Healthy Societies

One reason the legal recognition of gay marriage or civil unions is so important is very prosaic: health insurance. Currently, if you are gay and don’t work for an enlightened employer, you cannot put your partner (or your partner’s children unless you have somehow established a legal relationship with them—itself not easy) on your health insurance.

 Of course, that assumes your employer even offers health insurance. And the number of employers who do is declining.

 The bottom line is that America’s refusal to deal with our dysfunctional health system in a rational way affects gays and lesbians and poor people disproportionately. It is one more example why bad public policy—and not just bad policy on obviously gay-related issues—is especially important to the gay community. (The same thing is true of the battle over “net neutrality”—if the giant telecoms get their way, the web sites that will be hurt will disproportionately be those with fewer resources, those espousing less “mainstream” opinions. There are many issues with grave consequences to the community that are not “gay” issues.)

 So what would a rational, economically and fiscally sound, humanitarian and fair health system look like? What if the country were to go to a “single payer” health insurance system funded through tax revenues and administered through selected insurance companies, as is done in western Europe?

  •  Increased economic development/job creation and competitiveness with foreign companies. Businesses currently expend an amount in excess of total net profits on health insurance for employees. The cost of health insurance is the single largest “drag” on new job creation. For companies that can afford to offer health insurance, negotiating and administering those benefits, and complying with government regulations attendant to them, consumes untold hours of HR time as well. (It should be noted that doctors’ overhead would similarly decline: currently, medical offices spend considerable sums on personnel whose sole job is confirming insurance coverage, complying with insurer regulations, submitting claims and collecting amounts due.) Smaller companies—the engines of economic growth—are often unable to offer benefits, putting them at a competitive disadvantage for good employees. If health coverage was de-coupled from employment, these enterprises would be able to add workers. Employers could also increase wages by some percentage of the amount currently being paid for insurance.
  • The additional tax revenues needed to accomplish this would be minimal, for the following reasons: governments at all levels already expend huge amounts for health, through Medicaid and other federally required programs (Mothers and Children, AIDS, etc.), through benefits for public employees (Universities, police, public school teachers, etc.), and through support for public hospitals. A national system could effect considerable savings, by standardizing paperwork and administrative procedures (it is estimated that 30% of U.S. healthcare costs are administrative); negotiating with insurers to administer the program on condition that the premium structure eliminate marketing costs that are now included; providing more effective public health and prevention services; and by negotiating with drug manufacturers and other medical vendors for lower prices. Cost controls would also be enhanced by eliminating the practice of cost-shifting by hospitals (where those with insurance pay prices that have been inflated in order to cover the costs that cannot be recovered from those without), and by efficiencies of scale. Costs also decline when people are able to access routine medical care soon after the onset of symptoms, rather than visiting far more expensive emergency rooms when they can no longer ignore the problem.
  •  Individuals would save money. Auto and homeowners insurance premiums would decline, because the underwriting would no longer need to take the costs of medical care into account. The considerable percentage of citizens who are currently uninsured would not incur significant out-of-pocket costs attributable to illness or accident.
  • If all citizens had basic health coverage, we would also experience a decline in the social costs associated with the current dysfunctional system. Over 50% of personal bankruptcies are attributable to medical bills; those bankruptcies cost businesses millions of dollars, and are a drag on the economy. Employees with pre-existing conditions would no longer be chained to jobs they dislike. Absenteeism could be expected to decline. Immunizations would increase, and infant mortality decline. Studies also suggest that violent crime rates decline as social safety nets increase. While not quantifiable, these consequences are significant.

 And gay families would no longer face barriers to adequate medical care that straight citizens don’t face.