over both their insurance coverage and their relationship. Health insurance has been found to be a common reason for getting married — and for staying married when one would rather not — especially among low-income people. Upon the loss of a spouse’s coverage, it’s difficult and expensive to continue receiving the same care. COBRA coverage — a program that allows people who lose employer-based insurance to remain on it, so long as they pony up the amount formerly contributed by employers — is often the only way to maintain provider networks, but it’s wildly expensive and eventually expires. Ultimately, divorce leaves some sixty-five thousand women uninsured each year, with men being far more likely to maintain coverage after their marriages dissolve.

Women’s unpaid domestic work puts further pressure on the contradictory demands of home, work, and the need to access coverage. Women disproportionately shoulder the responsibility of caring for others, putting them in an impossible situation when it comes to child and elder care: in order to maintain health insurance, they can’t take too much time off work. As a result, they’re forced to spend a significant portion of their wages on private care for the hours they’re on the job. For low-income women who don’t qualify for insurance through employers, the problem can be severe, made worse still by right-wing efforts to impose higher copays and out-of-home work requirements on Medicaid recipients, or to defund programs like CHIP that help parents pay for their children’s health insurance.

During particularly urgent health episodes, like childbirth or a relative’s protracted illness, women opt to take unpaid time off instead of risking their jobs. Notoriously, the United States is one of only a handful of countries that doesn’t guarantee paid maternity leave, exacerbating the financial stress of an already pricey phase of life. The Labor Department has found that nearly one-third of women who take unpaid time off for their own or dependents’ health issues fall into serious credit card debt.

And from a bit ago, Sarah Seltzer:

Bernie Sanders’ Medicare for All bill, introduced this month, and which is getting support from all the major Democratic contenders for the 2020 race, offers us all this chance—a moment to think expansively, to imagine something radically different.

It allows us to ask the big questions: If you had guaranteed access to decent health care, what would you do differently with your life? Would you become an entrepreneur? An artist? Go live on a farm? Have a baby sooner, or later? Work on that rock opera or science experiment you’ve been dreaming about?

Or just do exactly what you do now, but with a little less anxiety?

Medicare for All, as it’s called by Sanders, is really what’s known as a single-payer plan. As NPR explains‑it would phase in a single system by lowering the eligibility for an expanded version of Medicare every few years until everyone is covered. The plan as proposed isn’t expected to pass—and the question of how it will be paid for remains a big one—but at least it’s offering us something we need: a vision that could really change our lives.

Think about the major shift that happened for the generation who lived during the legalization of birth control, and then of abortion: they were suddenly able to pursue careers and adventures and plan for a family at the time that felt right to them. That revolution in reproductive health care made the same kind of sea-change for them that universal health coverage could do for women now. New ways to join the workforce. New chances for equal partnerships at home. The ability to really consider when and how and in what order they wanted to have kids.

Medicare for All would give a new generation a whole new level of freedom and opportunity; last time I checked, those are two ideas that are part of a very American ethos of taking charge of your destiny.

Health care untethered from or employers would give America’s women a chance to follow their dreams. Maybe that’s why it’s so threatening to some men in power—like the congressmen who questioned why men should have prenatal care included in their insurance plans.

Today, most of us rely on employer-based health care, which was fought for and won when a government-run health care proposal faltered in the 1940s—when many women were still expected to be totally dependent on their husbands. If you think about it, it makes no sense. Why should the suits who judge the quality of, say, your spreadsheets, your lesson plans, your PowerPoint presentations or your carpentry skills have power over whether or not you have health care? There is no really logical connection between these two things. It puts us all at the mercy of the companies that employ us, and that’s not exactly comforting in these volatile times.

There are both great essays making excellent points. I am more agnostic about whether something is “single payer” precisely, because I worry that massive moves toward universal health care will be opposed by some factions on the left if they don’t fall under what is considered single payer. There are many paths toward something that looks like universal care, as the many examples across Europe and Canada demonstrate. But the principle is wise. If you support feminism, you almost have to support universal health care. It’s so central to women’s autonomy over their bodies and lives that I struggle to see how one can be satisfied or really accepting of contemporary health care, even with the improvements of the ACA.