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Mary Ruggie on Women and U.S. Healthcare Policy

How well-prepared is the U.S. health care system to address the needs of aging baby boomer women? The research of Mary Ruggie explores how the nation's health care policies affect this large segment of the U.S. population. Ruggie is an adjunct professor of public policy affiliated with the Malcom Wiener Center for Social Policy.

Q: In a recent article, you chronicle how heart disease, cancer, chronic illness, and disability have a greater effect on women, and in particular racial/ethnic minorities and the poor. You also document that nearly 20 percent of women aged 18-64 are currently uninsured in the U.S. How well-prepared is our healthcare system to meet the challenges of a rising generation of aging baby-boomer era women?

Ruggie: Not nearly well enough. We do very well when it comes to high technology to treat cancer and heart disease but our system is very oriented toward acute care and not chronic care and disability. And while women do have heart disease and cancer, they also have a lot of chronic diseases and disabilities. Also the poor, uninsured, racial and ethnic minorities tend to be diagnosed for heart disease and cancer much later than others. So, we have a long way to go.

Q:Please explain what you have called the 'feminization of Medicare,' and what 'boomer' women can expect from this federal program.

Ruggie: We know that women live longer than men. Right now approximately 70 percent of people over the age of 85 are women. So the higher up you go on the age scale, the more women there are. The Medicare program is a good program, and it's a good thing that we have this program. But the Medicare program is becoming increasingly strapped for funds. This is happening at a time when more and more people are becoming eligible for the Medicare program. So I'm not sure that we can rely on this program to do for baby boomer women what it is even currently doing for women on Medicare.

Q: How will the recent change in Medicare policy to include prescription drug coverage affect future generations of retirees? How do the different ways women use prescription drugs, as compared with men, figure into this equation?

Ruggie: What we have now with the new program - Medicare Part D - is certainly better than what we had before: nothing. Women are going to be affected more than men by this new program in a negative way. They have higher prescription drug use, and therefore, higher costs for their prescription drugs. With this new program, people have to make co-payments up to approximately $2,250. At that point they reach what we've started to call a 'donut hole.' This means that they then have to pay all of the costs of prescription drugs until they reach a little over $5,000. Because women have higher expenses, they're going to reach this 'donut hole' much sooner than men. Also, because the new program doesn't have any form of control of prices - it doesn't allow Medicare to use its power to develop discounts for recipients - that's going to be a continuing problem for all people who have high expenditures for prescription drugs.

Q: The role of government in the regulation and provision of residential and nursing care for senior citizens in the U.S. has been limited. When considering how quickly this segment of the population is growing, does this need to change?

Ruggie: Definitely. We do not do well at all when it comes to nursing home care. Right now politicians are on the privatization band wagon. They would like people to take more responsibility for their future needs by buying long-term care insurance. Long term care insurance is very expensive and that may be one reason why only about one in ten adults have long term care insurance. Government needs to play much more of a leadership role in encouraging people and helping people plan for their future needs. Germany is one country that recently made it mandatory for people to buy long-term care insurance through their social insurance program. I raise this example because it shows that government can play a leadership role rather than shifting responsibility.

One point that I'd like to add is that the nursing home industry in our country is a profit-making business. Where there's profit to be made, there are corners to be cut. Government could do a lot more in regulating the industry as well.

Q: Is there anything you'd like to add?

Ruggie: When we talk about baby boomer women, we really have to emphasize the fact that there are huge differences among women over the age of 65 depending on their race or ethnicity, their income, their education level. There are disparities in the U.S. that have to be tackled if we're going to live up to being the richest country in the world in more ways than one. And the best way to begin to change our ways is to implement universal health care coverage.