Let me begin by confessing that it has been a while since I have heard something new on the topic of same-sex marriage (SSM). After several years of gender studies courses in college and vigorous debates over Proposition 8, the topic of gender currently makes me feel the kind of exhaustion that can only come from struggling long and fairly fruitlessly with the utmost emotional commitment. So, I was pleasantly surprised by a recent encounter that showed me how at least one of the isssues that matters to both hetero- and homosexual couples might be resolved by a structural change in our political system that is seemingly unrelated to marriage: universal health care.
While volunteering at a local organization, I had the chance to converse with a woman who was in charge of benefits for the domestic and international divisions of a major company. When the topic of Proposition 8 came up, she remarked how much more controversial she found SSM or same-sex partnerships to be in the US than abroad. When pressed to answer why she thought that was the case, she remarked that in countries with universal health care, homosexual couples did not need the same kinds of benefits that couples in the US frequently need to provide critical services. In her field, the status of same-sex partnerships was always a bigger issue in the US than elsewhere, because the US doesn’t have universal helath care. By contrast, in places where everyone had access to basic services, spousal or partner benefits were not nearly as important, at least in the area of health care.
When we discuss marriage and its rights and benefits in the US, we generally tangle together a mix of political and spiritual relationships. But this woman’s comments have made me wonder to what extent our benefit and health care structures have unnecessarily contributed to this tangling. If some benefits, most notably health care, became the right of every citizen, then would this diffuse some of the anxiety around SSM, allowing us to more easily distinguish between the political and spiritual aspects of marriage in our conversations? I’m not taking a position on universal health care in this post, but it seems worth thinking about how historical differences in health care might inflect this other debate.
December 28, 2008 at 5:54 pm
Seems like a tough question since (nearly?) all wealthy industrialized nations have universal health care, yet SSM laws vary widely. Still, your question is not dependent on the accuracy of that woman’s statement. My guess is that universal health care would do little to change the debate in the US—we’d still have tax status, visitation, inheritance, child custody, etc. to worry about (from a political perspective).
December 28, 2008 at 6:04 pm
I am not sure if it is true, but I have heard that allowing same sex couples to have family rates on health insurance does cause the rates to increase. Same sex couples would be much less likely to have maternity claims but perhaps the risk of aids and related illnesses is a factor in the increased insurance rates.
December 28, 2008 at 6:08 pm
Interesting observation health care is certainly a big one. But as far as corporations go I know one guy who was listed as his aunts partner so he could have access to her companies benefits even though there was never a sexual relationship. She was allowed to list one unmarried person. So she used it to take care of family members.
December 28, 2008 at 8:02 pm
Gay people don’t want marriage rights because it will give them healthcare – they want the right to get married because everyone else gets it. Healthcare is certainly an issue, but not the fundamental one. Gay people just want to be able to marry the consenting adults they love – the same as straight people. Not very many straight people are getting married just because they want health insurance. It might be a factor, but they likely would have gotten married anyway because they love each other and want a part of the highest form of culturally accepted commitment.
Also, StillConfused: Perhaps insurance companies do consider gay couples a higher risk, however lesbians have the lowest instance of STDs – lower than straight people, so that actually seems unlikely: http://www.healthsquare.com/ftstd.htm
December 28, 2008 at 8:07 pm
I practice in the area of employee benefits, and have a number of clients that provide health benefits to same sex couples. While I am not an actuary, my understanding from the clients’ advisors is that providing same sex partner coverage has negligible, if any, effect on the per person cost, one way or the other. I think the reason why there generally is not a measurable effect on a per person basis is that the number of same sex partners who actually enroll is very small, and their individual situations are so different that, with the small numbers, it is difficult for actuaries (who usually work with large numbers) to identify a quantifiable effect.
Of course, there is an increase of overall cost if a company subsidizes the cost of domestic partner coverage–because the company is subsidizing the coverage of more people than it otherwise would. One study with respect to the Federal Government indicates that, over 10 years, the additional cost (for the full array of benefits) would be $675 million. http://www.law.ucla.edu/williamsinstitute/publications/S2521FiscalAnalysis_WilliamsInst.pdf
I do not see anything in the report indicating that per person costs would go up by adding same sex partners-but maybe I did not read it closely enough)
December 28, 2008 at 9:45 pm
“Per person” costs are irrelevant to an employer. The question for an employer is “per employee” costs. As a single person, I have always thought that the current employer oriented health system discriminates pretty heavily in favor of married employees, more especially those with children. That sort of discrimination ought to be illegal.
A better way to fix this problem would be to transfer the employer health care deduction back to the individual and let individuals buy in to their employers health plan on a non-discriminatory (i.e. full cost) basis or purchase their coverage elsewhere as they wish.
That would end the discrimination in favor of married employees and place everyone on a level playing field. If Congress then wants to encourage more children as a matter of social policy, they could increase the per child exemption to compensate.
