Health Care for Older Women: Contradictions

The following article is excerpted from "Gray Paper No. 3", a publication of the Older Women's League Educational Fund. For more information on OWL, write to Older Women's League, 3800 Harrison Street, Oakland, California 94611.

By Tish Sommers and Laurie Shields Developed through a number of brainstorming sessions of a special health committee of the Older Women's League Educational Fund, this paper is intended as a discussion piece. We hope it will be used to stimulate similar discussions at women's centers, in women's organizations, women's studies classes, and organizations of older persons with large numbers of women in their membership.

. Health care of older women cannot be separated from the needs of the population as a whole. But special concerns of older women have not been addressed adequately either by traditional medicine or by alternative women's health organizations. The otherwise excellent Our Bodies, Ourselves, for example, does not go beyond menopause, as though we ceased to exist when our reproductive life is over. This tends to separate us from our younger sisters. However, the responsibility is ours to define our specific problems and to place these within the context of efforts to make health care delivery more effective for all. By doing so, we can help to overcome sexism in this vital area of our lives.

Like most social questions today, health care is a quagmire of conflicting concerns. Although we would like simple answers, there probably are none. Health care has been described as an expensive and hazardous necessity, which expresses the contradictions inherent within it. In order to achieve an overview of the subject, this paper will examine some of those contradictions and will propose for each a strategy for finding our way through them.

We would very much appreciate comments and additions, as well as case histories which exemplify the problems.

Health Care Contradictions and How to Deal With Them Contradiction: Older women under 65 who are no longer dependents often find health insurance impossible to buy, with exclusions for "existing conditions", or else so expensive that they can't afford it, because access to group health insurance is tied to employment. Yet extending health care to unserved or underserved groups would increase costs considerably, and therefore be inflationary at a time when inflation is the nation's number one problem, it is argued.

A person has access to group medical insurance either by virtue of employment or as a dependent of an eligible worker. This excludes those (mostly older women) who are not part of the workforce. One can be virtually outside the system even with the ability to pay. Who are the excluded older women? Primarily former homemakers cut adrift from a breadwinner's coverage by widowhood or divorce. Since the problem has been invisible, they haven't been counted, but our mail suggests that the numbers are legion. -Who else is left out besides the displaced homemaker? Many part-time workers (e.g., department store'workers), lower income self-employed (e.g., babysitters and home health aides), domestic workers, and unemployed people and their dependents. All these groups include a disproportionate number of older women.

The plight of excluded older women is summed up in the following letter: "I am a 65-year old Christian lady whose husband, after thirty-two years of marriage, divorced me two years ago. The divorce cut me -off from our Blue Cross-Blue Shield which my hus-

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band had with his government job. Any hospital insurance I have been able to find say they start where Medicare leaves off. But with raising five children I never worked out to establish Social Security, so am not eligible for Medicare. Oh, yes, they said I could

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take Medicare insurance, but how many who are not eligible for social security can afford $60 a month? I can't."

Inflation is indeed a valid problem, for no one suffers more from rising prices than poor older women. But basic health protection is primary. Furthermore, excessive inflation in the medical field has priced health services not covered by health insurance out of reach of those who need them most. Inflation cannot be controlled on the backs of the poorest and most vulnerable citizens.

Strategy Principle: Health insurance coverage for uncovered women is the most pressing health issue faced by older women today. It is a question not only of equity, but dire necessity. Whatever other changes are needed, older women first must have access to the current health care system.

Contradiction: Several national health plans are currently on the Congressional agenda. The contradiction lies in the political problems these options represent. Is it valid to advocate small improvements of an existing system which leave the medical power structure intact or would it be better to work now on building a new foundation? And if the latter, how far would we get?

President Carter's proposals would put a ceiling on catastrophic costs to the individual, curb escalation of hospital costs, federalize Medicaid, and extend services to very poor people, now receiving limited coverage or none at all. All these are significant but minor reforms. Senator Kennedy has introduced a more comprehensive plan which recognizes health care as an "entitlement" or right, and sets standards for health care and prevention of disease. Unlike his earlier Health Security Act, it gives a major role to insurance companies, as opposed to the government as basic insurer. Congressman Ronald Dellums (D.Calif.) has the most far-reaching National Health Service bill. It would put doctors, dentists and health workers on salary, nationalize hospitals, health centers and laboratories, and would provide a full range of therapeutic and preventive services without co-payments.

Proponents of the more moderate course point out that with the exception of countries that have had social resolution, national health services have come about in an evolutionary process through health insurance, and that the path to national health service is thus through a sound insurance system. The British system, for example, was achieved after 37 years of experience with national health insurance.

On the other hand, many basic health care problems of older women, including coverage of persons who fall through the cracks of the present system, are not addressed in the Carter or Kennedy reforms. Medicare is considered by many a failure, since a beneficiary pays more now out of pocket for health care than an unprotected person paid in 1960 when

Medicare was passed. In other words, it is argued that we have had sufficient experience with insurance, and widespread disenchantment with this system has laid the groundwork for more radical change.

Strategy Principle: Recognize political realities. Work for improvement of Carter and/or Kennedy bills to ensure that older women are covered and for enactment of those provisions which best serve us. If these bills are so diluted as to make them meaningless, urge suport for the Dellums bill as a statement of the kind of health care service this nation requires.

Contradiction: People are urged to take more responsibility for their own health (e.g., smoking, diet, lifestyle). But doesn't this shift the obligation for health care, by considering individuals responsible for illness, away from society? And doesn't this reinforce a cut-back philosophy?

When we were small and had a hurt, we asked our mothers to "kiss it and make it well". As we grew up, we expected doctors to take over a similar magical function. Stimulated by the advances in medicine, both real and exaggerated, our expectations were often unrealistic. More recently, the mood has changed to an anti-physician bias, caused in part by exposure of physicianand hospital-caused illness, publicized by malpractice suits.

Also, the nature of health care delivery has changed drastically, with increasingly more specialists and fewer primary care professionals. This neglect of primary care flows from the "marriage of medicine and engineering," as seen in sophisticated testing and monitoring machines, organ transplants, etc., which have helped to distance us from the "family doctor".

Further, the MD is tied to the drug industry as never before. Even non-medical conditions such as sleeplessness are treated with chemicals, with more chemicals prescribed to treat side effects or symptoms of addiction. Older women, more than any other segment of the population, are recipients of prescription drugs, with Valium heading the list. The chemical solution to problems has been accepted to such a degree that many persons pressure their physicians to "prescribe something", and doctors, who should know the possible consequences, acquiesce.

There is no question but that a major shift away from dependence on doctors and drugs, especially in treatment of non-medical problems, would be beneficial to older women. Individual and group efforts to stay healthy in body and spirit are probably the most necessary and cost-effective advances that could be made. But these efforts must not be used to justify cuts in "traditional" medical care nor to slow down efforts to develop adequate health care services.

Health care is a right, as well as a responsibility. The unhealthy aspects of our lives (including smoking) have been publicly fostered through media, or added to our environment whether we like it or not. The responsibility for coping with the effects of these lifestyles cannot therefore be placed solely on the individual, but must be shared with a profit-making system that promotes unhealthy aspects of our lives and a government which permits it.

Strategy Principle: "Take Care of Your Own Health" is a positive slogan if seen as an addition, not a substitute, for government funded health care and controls on noxious elements in the environment.

Contradiction: During the past 40 years, chronic illnesses increased from 30 percent to 80 percent of all diseases. A very large proportion of the chronical-

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