The adage that "the hand that rocks the cradle is the hand that rules the world" has not been manifest in discussions of health care reform. For all we say about caring for women and children, women get the short end of the stick where medical insurance is concerned. Women use the health care system more than men, partly because of their reproductive needs. Yet women are less able to afford care than men because we earn, on average, 77% of what men earn.

Indeed, women spend more of their income on health care than men do, according to the National Women's Law Center, and another study showed that of those who declared bankruptcy due to medical bills in 2007, more than half were women. It is not too much of a stretch to describe women as a medical underclass. Consider these facts, most according to the National Women's Law Center:

*Women are more likely to work part-time than men, and therefore are often ineligible for employer-provided health insurance plans.

*In many states, private health insurers do not provide maternity coverage.

*Women who have had a cesarean section may face higher premiums when buying private insurance, or an insurer may not cover another C-section.

*In nine states and Washington, D.C., victims of domestic violence can be excluded from health insurance because of "pre-existing conditions."


*Women are more likely than men to forgo prescription drugs, medical tests and other health care services because of cost.

Where are women's voices in the medical reform discussion? On Sept. 18, first lady Michelle Obama asked female activists to embrace health care reform as an important women's issue. But women's voices have been drowned out by the Tea Party crowd opposed to reform.

The treatment of women in the medical system ought to be as compelling for women as workplace discrimination. Indeed, the fact that most insurance is tied to a job is a special burden for women (and those who are not covered by a spouse's plan) because women may move in and out of the workplace due to pregnancy and/or the care of elderly parents.

Women are not proportionately represented in the House or the Senate, but there ought to be enough women, and a few good men, to deal with some of the gender disparities in the medical system as we deal with health care reform. Helping women strengthens families and also, ultimately, strengthens our nation.

Julianne Malveaux is president of Bennett College for Women in Greensboro, N.C.