I just finished a great book: Why She Buys. I was stunned to learn just how much of the US economy is controlled by women: 65% of apparel, 52% of all auto and truck, 45% of consumer electronics and 70% of travel purchases. If influence over purchases is considered, women influence 80% of auto and truck, 91% of home, and 61% of consumer electronics purchases.  

Wondering about health care? It turns out that Dr. Mom makes more decisions than Dr. Welby; directing 80% of expenditures. It’s not just Dr. Mom, I’m guessing, but Dr. Wife, Dr. Sister, Dr. Friend and Dr. Daughter (or Daughter-in-Law) who help others with the health care maze.

A great book. I recommend it, though it raised my ire and blood pressure more than once as I realized how even with that level of seeming economic power that product design, marketing and purchasing is not woman/customer/consumer-friendly.

More women are in the workforce, complicating the activities of daily living.  Have children, a special-needs child and/or get divorced and life gets more complicated still. Time compression and multi-tasking is a way of life. How I wish that health care was like Ryland Homes, who designs and builds for the life a woman leads: a window over the kitchen sink to watch younger children in the back yard as she prepares dinner in open-plan kitchen-family room while supervising the older children’s homework, and of course, a computer workstation to check her own emails. Her day likely starts at 5 and ends at 11, errands are saved for weekends. Getting to the gym? Well, someday…..

Of course, that assumes she’s able to afford a Ryland Home. Many women are not. They face those chores in neighborhoods where the kids are not safe playing outside.

Heaven help any woman if she or someone she loves gets sick. Yeah, heaven help her, because it’s likely that health reform won’t. For women, the “unintended effects” of health policy decisions are not hypothetical. There’s a fight on, a battle, a war on the Hill and we’ll be left to deal with the collateral damage.

Drawing on some insights offered by author Bridget Brennan, sifting them through what I experience and what other women tell me, here are some reasons I’m not buying…

First, women’s busy lives make primary care essential. We understand prevention, practice it for ourselves and children and try (often unsuccessfully) to get the men in our lives to do likewise. So where are the health reform proposals for radical increases in primary care physician fee schedules and more widespread access and better compensation for physician assistants and nurse practitioners? Forget loan forgiveness programs that might provide us with care in a decade. Increase the payment rates now.

Radically improve primary care access and health care will finally be woman- and health-friendly. Offices will staff-up, use EHRs and shorten our wait-times. I doubt any woman believes that her physician needs “incentives” to do these things and provide good care, by the way. Health care is not an economic transaction for us, it’s a relationship and we’d sniff out a mercenary in the first visit. We understand the real problem — that there are plenty of “disincentives” to being a primary care provider. We notice other people and we care. As I watch my own physician gain weight, get weary, get cynical and burn out, it’s not because she lacks incentives. I see her office staff and how surley they can be. It’s because they’re all working in an increasingly hostile climate created by policies put in motion far from her exam room. 

Second, women want to know about the practical benefits of a product or service. Brennan cites evidence that women have higher language fluency, one reason why we find it easier to give and listen to speeches. I’m listening….but don’t hear the practical benefits of reform proposals. Deficits a decade out? In this recession? Sorry, that’s not compelling.

How do I make it through this year? What, really, is this going to do to my taxes? I might be willing to pay more, but I need to know I’m getting some value for it. What impact will it have on my small business (remember many small business owners are women, we generate jobs and have much better business success rates than our male counterparts)?  What will it do to my wait times for doctor visits? Appointment waits for a mammogram in my town are already six months. Will that get better or worse?

How rigid will regulations be? I called for an annual pap smear recently. The timeframe that worked for me was a brief vacation window, but as the office informed me, is two weeks before the date of last year’s test. Oops! Two weeks shy of the “annual” date and I can’t qualify for reimbursement. By the time the “regulated” date comes arrives two weeks later, I’ll be into a busy work and travel season and unable to take the time off work. I’ll postpone, probably until next spring. I’m taking two risks, first, that this pap smear won’t be normal, but then my pap smears have always been normal and this one probably will be as well, and second, that my physician is  not on some PFP or HEDIS-watch that will impact her pocket for non-adherence to clinical guidelines. Being self employed means that the visit to the doctor will take me out of the office for a least a half-day, during which time I won’t be earning an income. Will reform create more flexibility so that I can get care on a vacation day?  Will it adapt to my needs as a working woman?

Third, women value social harmony. Perhaps that’s neurobiology, perhaps it’s an evolutionary gift that promoted the survival of the species when we jointly cared for children and each other when the men failed to return from a hunt or a battle.  Perhaps it’s just having broken up too many preschooler fights.

We know there is very real risk in conflict, likely no single ‘bad guy’ and that if there’s a fight on the playground, chances are no one is truly “innocent.” In fact, the one finger-pointing is probably the one who started it. So a word to the wise health policy wonk and politician…stop blaming someone else. I’m guessing women know that it’s not so simple as blaming doctors or drug or insurance companies. Actually, we now suspect that you might actually be part of the problem…creating confusion. Could it be because you are running for re-election? Or helping some buddy who is? I want to buy a system that heals and have become firmly convinced that a healing system cannot be built by those who fight and finger-point.

Last, when women buy they want to know they can “plug and play,” that the product will make our lives easier. Men, Bridget Brennan says (citing the literature), like to buy now and figure it out later. Tinkering is apparently fun. Not for women. We don’t relish hours of cell phone, computer or DVD programming. We already have a “to do” list longer than most arms. Maybe this is the biggest disconnect for us and my own greatest sense of frustration.

I’ll agree that the system is broken and needs to be fixed. I join other women who know just how important health is — after all, we’re the ones who take of sick kids, friends, spouses and parents. But health reformers are pushing ahead, promising better access and quality at lower costs even though Peter Orszag (who I personally admire and respect as one of the scary-smartest people on the planet) recently told the Council on Foreign Relations. “The truth is that we don’t know today all of the steps that are necessary to move towards providing higher-quality, lower-cost care.” 

The policy players might be willing to ‘buy it’ now and figure it out later, but as a woman, I’m not. I’ll make  my buying decision when the seller can tell me exactly what I’m buying, how it will work, how it will make my life easier, how it will care for the people I care about – including my primary care physician, and how much it will cost. With that, I’ll assess the value to me, my family and my business and make my decision.

Where this Disruptive Woman is concerned….even if today’s health reform –  in its current form — passes, it fails. 

Related posts:

1. The NHMA Forum on Health Care Reform offers an opportunity to impact health reform legislation
2. Health Reform: Patient Rights, Patient Reponsibilities
3. Watch, Discuss and Engage: HHS Secretary Sebelius & Health Reform Director Nancy-Ann DeParle
4. Employment : A Public Health Intervention
5. News Flash to Health Reform Buddies: Insurance Coverage is Not Enough

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