December 28, 2008 at 9:52 pm
StillConfused, your screen name is apt and your post reveals latent homophobia. Why would would you assume that people in a committed, legally-sanctioned, presumably monogamous marriage be at higher risk of Aids? Is that you think gay people are incapable of being monogamous?
December 28, 2008 at 11:05 pm
I’ don’t see how health care would make a difference in the SSM debate.
In California, it was (and still is) against the law to treat a same-sex partner differently in terms of health benefits than it is for a couple in a traditional marriage. Even with the passage of Prop 8, same-sex couples in a domestic union have all the legal rights and obligations of a married couple, except for one, and that’s the right to use the word “marriage” as a legal term to describe the relationship.
What the SSM debate is about isn’t health care, visitation rights, probate or anything of the sort. On the pro-SSM side, it’s about erasing the stigma of homosexuality from our culture. On the anti-SSM side, it’s kind of the flip side of that, trying to make certain that homosexual and heterosexual relationships aren’t seen as the moral equivalent. And that’s why we’ll have universal health care before the SSM issue is resolved (and I don’t think we’ll have universal health care any time soon).
December 28, 2008 at 11:35 pm
#6, how does the current system discriminate in favor of married employees? I don’t follow.
December 28, 2008 at 11:37 pm
I don’t think health care has anything to do with it. I suspect that marriage is more important to gay-rights advocates in the US because the stigma against homosexuality is greater in the US than it is in certain other countries (which happen to have universal health care). The marriage equality issue in the US is not really about any specific right. It’s about lessening and eventually removing the stigma against homosexual relationships. The attendant rights of marriage are the gravy. I don’t mean to discount the importance of gravy here. But if it were only about a set of rights, we would have reached a compromise by now.
December 28, 2008 at 11:39 pm
gfe, you wrote: “same-sex couples in a domestic union have all the legal rights and obligations of a married couple,” which is incorrect. I watched an interview with a lawyer practicing in CA, and although she did not elaborate on what they were, she explicitly said that there are still several things that aren’t covered under domestic partnerships in CA that ARE covered under marriage (I think she said they were mostly in relation to estate taxes, but I’m not totally sure).
One thing I know that isn’t the same is that domestic partners must live together to be legally considered domestic partners, whereas married couples can live apart. That can certainly create hardship if one partner has to work far away, or out of state (as some married couples I know do).
In any case, as you stated, it has to do with the stigma. Separate is not equal, no matter how many details are the same. Healthcare is a detail of the issue, not the issue itself.
December 29, 2008 at 12:09 am
Rebecca, any substantive legal advantage of marriage over domestic partnership in California is a result of federal law, not state law. Prop 8 was designed to maintain the sole advantage of marriage over domestic partnership in California: the application of the term “marriage.” The passage or failure of Prop 8 could have no effect on anyone’s health care benefits one way or the other. Most opponents and proponents picked up on this, and it was not disputed.
December 29, 2008 at 12:18 am
re: 10
“….we would have reached a compromise by now.”
Oh were it so.
I see no evidence for this.
December 29, 2008 at 12:39 am
gst:
In theory, this is true, but in practice, not so much.
December 29, 2008 at 8:52 am
Mark #6 I just spent 4 years working for a company that had the employees pay for their own insurance. Very very few employees participated. Most went without insurance.
December 29, 2008 at 9:55 am
#7. Please re-read the first few words of my post…. “I am not sure if it is true but”. That might set your mind at ease as to your incorrect assumption.
I personally have an individual health insurance policy. Since I am a healthy person it is SUBSTANTIALLY cheaper than any group plan I have been offered, ever, even as a federal employee. (I don’t know about you but I was astonished to read that). I also have an HSA which allows me to control my health care costs and decisions. I wouldn’t have it any other way.
December 29, 2008 at 10:17 am
I also do not think that a change in health care will change the debate much. The real difference is how religion is viewed in the USA versus Europe and elsewhere. Religion is very active in politics here, especially on moral issues such as abortion. Not so in Europe, which is rather interesting given that Italy is the center place for Catholicism, Germany for Lutheranism, and England for the Anglican Church! These religions do make policy statements on certain topics, such as the Pope recent statements on homosexuality and SSM, however it does not seem to affect decisions by the largely Catholic government in Rome.
While archbishops here will refuse the communion to pro-abortion/pro-SSM politicians, you do not have that happening in Europe.
December 29, 2008 at 11:56 am
Well said Rebecca #11 and Rameumptom. That’s why I feel so strongly that faith-based coalitions are better served by lobbying the U.S. Government to get out of the “marriage” business all together and award civil unions universally. This approach distributes social bennies equally, neutralizes zealous extremists on both sides of the debate, and BONUS… this solution keeps the various faith claims of divine concern/authority over marriage separate from state concern/authority while leaving the faiths in positions of authority with their followers.
