A Feminist Argument for Single-Payer Insurance

Dana Goldstein reports that women are twice as likely as men to depend on their partner for health insurance coverage. (Via figleaf.) That’s a big problem for women when a relationship ends, as she notes. Both widows and divorcees can find themselves suddenly uninsured.

From my own experience, I know it’s terrifying enough, worrying whether your spouse will survive a life-threatening illness. No one needs the added fear of becoming uninsured. And when women are uninsured, their dependent children often suffer the same fate. That’s exactly what would have befallen me and my kids, had my husband not survived.

Here’s another important point that Goldstein doesn’t cover: Being dependent on one’s partner for insurance creates a perverse incentive to stay in bad relationships. This does no favor to either partner. The insured person may feel an obligation, especially if his or her partner has had some health problems. The uninsured partner may feel trapped. I can understand staying together for the kids, if a relationship is otherwise dead. But for the insurance? Somehow this seems even more twisted and cruel than being stuck in a lousy job for the same reason.

Goldstein suggests expanding Medicaid coverage to the poor and letting partners who lose their insurance take part in health insurance exchanges, which should offer lower rates. But these are frustratingly incomplete solutions. They’re just a patchwork, even if they might be the best we can hope for, politically, at the moment. Lower-middle-class women, in particular, would be squeezed out, too rich for Medicaid but too poor to afford premiums without employer subsidies.

The simplest solution – which doesn’t require women to be either poor or well-paid – is a single-payer system. In a climate where the Democrats are waffling even on a “public option,” that may seem utopian. It’s the only route to full coverage and fairness, however. A public option may still be unaffordable for those with modest incomes, and adding a “mandate” to the system wouldn’t change that fact.

Ultimately, we have to decouple health care from employment status. We have to stop seeing it as a perq to be earned, and start regarding it as a human right.

Women are still more likely than men to interrupt paid work for family work, and that’s unlikely to change anytime soon. They’re also still clustered in lower-paying and part-time jobs, which are less likely to carry benefits. Separating insurance from employment is the only way to ensure full inclusion of women, as well as minorities, the very old, and the very young. For that matter, it’s the only way relatively privileged pale males won’t get left out in the cold when they become seriously ill. Right now, anyone who suffers serious illness is at risk of losing their jobs, and then losing their insurance. Even those who keep their coverage may find themselves woefully underinsured, resulting in bankruptcy or crippling debt. What’s more, the current recession has put more men out of work than women, and they don’t deserve to be uninsured or dependent on a partner anymore than women do.

Hmm. It turns out that the “feminist” argument for single-payer is good for everyone, not just women.

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