Women’s Double Healthcare Jeopardy

North Texas DSA at the Dallas women’s march, January 2018.

There are two competing realities in U.S. life today: (1) Our economic system is rigged to create extreme inequality and relegates almost all goods to the private market and (2) leading a dignified life depends on being able to buy those goods in the private market. Of course, not everyone can afford a dignified, much less a “good” life. What to do about inequality is the central question of contemporary politics. The conservative attitude is that poverty is the result of individual failures. Others, from liberals to leftists, address different aspects of the economic system to make it fairer, such as increasing workers’ buying power through minimum-wage laws or shifting certain necessities from the private to the public sector to defray costs for people who can’t procure them through the market. How a given society manages these issues determines the amount of pain it can levy against those who aren’t part of the ruling class.

In the United States, our meager social safety net provides only marginal protections against poverty, which we tolerate at a rate far higher than those of other industrialized countries. That also makes it a fabulous place to be rich: unlike other comparable countries, the United States does not fund robust universal entitlements through progressive taxation. If capitalism forces all workers to sell their labor to survive, so too does it oppress marginalized people by valuing their labor less. The result is that people of color, disabled people, gender-nonconforming people, undocumented people, and others are disproportionately less able to procure safety and security on an individual basis.

Women and Unpaid Labor

Also individualized are the demands of unpaid domestic labor, which disproportionately fall to women. With no public entitlement to childcare or eldercare, women often must make their own arrangements—either paying for such services or taking them on themselves and forfeiting the flexibility to perform paid work. This unpaid labor is a major reason for the so-called gender and racial “wage gap.” The lack of public relief available for domestic duties, combined with a safety net that is mostly accessible only through traditional full-time employment, creates a bind for women: they’re pushed to balance wage work with care roles and thus often end up in part-time or freelance jobs that provide few benefits. This dynamic has disastrous implications for their healthcare in particular: without employer-sponsored health insurance, women are perhaps insured as dependents through spouses or parents, which gives them less control over their own lives.

Others are poor enough to qualify for Medicaid, whose blocked expansion in several GOP-controlled states disproportionately harms women, who also stand to be harmed by new legislation imposing stringent work requirements that impose heavy taxes on recipients’ time (a luxury that low-income mothers do not have). For those women forced to buy coverage on the Affordable Care Act exchanges, high levels of cost-sharing mean they may not even be able to use the care they’re entitled to. Those who can afford the co-pays may still be left without coverage for reproductive care such as birth control or abortion.

High co-pays and deductibles mean that even people with insurance coverage have high out-of-pocket payments. U.S. healthcare shifts disproportionate costs onto those who use care. This group is often referred to as “the sick,” but contains within it women, whose bodies tend to yield higher profits than men’s in our highly commodified system. Maternity care and childbirth are among the most common reasons for hospitalization or treatment, gender-affirming care for trans women is expensive and often uncovered, and oppressed women are particularly vulnerable to poverty and its accompanying health effects. Women of color and disabled women are even less likely than white women to have any paid time off from paid work to fulfill health or care needs. Finally, women live longer than men, spending years on a fixed income during the phase of their lives when care is most expensive, leaving them open to critical gaps uncovered by Medicare or Medicaid.

In short, we’ve created a society whose existence relies on women to perform individualized domestic duties that keep families safe and secure while making them less valuable to employers.

Rather than correcting this problem, the U.S. system doubles down: by privatizing nearly all basic needs, we ensure that those valued least by capitalism also lead the least dignified lives under it. We distribute too much financial burden for healthcare onto the people who use it.

Socializing the financing of U.S. healthcare through a Medicare for All plan wouldn’t solve every gender-based inequity of the healthcare system: many of the dynamics that produce disproportionate poverty and negatively affect the health of marginalized communities would remain unchanged. For-profit providers and drug and device companies would still have perverse incentives to prioritize business considerations over health.

But we have only to look across an ocean to see examples of better healthcare: women who give birth in the United Kingdom’s National Health Service do so for free. Iceland, Norway, and Finland—the top three nations in gender equity—all have robust universal systems wherein healthcare is publicly financed or publicly provided, as well as generous publicly funded childcare and parental leave.

Universal access to free healthcare from the point of use would do much to liberate women from the yoke of bosses and family members and reduce the amount of suffering to which they or their families can be subjected. By relieving U.S. women from being forced to consider healthcare as a budget item or a reason for marriage or domestic partnership, we can guarantee women more autonomy and freedom when it comes to their time, stress, and family choices. ϖ