Event to celebrate Gainesville Women's Health Center
"Health Care for People, Not for Profit" was clinic's mission
When the Gainesville Women's Health Center closed its doors last fall, it closed a 23 year long chapter of feminist history in Gainesville. Feminists in Gainesville, fed up with sexist medicine, founded the Gainesville Women's Health Center in 1974, shortly after abortion was legalized by the Roe vs. Wade Supreme Court decision. The clinic--and the movement of which it was a part around the country--would not just provide abortions, but would break through myths, prejudices and restrictions created by male-dominated medicine. Sage-Femme, the Health Center's newspaper, stated in its first issue: "Because [women] have been excluded, policies and practices in medicine have never reflected our needs."
"The clinic was always a lighthouse" said former director Patricia Lassiter, pointing out that feminists led changes in healthcare which resulted in a more pro-woman, pro-people approach, patient's rights and decision-making, explanations and information. The experience of the clinic is in many ways a microcosm of how our health care system drowns good healthcare in favor of that which is more profitable.
Gainesville Women's Liberation, Gainesville Area NOW, UF/SFCC Campus NOW, and former clinic workers are organizing an event to celebrate the work and mission of the Gainesville Women's Health Center and to talk about how we can make what the clinic stood for, "Health care for people, not for profit," a reality for everyone. We invite participation by everyone in our community who wants to see changes in our health care system.
The event is Saturday, May 30, at 7:30 p.m. It will be held at United Church of Gainesville's Fellowship Hall, 1624 NW 5th Ave. (See ad page 7.)
The clinic was founded as part of the "Women's Health Movement, itself a focus of the Women's Liberation Movement," according to Sage Femme. "The Women's Health Movement is concerned with ... women's health, sexuality and reproduction...for male definitions of our biology have been used historically to legitimize all forms of discrimination and to maintain the oppression of women." (Sage- Femme, October 1977)
Beginnings in Women's Liberation
In 1968, abortion was illegal, contraceptives were hard to obtain, women weren't supposed to have "pre-marital sex" and condescending anti-woman views of "female problems" were the norm. Medicine was a male bastion, with medical school admission quotas restricting the number of female applicants. Women formed into a new movement, the Women's Liberation Movement, which demanded women's equality in all areas of life.
"Women are the experts" stated Redstockings of the Women's Liberation movement as they broke up an abortion reform hearing in January 1969 to demand repeal of all abortion laws. They effectively countered the phony expertise of a panel of "experts", 14 men and a nun, who were advising the government of New York about whether to change its abortion laws. Then they held their own hearing, in which the real experts--women--defied the law to tell about their then-criminal abortions.
In 1968 in California, feminist pioneers Pat Maginnis, Rowena Gurner and Lana Clarke Phelan, who had been organizing for abortion law repeal since the early '60's, passed out "at that time felonious leaflets inviting the public to abortion classes" according to Maginnis. She was arrested and her case overturned the local law against distributing abortion information. (Baehr, 1989)
In December 1970 the Boston Women's Health Collective published the first edition of "Our Bodies, Ourselves: A Course by and for Women," a leap forward in developing and spreading true grassroots expertise, knowlege of women's reproductive systems that combined the advances of science and the experiences of women. Knowledge of women's bodies could no longer be locked up and distorted by medical "experts."
In Chicago, an underground abortion referral collective called Jane learned to perform abortions themselves and provided thousands of safe abortions to women who needed them.
Feminists were making underground referrals in Gainesville, too. Carol Giardina, then a UF student and later a co-founder of Gainesville Women's Liberation, recalls tracking down phone numbers and leads for women in the mid-sixties from her Reid Hall dormitory. Florida law also had a statute specifically making it illegal to offer any information of where abortions could be obtained.
In 1971, the Alligator was kicked off campus and lost its funding when they ran an insert listing numbers to contact if you needed an abortion. The editor, Ron Sachs, was arrested. This led to overturning the Florida law against distributing abortion information.
Feminists started an abortion referral service in 1972, the Abortion Information Dissemination Service, which had an office on campus and received student government funding. They arranged trips for women needing abortions, mostly to New York, where feminist agitation had resulted in a much liberalized law in 1970.
Judy Levy, Byllye Avery, Margaret Parrish and Joan Edelson founded the Gainesville Women's Health Center in 1974, shortly after Roe vs. Wade, the Supreme Court decision which legalized most abortion. The clinic provided abortions, annual exams, sexually transmitted disease testing and treatment, and many other gynecological and primary care services. Not only the services provided but how the services were provided took a pro-woman, pro-patient approach. "The clinic serves as a vehicle for consciousness-raising," stated Sage-Femme, "We attempt to create an atmosphere that encourages decision-making and responsibility, one in which women are treated as participants in their health care rather than as passive objects. We attempt to demystify medicine through sharing information, explaining fully all procedures, uses, indications and contraindications of treatment. We try to create a non-authoritarian, non-elitist system and we invite feedback from women for improvement of services." (Vol. 1, #1, October 1977.)
