When Tom Daschle and the Obama health policy team sit down to discuss how we can fix our broken health care system, they need to make sure the table is big enough for the multiplicity of perspectives that matter.

Women want more than a White House Summit and C-SPAN broadcasts to meet the needs of our grassroots communities. We want representation in the health policy conversations. We want reproductive health and community health experts to have the chance to weigh in. We want to see midwives and low-income women involved and not simply the insurance industry and big pharma. We want a big table, because we have big problems to address.

This is what women told Raising Women's Voices in two sessions that we held in late December. President-Elect Barack Obama and the transition team asked Americans to get together over the holiday season for community discussions about how to reform our health care system.  Raising Women's Voices for the Health Care We Need responded. We called up our friends and colleagues around the country and in New York City to respond to the Obama team's request.

Because we know that women are extremely busy during the holidays, we decided to make it easy for our colleagues who care about women's health issues to join in this important discussion. We held two events with women's and reproductive health organizers and activists.

Our colleagues shared a tremendous amount of wisdom with us, and we, in turn, shared it with the Obama team and Tom Daschle.

What is health care? What should health care be?

In the New York City area, we asked these very questions by organizing a "Drinks with Tom Daschle" session as part of a monthly "Reproductive Health Happy Hour" held at a pub in the East Village. We even brought a cardboard cutout version of Tom so participants could feel like they were talking directly to our incoming administration

Those were the questions we asked. Here's what advocates responded:

For our colleagues working on women's health in communities across the country, we hosted a "virtual" community discussion by telephone. On December 18, we brought together in a conference call 35 women's health advocates from 10 states. Here is what participants asked us to tell the incoming administration.

The Problems: What are the concerns of women? What trends are we seeing?

Many of our colleagues told us about the problems they see in the existing system. While the Obama transition team asked us to choose among five possible issues (a. cost of health insurance; b. cost of health care services; c. difficulty finding health insurance due to a pre-existing condition; d. lack of emphasis on prevention; and e. quality of health care), women told us there was more to address.

They mentioned health disparities, difficulty navigating within a fragmented system and the refusal by some health providers to deliver needed reproductive health care.

"People are not getting the health care they need and deserve," one woman said.  "They can't find it and no one coordinates it."

One of our activists said: "Seeing my doctor shouldn't be so complicated."

Another participant cited the enormous number of uninsured Americans and the problems that even those with health insurance have in figuring out how to obtain care: "We have a health industry, not a health care system," she said.

Our participants were also acutely aware of the effect that the economic crisis is having on women, in particular. They cited a number of reasons why women are especially vulnerable to accumulating medical debt:

• On average, women earn less than men and have less disposable income, and therefore are more likely to go into medical debt if faced with large medical bills.
• Women are also more likely to be employed part time or be employed in the service industry sector, without the benefit of health insurance coverage.
• Women move in and out of the workforce to have babies and take care of relatives, thereby losing health coverage.
• About one quarter of women receive their health coverage through a spouse's employer, and thus are vulnerable to losing coverage upon divorce or death of a spouse.
• Women are more often the head of a single-parent household, struggling to ensure that children receive health care and deferring our own health care needs until they become serious and costly.
• Even with insurance, many women find that not all of our reproductive health needs will be covered. Or, we find that deductible and co-pays are going up. Contraception costs, specifically, increased significantly because of the Deficit Reduction Act's effect on low-income women's access to contraception.
• Middle-aged women too young to go on Medicare could experience a five to 10-year gap in coverage due to job loss, divorce, family care giving responsibilities or health reasons. These women are especially vulnerable to medical debt as the individual market is unaffordable.
• Elderly Americans -- more than half of whom are women -- are so overwhelmed with medical costs that they are skipping doctor visits or medication schedules to save money. Part D coverage gaps, and the failure of the federal government to allow Medicare negotiations with drug companies for Part D coverage, were both cited as problems.

The Solutions: We acknowledged the problems and moved into talking about solutions.

Our participants told us that health care should include:

... all people.

... comprehensive reproductive health care, including birthing options and abortion care

... a strong role for the government

... an well-funded and viable approach to reducing disparities.

Several participants said greater reliance on a primary care treatment model would make it easier for women to find a doctor who could treat them across the stages of their lifespan and could make referrals to qualified providers for specialty care.

They also told us that one way to ensure the diverse needs of diverse groups, is to expand the health care reform policymaking table. They want to see the following people represented:

• Experts on the particular health needs of women and the ways that women interact with the health system. For example, researchers from organizations like the Guttmacher Institute and the National Institute for Reproductive Health;
• Immigration reform experts to integrate the issue with health care reform, because immigration policies currently are seriously affecting the ability of immigrant women and their families to access health care;
• Representatives of the LGBT community, to ensure that health services and the structure of health coverage suits the needs of LGBT families;
• Low-income women who have had public health insurance, to serve as experts in the current pitfalls and problems of Medicaid, Medicare and other public programs, and how these problems could be addressed;
• Single-payer advocates;
• Family practice and primary care providers, especially those with experience treating women's health issues across the lifespan. (One participant noted that "The AMA does not speak for primary care providers!");
• A variety of advance practice providers (family practice, nurses, midwives, public health nurses), in addition to physicians;
• Pharmacists (not representatives of the pharmacy industry, but rather individual practicing pharmacists and people from pharmacy schools);
• Representatives of both rural and urban health care consumers, who can speak to the particular health access issues facing each of these groups.

As you see, women and women's health advocates have perspectives that are critical to ensuring successful and comprehensive health care reform that meets the needs of women. We have and will continue to share our ideas and strategies with the Obama Administration and we expect that health care reform that takes these ideas and strategies into serious consideration will help us achieve reform that meets the needs of women and our families. We're ready to sit down at that big table.