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Excerpts from Ourselves Growing Older
WOMEN’S REFORM PROPOSALS
Despite lack of funding to oppose the messages of the special-interest groups and the media, women’s health activists and groups are mobilizing to bring the health-reform message to a wide diversity of women’s groups across the country. They are calling for some basic reforms in women’s own health- and medical-care benefits, such as:20
Beyond demands for comprehensive and particular benefits and services for women, many women are also calling for other specific system reforms, such as:
- Comprehensive benefits:reproductive/gynecological/childbearing, occupational/environmental, mental, dental, long-term care
- No links to welfare employment, income or health status.
- Preventive health services, periodic checkups, health promotion for women’s health needs—not just treatment
- Access to midlevel practitioners (midwives, nurses) and other health practitioners—not just doctors
- Primary care, especially care designed for women
- Community-based services near home
- Power in the hands of community women
- More training, upgrading and pay equity for women health workers
- Coverage of services, special treatment needs of HIV-positive and substance abusing pregnant women
Women’s groups are not simply looking out for their own health in any reform proposals. They are interested not only in issues of cost and financing mechanisms, access and insurance coverage, quality of care and services, and women’s health research. Women are also concerned about many other needs for change in the whole system. These include:
- Recognition of women’s unpaid labor as health workers in community, family, and home (income-tax credits or Social Security credits, respite services)
- Better quality, unbiased women’s health information
- Recognition of patients’ and consumers’ rights and roles, especially women’s, in system planning and decision making
- Specific mechanisms of accountability of the system to its users at all levels
- Redress when the system fails or damages us
- Universal access and equity
- Elimination of all existing insurance discrimination against women
- Choice of providers
- A single-payer system
- Global budgeting
- Rigorous elimination of waste, fraud, and excess administrative activity
- Fiscal control if a fee-for-service system is continued
- The training and retraining of health professionals in the economic/cultural/psychological and race/gender/age determinants of health
- Better technology assessment and feedback of results
- More investment in evaluation research
- A health-planning system (such as existed in the 1970s)
- Clinical practice standards, reviewed by consumers
- Controls on the drug industry
- More community settings and community-based services
- Improved investment in and recognition of our public health system of services (not only for poor people); better monitoring of health status21
- An independent ombudsprogram to guarantee fair adjudication of complaints and claims
- Recognition of violence against women and elder abuse as public health issues (not only as family/mental health/social service concerns)
- Long-term care, rehabilitation and disability services
- Coverage of necessary drugs
- Research on appropriate elements of primary care for women
- Home-care services, including birthing and hospice
Many of us depend on mainstream media like television and daily newspapers for our understanding of both women’s health issues and the key points of the health-reform debate. Many conscientious reporters and editors work hard to provide documented facts and thorough analyses; some television producers have also tried to offer discussions that illuminate the nature of the debate. Without them, our understanding of these very complicated issues would be much poorer.
The health industry’s special-interest groups have influence in Congress, and influence over the media. We need to know exactly how they are likely to shape decisively any new federal system, if and when it ever becomes law, despite what the people may want. We also need to know that the media are often careless about identifying whether invited spokespeople and "experts" represent special health-industry interests or special political interests rather than the public interest. Reporters sometimes quote study outcomes or results of polls without explaining how these were conducted or who paid for them. Conflicting poll results are sometimes ignored.
Among the media’s most pervasive biases, however, has been the failure to question the profit motive in health and medical care at all. They have failed to emphasize sufficiently how the health industries spectacular rise in PAC (political action committee—see "Reformspeak" box) donations will influence key members of Congress in coming debates and votes. Recipients of large PAC donations will be expected to favor these industries’ preferences and work against progressive legislation. (see PAC box)
In addition, the media do not advocate for the public and consumers to have a large and important decision-making and oversight role in such a massive change as national health reform. Media focus on the malpractice issue tends to be dominated by the viewpoint of physician groups, and distorted by a few reports of large jury awards. The media have also virtually ignored women’s central and unique place in the entire health- and medical-care system, women’s long history of activism and analysis in health reform, and their key stake in progressive change.1
The single-payer option (see "Reformspeak" box) for health reform is rarely mentioned in the news except as something we will not get, even though the government’s own fiscal management and budget experts have made it very clear that this system would save the most money for the urgent task of increasing access.2 Articles critical of the Canadian and other government sponsored systems abound.3 Well-packaged, well placed materials from the special interest groups are always available for reporters. Often media researchers don’t take time to follow up on the viewpoints of reform-movement groups working for the public interest. To learn about other views, the public has to consult public television and radio, and be on the lookout for literature other than daily newspapers and weekly news magazines.
Partly as a result of the media’s focus, many Americans have been persuaded to fear progressive reforms, believing they will lose access to "the best" of care.4 Hostility toward the older generation’s entitlement "privileges" and cost of care is also beginning to rise.5 Few even question why we cannot provide benefits for all ages, as other countries manage to do for so much less cost. We must challenge these assumptions. (See Box, "What One Woman Can Do About Health and Medical Reform")
|1. An extensive search of both the scientific and "lay" literature in Mid-1992 revealed almost no material connecting the idea "Women" with the idea "Health Reform." Search conducted by librarian at the request of the author, Norma M. Swenson, at the Countway Medical Library in Boston, and by the same author at the Newton Public Library, spring 1992.|
2. Robert Reischauer, testimony before the Committee on Ways and Means, U.S. House of Representatives, October 11, 1991. Also, the Office of Management and Budget (OMB) produced similar estimates of savings.
3. Jennifer Brundin, "How the U.S. Press Covers the Canadian Health Care System." International Journal of Health Services, Vol. 23, No. 2 (1993), pp.275-77.
4. Erik Eckholm, " Those Who Pay Health Costs Think About Drawing Lines." The New York Times, Mar. 28, 1993, pp. 1, 3.
5. Robert P. Hey, "Entitlements Under Fire, but No Big Changes Now." AARP Bulletin, Vol. 33, No. 11 (December 1992), pp. 1, 5.
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