Initially, after the legalization of abortion, poor women whose medical services were paid for with Medicaid were covered for abortions. It wasn't long before Congress passed the Hyde Amendment, which stated that no federal funds could be used to provide abortion. Then-president Jimmy Carter signed the bill into law, ignoring angry and shocked protesters with the quip, "Not everything in life is fair."
Medical costs rise
The conservative decades following the '60's have seen skyrocketing health care costs in the U.S. unparalleled in the rest of the industrialized world. There are many reasons for this, and a full analysis is beyond the scope of this article. But it's clear that the rise in costs was not accompanied by an improvement in the health of the U.S. population or an extension of health care to all everyone in the country, which other industrialized nations have been able to do.
The U.S. has fallen behind other countries and is now 18th in life expectancy, behind countries such as Greece, Spain, and Italy, according to Leonard Sagan in The Health of Nations (1987).
The medical system has passed more and more from the hands of publicly run or regulated institutions and individual professionals into the hands of private investors and corporations. Hospitals which were chartered to give the public care, such as Alachua General Hospital, have been sold to private interests which claim to be nonprofit but in fact are just as prone to corporate takeovers as their for-profit brethren--except they are able to execute these deals tax free!
Our County Commission sold Alachua General Hospital to Santa Fe Healthcare, Inc. for $1 in 1983. According to FACT, Santa Fe "Immediately started using the income and property of AGH as collateral for a series of acquisitions of other health-related facilities." When the County Commission sold the hospital, it was on condition that AGH "would always be operated as a general- purpose public hospital." Now it has been sold to Shands (the public gained no benefit) and a condition of sale was that the clause requiring them to operate in the public interest be removed. (FACT, April 1998)
An increasing private monopoly on health care and medication has meant that these companies can charge whatever the market will bear. The price, for more and more people, has put health care out of reach.
Drug companies are making a killing. "The top twenty drug companies saw their profits increased 15 percent per year [from 1984-1994] compared with an average annual increase of 3.2 percent for the top Fortune 500 companies." says Vincente Navarro in his 1994 book, "Dangerous to Your Health: Capitalism in Health Care."
In past years, those who had insurance could count on being subjected to more tests and procedures than were warranted because doctors and medical companies stood to profit from each procedure. Now, with HMO's (Health Management Organizations) there is pressure on doctors to not refer patients for tests, treatments or to specialists because the HMO gives them a quota and can drop them if they exceed it.
The Florida Medical Association recently considered unionizing as a result of this pressure. "Complaining they have less control over the care of their patients because of strict guidelines in managed care policies, doctors in the FMA had for a year considered forming a union to deal with insurers" the Gainesville Sun reported on May 17. Instead the doctors formed a center to collect complaints and push for doctors interests in legislation. Another Florida doctors group, the Florida Physicians Association, is still looking at unionization, even though, according to FPA President George Edwards, "Current laws do not allow traditional collective bargaining on behalf of independent physicians,"
Independent clinics and medical practices, like many small businesses, are almost extinct because of the insurance and medical companies efforts to consume and incorporate their competition.
The move towards HMOs has hurt small non-profit clinics. To prevent higher costs down the line, HMOs have a greater emphasis on preventative medicine, so many pay for women's annual exams pap smear and pelvic examination--but only by doctors in their stable. This has cut out the independent clinics which worked on a fee for service basis. Their cost was much cheaper than a regular for- profit practice, but more expensive than the co-payment of $5 to $15 required by the HMO.
Meanwhile, insurance premiums--HMO or no HMO--have gone through the roof. Seventeen percent of Americans have no insurance at all, and as a whole, Americans pay 27% of our medical costs out of our own pockets. Medicare, the medical program for the elderly, pays only about 50% of what older people spend on health care. In particular, it doesn't pay for medicines.
These rising costs mean people have less money to spend, so when insurance doesn't cover what we need, like birth control and abortions, we're hard-pressed to come up with the money. "I can't tell you how many times women have called the clinic about getting an abortion and hung up when they heard the price ($300)," said Amy Coenen, a former Gainesville Women's Health Center worker. "Of course, it costs much more to have a baby, and it's ten times as dangerous, but if you don't have the money right away, what are you going to do?" The clinic provided some free abortions but was never able to provide for the large number of women who need but cannot afford an abortion.
