One thing that our health care system does is tend to generate cross-subsidies between people who don’t use much health care over to people who use a lot of health care. The system doesn’t necessarily do this very well, because the system’s not very well-designed, but it definitely does this to some extent. If you had a universal system with everyone in a single big risk pool, you’d do this to an even larger extent.
On the other sign of the fence is the emerging conservative orthodoxy about health care which holds that the problem with health care in the United States is that there’s too much health insurance. Thus, you have John McCain supporting some changes to the regulation of private health insurance and to the tax treatment of health insurance that are designed to shove people in the direction of cheaper plans that don’t cover as much stuff. There are some things to be said in favor of this approach. In particular, it really would cut down on wasteful health expenditures to some extent. But it would do so in a fairly indiscriminate way with the downside disproportionately borne by people who have less money and by people who use more health care. Among other things, as a whole women make less money than do men and women use more health care services than do men. Consequently, the impact of McCain-style health reform would fall disproportionately on women.
You can see all this spelled out in some detail in a new CAPAF report on women and McCain’s health care proposals.