Healthcare reform has been a topic of conversation for years, stimulating many thought-provoking questions, debates, and insights. Today’s Woman Dreamer, Rosemarie Day, is a health reform pioneer. She is the founder and CEO of Day Health Strategies, a successful mission-driven, woman-owned consulting firm, and the author of Marching Towards Coverage: How Women Can Lead the Fight for Universal Healthcare . A true woman leader fighting for change, we are excited to share Rosemarie’s take on the healthcare system’s most pressing topics, ranging from the gender gap, the largest flaws currently existing system-wide, and why this reform is her life’s passion. Rosemarie also shares her insights on activism; find out what type of activist you are. Enjoy Rosemarie’s inspirational and informative story.

1) What are the different types of activists that you've encountered, and what kind of role does each one play in healthcare reform advocacy?

I group the activists into four main categories: those who are aware, those who share, those who participate, and those who lead. The roles each play in healthcare reform advocacy are along a spectrum of engagement:

1.       Aware –Is informally affiliated with the cause, less social when it comes to activism, and focused on simply gaining knowledge around the topics closest to heart. Some activities engaged in might include reading, listening to podcasts, and attending lectures/talks about the cause.

2.       Sharer- May be informally affiliated with the cause, vocal in the community and focused on having high impact discussions. It is likely that they enjoy talking to others in-person and online about ideas and the issues closest to heart.

3.       Participator- Tends to approach things in a “hands-on” way. A likely participant in the community and more vocal about the issues closest to heart. This activist is probably already affiliated with an event, group, or organization dedicated to the cause.

4.       Leader- Probably already formally affiliated with the causes closest to heart. This activist seems to have an ability a passion for mobilizing others and has interest or experience in organizing or leading events, communities, or organizations dedicated to the cause.

I have created a short quiz on my website to help people assess their personal level of activism and to provide resources to increase their type of engagement. You can find the Personal Activism Assessment here to learn more.

2) What type of activist are you?

By writing Marching Toward Coverage, my level of activism has moved from “participator” to “leader”. My book’s mission is to inspire a movement for universal healthcare coverage. I believe that we don’t have to agree on our specific path to get there, but we all need to be working in that direction and women should lead the way.

3) What inspired you to pursue this? When in your life did you become passionate about healthcare reform?

I started my career working on inequality and social justice issues, which led me to the Harvard Kennedy School to study public policy. This program made me excited to work in government, especially in an innovative state like Massachusetts, which exemplifies the idea that states can be the laboratories of democracy. I worked in the Massachusetts government on different initiatives starting with welfare reform and ending in health reform.

When I worked on welfare reform, the pressure was always to get people employed. However, once they were employed, they tended to get low wage jobs with no benefits. It felt like we were abandoning people because we pushed them so hard to get jobs, but once they did, they lost their Medicaid coverage. I saw that there was a huge gap in the provision of health care for the people who were working but did not receive health insurance through their employer. I wanted to work on health reform to fill those gaps.

I went on to serve as the Chief Operating Officer for the Massachusetts Medicaid program. I then became the founding Deputy Director & COO of the Massachusetts Health Connector where I helped to launch the nation’s first state-run health insurance exchange. During my tenure, the Health Connector became a model for national health reform.

Because I had the experience of launching the first exchange, once the Affordable Care Act (ACA) was passed, I founded Day Health Strategies to help other states implement national health reform. I began working with insurers and providers as well and found that I loved consulting. Day Health Strategies is now serving organizations that want to transform their approach to offering or delivering health care. We have worked with numerous private and public sector organizations in developing and implementing health reform, health care transformation efforts, and related strategies.

Over the course of my career, I have gone from focusing on filling coverage gaps to believing that health care should be a right and should not be tied to other factors, such as employment. I am now focused on improving our health care system and achieving universal health care coverage.

4) What are the biggest flaws in the current healthcare system?

• First, the US does not have universal health care. We do not treat health care as a right, which is leading to people getting sicker than they should and dying unnecessarily.

• Second, when you look at overall population health, we spend too much to get too little. As a country, our system does not focus or invest enough in prevention. We can always point to extreme cases where we solve some medical mystery or do something miraculous, our medical system does this extraordinarily well. However, this comes at the price of insufficient investment in prevention. If we redeployed some dollars from high-end specialty care to prevention and public health, we would get to better overall population health.

• Third, we do not spend enough on social safety net services. Compared to peer countries, the US government spends much less on social services and we have worse health outcomes. As a country, we tend to over-medicalize and under-support people. Generally, our investment strategy is off — we spend a lot of money in the wrong places.

• Fourth is price. Compared to other countries, we have way higher prices for the exact same health care service, whether it’s pharmaceuticals or procedures. There is a lot embedded in what goes into these high prices, some of which is legitimate, but other aspects are wasteful, including excessive profits. Other countries’ solutions are to regulate prices and we don’t, generally speaking (other than for government programs, such as Medicare and Medicaid). Capitalism is not working in the health care industry because it’s full of market failures. While we don’t like to regulate prices or control markets in the US, there needs to be some government intervention to combat these market failures. Other countries successfully have government intervention in their health care industries, but we have been squeamish to do so, and we pay a high price for that.

5) Does gender bias play a role in healthcare/healthcare reform? Are there any issues in the system that women face more than men?  

Yes, absolutely. The gender bias has only been heighted further by the pandemic. The COVID-19 crisis has shown everyone that we are essential – women make up over half of the workforce deemed “essential,” including 77% of healthcare workers.  Our lives are on the line as front-line healthcare workers:  the CDC reports that 73% of healthcare workers who have contracted coronavirus are women.  On top of all of this, our stress is through the roof with the roles we play at home:  women were already making 80% of the healthcare decisions in families, and now, as at-home caregivers, we are juggling even more, with home-schooling added to our paying jobs.  

For more on how we can come together to demand a deep and lasting recognition, check out my blog post featured on MomsRising here!

Thank you so much Rosemarie for educating and empowering our global women’s network!

Bio:  Rosemarie Day helped lead the launch of health reform in Massachusetts in 2006, which became the model for the Affordable Care Act. She has been working on health reform ever since, and is passionate about universal healthcare and women's health issues. She is the founder and CEO of Day Health Strategies, a successful mission-driven, woman-owned consulting firm that is celebrating its 10th anniversary.  She is also a mother, a breast cancer survivor and an activist. She is the author of Marching Toward Coverage:  How Women Can Lead the Fight for Universal Healthcare which was published by Beacon Press in March, 2020.  Additional bio information can be found here:  https://dayhealthstrategies.com/team.

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