The Terrible Truth I Wish I Had Known as a First-Time Voter

I didn’t take my first chance to vote. I was eighteen in 2004. I was a virgin. I didn’t watch the news. I was probably at a party or popping in a pretentious VHS tape or kissing someone wearing Vans. It was hard to see the choice—between one white man in a suit who had started an endless war and another white man in a suit whose politics seemed only marginally less troubling—as a personal one. I could not have been more wrong.

We all have the issue that calls us to action, the one that hits close enough to home that we are inspired to participate politically. For some, it’s the changing climate destroying their homes. For others, their experience with college loans. For me, it was when my body began to fail me, a development that ultimately allowed me to understand how interlinked every crisis facing our nation really is. Our healthcare system is the place where the Venn diagram of every form of injustice meets. But, like so much in life, I had to see it to believe it, to really comprehend what second-wave feminists meant when they chanted “the personal is political.”

It’s no secret that I have been a weary traveler through the medical industrial complex. I’ve written extensively for this magazine about my history with endometriosis and chronic pain, the endless circles I walked just to get answers, the emergency room visits all over the country when symptoms were out of control (I’ve often joked that I could write a book called “A Doctor In Every Port”), and the radical hysterectomy that was ultimately necessary. What I have written less about were the men—so many men—who I met on that journey. (While roughly 85% of practicing OBGYNs are women, 62% of practicing physicians are men, and they make up roughly two-thirds of the emergency medical field.) Some were established doctors, some were interns, some were anesthesiologists. There were ones who sent me home bleeding too much, explaining my period to me like I was in fifth grade health ed. There were the ones who eyed me with skepticism when I rated my cramps as a 10 on the pain scale. There were the ones who carelessly reached inside me as if I were a car with a faulty engine, and not a human woman gasping at the careless intrusion.

After my first endometriosis surgery, I was placed in the urology ward at a prominent New York hospital. The rooms were much nicer, explained my doctor—out of network, it should be stated, and found after turning over every rock and finally consulting the Endometriosis Foundation of America. A wealthy man with prostate cancer had made a generous donation that allowed for wood paneling and flat-screen TVs versus the peeling yellow walls and tiny televisions with three channels up in obstetrics and gynecology. I was told to walk every day after the surgery, up and down the hall eight times. I pulled my IV bag alongside men named Frank and Bob, who chatted easily about sports as the nurses guided them. I thought about the women upstairs, waiting to have their bed pans changed, wondering who had forgotten about them. I thought of the women in state hospitals and jails, who would regard the ignored obstetrics wing as an incredible upgrade. I thought of the women waiting outside of emergency rooms all over the country, too afraid to go in and face the cost. I thought of the women who wouldn’t even consider parking outside.

I knew that my presence on the ward was a privilege—every inch of my journey had been possible because of financial freedom, perceptions about race and class from within the medical industry, and the advantages that come with any measure of cultural capital. Still, and with all of that, I felt like a wanderer on a treacherous path, wanting to trust the kindness of strangers but finding myself—again and again—heart sinking in the face of danger. If that was my experience, it was impossible to calculate the amount of pain occurring across our nation.

It’s glaringly obvious that we have a very big problem in this country when it comes to the bodily autonomy of people who are not cisgendered, heterosexual white men. It’s so big that it cannot even be described as a problem. It’s a cancer of thought, a displacement of power so great that the majority of citizens are living in fear of their bodies betraying them—they can’t get the care they need, and they can’t pay for the care they get. Meanwhile, the many doctors and nurses who joined the medical profession hoping to do meaningful work are stymied; bias that is baked into the US healthcare system makes even individual attempts to do good within it a constant fight. I think of nurses, who work tirelessly and thanklessly to support a patient population who are subject to the laws they don’t create. It’s no wonder that studies have shown doctors in America experience significantly more burnout and depression than the rest of the population.

Lena Dunham in September 2024Photot: Jed Cullen/Dave Benett/Getty Images

Growing up with a pro-choice activist mother, I knew what abortion was before I knew about sex. I watched as she and her friends linked hands at clinics across America, blocking protestors and ushering in the women who needed their help to enter without harassment. Most of them knew intimately what it was to seek help outside of the law, to command their own destiny at their own peril. They never wanted us to experience that again and I thought, with the naivety of a child, that we would be free to tackle the next injustices. But that freedom can only exist when we are given the power of choice—without choice, we are forced to live in a defensive crouch.