Paperwork & red tape
Part of being an independent non-profit clinic is the paperwork. The American medical system spends 25 cents out of every dollar on administration, billing, and paperwork. In contrast, the British National Health Service spends 6% on administration, and the Canadian national health insurance system, what health care activists in the United States call a "single-payer" system, spends 12% on administration.
One reason the American system is so expensive is no mystery to anyone who's tried to get an insurance company to pay for a medical procedure. Insurance companies spend a lot of staff time and ingenuity trying to get out of paying.
In a planning meeting for the May 30 "health care for people, not for profit" event, a volunteer mentioned that one insurance company told her mother that they could not pay for a treatment related to her menopause because "Menopause is a pre-existing condition." She responded, "Oh, is being a woman a pre-existing condition, too?"
Blue Cross told another friend that they would pay for one doctor visit for a covered home accident but not the doctor visit two days later for the same injury. A woman who was paying for insurance at her job reported she never used it for two years because she couldn't figure out how. She blamed herself for not being smart enough to figure it out. But after hearing other complaints about this, we concluded that the forms and instructions are deliberately complicated to deter people from using their insurance, or if they use it, from getting reimbursed.
Small providers suffer from the paperwork nightmares, too. For a clinic dealing with many different insurance plans, the costs of administration and billing the insurance companies are astronomical. "We would have had to dedicate at least one full-time staff person simply to deal with the insurance" a former Gainesville Women's Health Center worker commented. Yet most insurance--despite the high premiums--doesn't cover many of the services the clinic provided such as birth control and abortion. And those who have insurance with high deductibles are paying out of pocket for much of the health care we need.
Obstacles to health care
There are a lot of other reasons even people who have insurance still don't get the care we need. Some insurance companies require you to pay up front and get reimbursed later. This saves them a bundle because they can make interest on the money they aren't paying, and every delay in reimbursing you makes them more money. If you can't come up with the money up front, it's another way to prevent us from using our medical insurance.
The HMO co-payment system--$5 to $15 per visit, $5 to $12 per prescription--sounds like a good deal at first. But you're already paying for health insurance monthly. My experience a couple of years ago was, there's the doctor visit ($10), then the bloodwork ($10), then the bloodwork again cause they didn't do it right the first time ($10--over my objections), then the x-ray ($10), then the medicine ($12), then the followup ($10). Total: $62.
One woman working on the May 30 event stated that she has several prescriptions a month for chronic conditions which each have a $5 copayment. The costs for medicine alone--even though she's paying for insurance that's supposed to cover it--can end up being $50 a month.
A maintainence worker at the University of Florida with several children reflected on the co-payment system as a child tax. "Every time you visit, they charge you for each one. It adds up! And I'm already paying a lot for the insurance." A couple of years ago Medicaid, the medical program for low-income people, started charging $2 copayments for each visit. Is $2 from each person really helping the program? Or are they just putting up another obstacle to deter people from going to the doctor? And Medicaid only covers 37% of people living below the poverty line, according to Himmelstein and Woolhandler.
Because we are under the threat of being dropped, both insured and uninsured people avoid going to the doctor for fear they will be found to have a condition that will make them uninsurable in the future, or cause the insurance they have to increase in price. Sixty-two percent of working people "can have their health insurance dropped if their condition requires treatment that is considered too expensive." (Navarro, 72) He says in addition to the 17 million Americans who have no coverage, 50 million have major gaps in their benefits.
Few realize the toll that all of this takes. Physicians Steffie Woolhandler and David Himmelstein of Harvard University estimated in 1994 that 100,000 people die in the United States each year from lack of care.
"We are in a crisis of astronomical health care costs and poor results in terms of a healthy nation of people..." The radical feminist group Redstockings said in 1987 in their introduction to the pamphlet, Women and the Danish National Health Care System.
HMO: Healthy Members Only
The Gainesville Women's Health Center, the pioneering women's health clinic in Gainesville, long fought these larger processes, as well as the particular problems of clinics offering abortions in the midst of hostile pickets, bomb threats, and attacks on sister clinics.
The Gainesville Women's Health Center provided abortion and other care to patients who were turned away by doctors or other clinics for medical reasons such as high blood pressure, diabetes, HIV infection, or other health risk factors.
It cost more to provide for these higher-risk patients but because the clinic's mission was to provide care to all patients without discriminating, it didn't charge more for these services. They also provided services others did not, such as second trimester abortions (up to the 24th week). With the clinic closed, people with tricky medical problems--or who simply need a 2nd trimester abortion--have fewer places to go.
This is a phenomenon that has been occuring throughout our medical system. An extreme example of it occurs when private hospitals "dump" patients who can't afford to pay in the emergency rooms of public hospitals. Insurance companies compete with low rates for healthy people, while people with pre-existing conditions can't find any insurance at all.
