The Elephant in the Room

I, like many women, and perhaps like physicians in general, am averse to political activism. Medical problems have, or we are taught to think they have, right answers. Controversy and disagreement are uncomfortable to us, implying that our judgment or knowledge is somehow at fault. Even the formal exercise of an M and M conference does not help us recognize and accept legitimate differences; at the end of the disagreement, the pathologist is there to provide the single right answer. And as women, we want to make others feel accepted and comfortable. So I am reluctant to take a political position in this blog. Some of my best friends, etc....

I am not about to rant on either candidate, but I do want to share my dismay at some of the health care issues that are going to be affected by the outcome of the next election. A friend of mine in Hawaii wrote to me that blue cross/blue shield in her state requires women to pay higher premiums than men--and gets away with it! Yes, women have expenses related to reproductive care that men don't, and yes, we live longer. But the whole idea of health insurance is to spread risk fairly through a population. Differential pricing by gender implies that men are the true representatives of the population and women somehow deviant from the norm (despite being an absolute majority). This stands the very edifice of health insurance on its head.

Beyond reproductive health care services like abortion and contraception, adequate insurance for the elderly, including nursing and other support services, are also "women's issues." When insurance fails to cover services, it is typically women--wives and daughters--who pick up the responsibilties of caregiving. When insurance does not pay for services for children, it is mothers who step in fill the vacuum. Now that women are more productive in work outside the home, the economic costs of us having to cut back our own work to become caregivers are huge, and rarely acknowledged.

The underlying problem is one of state/federal conflict, not necessarily Democratic/Republican differences. The regulation of private health insurance is a state rather than a federal function. Many insurance companies have budgets--and therefore political clout--larger than the state governments that regulate them. Only the federal government is large enough and strong enough to rein in the rogue health insurance industry. Personalities and records aside, this mother in medicine is going to vote for the candidate who believes in using the power of government to regulate crucial service institutions directly, not through byzantine manipulations of the tax code. Three guesses as to who that will be.