What I didn’t understand—and it would take over a decade on my medical odyssey to really comprehend—was that who we elect dictates just who gets the chance to survive. In the 2023 fiscal year, $110 million dollars of research money was allocated to prostate cancer. The average yearly expenditure on cervical cancer research is $51.6 million. $45 million for ovarian. Uterine cancer research in the United States is funded at a lower rate than other cancers, with only pancreatic cancer (much less treatable and also much more rare) coming in below it. Meanwhile, endometriosis (which affects at least 10% of women, although the research simply isn’t there to accurately state the facts) receives less than $16 million dollars a year in funding.

The information about how much money goes to trans health research is hazy and hard to track, but we do know that the average cost of gender-affirming surgery is over $100,000 dollars—insurance companies are only forced to cover what is deemed “medically necessary,” which is up to their discretion. That same discretion is applied to women with chronic conditions like endometriosis, which means our insurance providers—people who have never met or spoken to us—are the ones allowed to decide just how much pain it is appropriate to live with.

However, the cost of care—for trans people and for women—becomes a secondary issue when legal access to that care is what’s at stake. That conundrum—fighting for access to care that citizens ultimately cannot afford—creates a compound fracture in our system that leaves our most vulnerable citizens helpless and hopeless. It should be noted that none of these statistics focus on the mental health crisis in our country. They intersect with, but do not fully highlight, the specific abuses faced by women of color and trans people in the field of reproductive medicine, or their often limited access to medical care more broadly.

Just like the Dobbs ruling, these statistics are the clear result of a country run by men. Men whose values remain on the homestead, when women were vessels for reproduction, and queer people were invisible. The fish rots from the head. The priorities of a nation reflect the priorities of the people who run it, not the people who suffer within its confines.

I’m not voting for Kamala Harris because of her gender. But it is a buoy of hope—that someone with a more intimate understanding of these injustices will have the empathy and equilibrium to make moves to correct them. That the people she places power in the hands of will use it to empower. That the literal and figurative cost of living in a marginalized body will decrease, as access increases. This election determines more than just our access to abortion—our leaders decide how to allocate research money, whose bodies matter enough to heal, whether we are met with obstacles when we seek treatment and, ultimately, who is given a shot at life. The definition of pro-life to me is a leader who wants to give every existing member of our society the greatest chance not only to survive, but to thrive.

Given the issues that our country faces, and the backslide of progress even with a Democrat in office, it’s not hard to understand why only 50% of people between 18-29 voted in the last presidential election (up a hopeful 11 points from 2016). Still, since 1980 the voting gender gap has strongly reversed, with women showing up to the polls in the last nine elections. Black voters show up more consistently than any other group for the Democratic party. They feel, from the depths of their being, that this is not abstract. They do not lose hope every election year that they will see their reality reflected in the choices made by their leaders.

A message directly to the youth voters: My prayer is that young people will come out in the greatest numbers yet this year, rather than make the mistake I did in 2004. You are tasked with electing a leader who represents your concerns, with moving the country you will inherit toward progress. I also hope you will be inspired to work locally and nationally not just to change the laws but to change the face of power, so that your children can say the work that you did stuck. I know how much it pains our mothers and queer elders that they cannot currently say the same, despite giving it the fight of a lifetime. There is only so much that can happen when the face of power is not theirs.

And, while a female leader doesn’t always equal advancement for the marginalized (Margaret Thatcher wasn’t exactly for the girls and the gays, to paraphrase a Tik Tok meme), Kamala Harris has made it clear, in no uncertain terms, that these are issues that matter to her. Reinstating Roe is her immediate concern, and the Biden/Harris administration has made medication abortions available to any patient via telehealth (reducing the number of people with uteruses forced to undergo a humiliating series of ultrasounds and undermining lectures). She promises to make the health care subsidies set to expire at the end of 2025 permanent, meaning that the government would supplement the cost of state healthcare for anyone, without an income cap. I wish I could say her policies on trans people’s access to healthcare were this clear, and that the system wasn’t riddled with loopholes—I hope that she will hear the voices of cis women saying that women’s rights are meaningless unless they include all women, that gender affirming care is just as urgent as the fight to regain choice. In the meantime, our family has been focused on fundraising for candidates like Senator Sarah McBride who, if elected in Delaware, would be the first openly transgender member of congress.

I wish, on that election day in 2004, I had known where my body would take me, the questions it would force me to ask about access and dignity, and the answers that would play out as protracted fights to get what I needed in order to live. Fights with doctors. Fights with insurance. Fights with the pervasive perception of female pain as weakness and the female form as indecent. I am far from alone in that fight. In fact, I am a lucky one.

I wish I had known that our bodies are still the battleground.

We cannot let them win.