The Blues get "Cherrypicked"
In the 1930's, hospitals set up Blue Cross and doctors set up Blue Shield because they wanted a steady flow of patients, and during the Depression people weren't able to afford their services. For an annual payment, the Blues guaranteed they'd take care of you. The government gave them "tax exempt status in return for their agreement to offer coverage based on an average premium for the community in which they operated, rather than requiring sicker people to pay higher premiums." (Navarro, p. 30) When health insurance companies started to provide insurance, they undercut the price of the Blues and only enrolled people who looked like they weren't likely to get sick. The Blues stayed afloat by starting to do the same thing as the insurance companies. "Before long, both the Blues and the commercial insurers were avoiding the sick and vulnerable and favoring the young and healthy." Congress withdrew the Blues' tax exemption in 1986.
Whether it be private hospital dumping, insurance company "cherrypicking" of healthy customers, or clinics that take on more difficult cases, the result is the same: The hospital, clinic or the Blues are either forced to stop providing for very sick people or go out of business. This seems to be an irrational way to run a medical system, which is, after all, supposed to provide care to sick people. And since anyone can get sick or be injured and need care, it's in the interests of all of us to make sure everyone has access to quality health care.
Broad support for change
Contrary to impressions created by the corporate media, there is broad support for national health care in the United States. Physician activists Steffie Woolhandler and David Himmelstein cite a survey showing that 72% of Americans favored national health insurance. Ninety percent of blacks and 69% of whites support it, 79% of low income and 66% of high income people support it, 77% of Democrats and 61% of Republicans support it. (Survey by Arthur D. Little Corporation.)
Six national polls between 1989 ad 1990 showed that on average 66% of Americans want a tax-financed national health plan (Navarro, p. 59).
A 1986 survey of physicians found that 56% favored some form of national health insurance, but they thought they were in a small minority. "About seventy-four percent of doctors thought that most of their colleagues oppose such reform," according to Woolhandler and Himmelstein.
Redstockings argues for why women should be particularly interested in changing the health care system: "A system of free quality health care for all--paid for out of public funds--always a necessary part of the program for women's liberation, a much needed step, is now on the agenda in the United States. For a majority of the people, it will bring much-needed relief, and for women in particular, a little more of a base, a springboard toward more and more independence, a greater social sharing of the costs of child care, without which the goal of fully equal relations with men cannot be finally achieved."(Women and the Danish National Health Care System, 1987.)
The labor movement, which for decades has negotiated health insurance coverage with individual employers, has concluded that the workers are losing at the bargaining table again and again because of rising health costs. Workers can't change jobs, and face extra insecurity in strikes because they fear of losing health insurance which is tied to the job. Many unions are now supporting universal health coverage, saying "Health Care is a Right, Not a Benefit."
In 1989 the Oil, Chemical and Atomic Workers Union (OCAW) voted to work for a "Cradle to grave" national health program which would "Provide all U.S. citizens with free health care on demand... Our program is similar to Canada's very successful National Health Program," OCAW states in a 1990 pamphlet. "Every Canadian is fully covered by the Government insurance program and can go for care to any hospital or doctor in the country."
Floridians for Health Security is collecting signatures to put a constitutional amendment on the ballot in Florida which would provide health care for all Floridians through a "single payer" system. (Floridians for Health Security, 10340 SW 121st St., Miami, FL 33176 (305) 253-9659.)
The Gainesville Women's Health Center and the freedom movements of which it was a part caused a wave of changes in healthcare--patient's rights and decision-making, explanations and information--including counseling and consent forms--and women and minorities breaking into the ranks of doctoring. The medical system was another place greater democracy was desperately needed- -and women, who bore the brunt of its unfairness, fought and won some space. But a key element, "Health Care for People, Not for Profit," the slogan of the clinic, is missing and it is making our medical system ineffective.
The experience of losing the clinic has been a wake up call that our gains are endangered in the curent environment. More and more, health care activists and observers of the current system have come to believe that unless the system advances to one that guarantees universal health security, as many other nations have, the improvements already won cannot be defended.
The Redstockings Women's Liberation Archives for Action provided many materials and ideas for this article.
Women & Danish National Health Care System (1987) and Feminist Revolution (1978) by Redstockings( Both available from Redstockings Archives, P.O. Box 2625, Gainesville, FL 32602. Send two first class stamps for a catalog of materials.)
National Health Program Book by Steffie Woolhandler and David Himmelstein (1994)
Dangerous to Your Health: Capitalism in Health Care by Vincente Navarro (1993)
Abortion Without Apology: A Radical History for the 1990's by Ninia Baehr (1990)
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