Beyond Medicare-For-All: The Inequities Plaguing Women’s Healthcare Today
Gender and racial inequality are pervasive in healthcare. It’s time we talked about it.
Can we have a conversation about healthcare that goes beyond Medicare for All? Whenever I bring up women’s healthcare issues these days I’m told passing Medicare for All will fix that. Abortion access? Maternal mortality? Medical mistakes? Don’t worry, they say, Medicare for All will cover all of that.
This particular conversation is highlighted in the Kansas 3rd congressional primary. Sharice Davids is running to possibly be the first Native American woman in Congress (Deb Haaland is also running from New Mexico this year), but many people have declared one of her primary opponents, Brent Welder, as the more progressive choice. Their reason? Medicare for All is part of his platform. Sharice Davids’ healthcare platform includes specific policy to address maternal mortality as well as calling for fertility treatments to be covered by insurance. When I brought these policies up to someone advocating for Brent Welder, I was dismissed and told those policies wouldn’t be needed if we could just pass Medicare for All.
The discrepancy in healthcare for women isn’t just about insurance coverage. Access, diagnosis, high-quality care, and doctors believing us are all more difficult.
Let’s start with abortion access. I’m going to assume that when Medicare for All is passed the Hyde Amendment will have been repealed (meaning it’s legal for government funding to go towards abortion), so yay abortions are insured (also assuming abortion is still legal)! But wait…what about all the other anti-abortion laws currently limiting abortion in this country? TRAP laws (Targeted Regulations of Abortion Providers) make it almost impossible for abortion providers to stay open due to nuisance laws that put a heavy burden on providers. Waiting periods would also still be law. Waiting periods often require women to wait 72 hours between their first appointment and the abortion. This puts a heavy financial burden on women who have to travel far to reach their nearest abortion provider. Even if abortion is insured, waiting periods could still make access to one too expensive for many women. Women also must contend with crisis pregnancy centers which the Supreme Court recently ruled could lie to women about their healthcare options. What all this means is that Medicare for All will ensure abortions are affordable if (and this is a big if) women can access them.
The US currently has the highest maternal mortality rates of any developed country. The rates are high across income and insurance levels but highest among black mothers. White women also have high rates of maternal mortality in the US, but black mothers are three to four times more likely to die of pregnancy or delivery complications than white women. Maternal mortality rates are high for many reasons including the fact that doctors aren’t trained to listen to women enough and that protocols aren’t systematized. Serena Williams told the story of her doctor ignoring her distress leading to much worse complications and threatening her life after childbirth. Doctors need to be better trained in how to treat delivery complications, but they also need anti-racism training if we want to lower the rates of maternal mortality.
Women are much more likely to be misdiagnosed than men are. For example, The American College of Obstetricians and Gynecologists estimates that while endometriosis affects 1 in 10 women of reproductive age, it takes an average of 6 to 10 years for an accurate diagnosis after the first symptoms appear. Women are 50% more likely to be incorrectly diagnosed when they have heart disease even after a heart attack and are 30% more likely to be misdiagnosed after showing symptoms of a stroke. Finally, according to the National Pain Report, over 90% of women with chronic pain feel the healthcare system discriminates against them. Sexism (and racism) in medicine are causing years of misdiagnosis that lead to more pain, frustration, and unneeded advancement of diseases without treatment.
Most discussions of Medicare for All assume it will guarantee basic treatment. Without a clear plan in place for politicians to vote on we don’t know exactly what that means. How often will mammograms be covered? Pap-smears? Will all kinds of birth control be covered? Will fertility treatments be covered? What about having your tubes tied? Will the HPV vaccine be covered? How many concessions will we have to make to the so-called “morality” of Republicans to pass Medicare for All? What will be considered above basic treatment that we need to pay extra for? These things might very well be covered, but they won’t be unless we fight for them to be included.
Reforming the insurance system in the US so more people can be covered must be a priority but while fighting for that reform, we can’t forget about the healthcare issues that remain. We don’t know when we might be able to pass Medicare for All but in the meantime, we can fight to repeal the Hyde Amendment, pass bills to require specific protocols to address maternal mortality and force medical schools to train doctors to believe women. With the fear of Brett Kavanaugh being confirmed to the Supreme Court, we can’t assume Medicare for All will address abortion rights protections. Abortion insurance will mean nothing to poor women if the legality of abortion is left up to the states and access is denied for millions of women.