December 29, 2008 at 12:01 pm
This drives me nuts. How is it the guy with six kids gets to pay the same amount for health insurance that I pay with my two children?
December 29, 2008 at 12:36 pm
jjohnson it works the other way to.
It makes me nuts (tongue in cheek kinda) that you and your spouse will collect the same SS when retired as I will with 5 kids paying into the system.
December 29, 2008 at 12:42 pm
#20. What does the number of children have to do with social security retirement payments? Ahhh… unless you are saying that social security payments are really funded by subsequent generations. That is actually a very witty statement if that is what you mean.
December 29, 2008 at 12:50 pm
That is what I mean.
December 29, 2008 at 2:48 pm
MarkD (#6)
“That sort of discrimination ought to be illegal.”
Usually “illegal” discrimination is reserved for the kind of things that, uh, can’t be changed/altered…like, say, age. Or sex. Not so much for your personal choices in child bearing.
Specifically, what discrimination are you talking about? I have a wife and two kids, and my two coworkers are single. They pay roughly 1/3 of the premium that I pay.
December 29, 2008 at 6:48 pm
Well, I suppose it depends on how you define “compromise.” If “compromise” = same-sex couples get the right to marry (or alternatively, the state leaves the marriage business altogether), then no, I guess there is no evidence that a compromise is anywhere on the horizon. There’s certainly a contingent of people who refuse to grant any legal status to homosexual partnerships that could possibly be construed as “marriage-like,” but it’s not nearly as strong as the contingent of people who support virtually-equivalent-to-marriage-in-all-but-name proposals. At least that’s the case in politically insignificant Oregon, where a large majority of people favor a compromise along those lines. Of course, there’s also a contingent of people who won’t settle for anything short of marriage equality for gays, and they refuse to support civil unions or reciprocal-benefits proposals (probably because they feel so close to getting marriage that they can taste it). Anyway, I’m not saying they should compromise. Just that they don’t.
December 29, 2008 at 11:13 pm
You’re probably right, Rebecca. Here in CA I have the sense that people are in no mood for compromise at this point, especially younger people. I find myself increasingly agreeing with them. Think of it from our perspective: Why should gay families say OK to a separate-but-equal situation? Why wouldn’t they fight what is perceived to be overt legal discrimination, especially given the history?
A legal marriage in all-but-name is still a marriage.
December 29, 2008 at 11:28 pm
I wonder if we should just get employers out of the health insurance business altogether and have single policies for everyone. It seems that would de-politicise the matter greatly. We don’t look at employers to pay our car insurance or home insurance. Probably not practical at this point but it would be interesting to see the change in dynamics.
December 29, 2008 at 11:39 pm
#19: “This drives me nuts. How is it the guy with six kids gets to pay the same amount for health insurance that I pay with my two children?”
Well, where I work, there are three price levels, and so far as I’m aware, they’re set by the insurance entities: employee alone, employee with 1 dependant, employee with 2 or more dependants. I don’t know if it’s an economy-of-scale kind of thing, but those providing the health care (or paying for the cost of it) don’t seem to see much of a difference between a guy with 2 kids and a guy with 6.
December 29, 2008 at 11:59 pm
Scott (#23),
If your employer is paying a pro rata share (50% say) of the cost of each employee’s healthcare benefits, then they are providing three times as much subsidy to you as they are to the single employees you mention.
December 30, 2008 at 12:30 am
Kids are pretty low cost for insurance. My kids have only surpassed our deductible about 1 out of every 3 years.
Until the government provides insurance employers will need to keep stepping up. Private insurance is next to useless. Most private insurance I have found are major medical only which means the first 5 grand each is out of your own pocket for the least expensive. In the last 20 years only my wife has ever gone over that amount. If you have pre-existing conditions government subsidized plans are the only option available because private companies can deny insurance to anyone they want to. I could go on but I think you get the idea private insurance is a joke if you are not young and healthy.
December 30, 2008 at 1:05 am
28, seems like then employers would be more likely to hire single people, because their benefits are cheaper. Of course, that sort of discrimination would actually be illegal.
December 30, 2008 at 1:10 am
According to the Kaiser Family Foundation, in 2008 the average employer will contribute $3,983 for an individual health insurance policy and $9,326 for a family policy for each employee. That corresponding average employee contribution is $721 for employees with individual policies and $3,354 for employees with family policies.
In other words, the average employeer pays an employee with a family plan $5,343 more in yearly total compensation than they pay employees with individual plans. That is pretty sizeable discrimination if you ask me. In addition, it provides employers with a significant incentive to discriminate in favor of single employees, even where such discrimination is illegal (as it is in many states).
December 30, 2008 at 6:34 am
My employer pays half for single coverage, period. If you have family coverage you pay 100% of the incremental cost. Not too many people have family coverage.
December 30, 2008 at 10:09 am
#29. I have a high deductible policy tied to a Health Savings Account. It is for major medical. Basically, I provide 100% of everything below $5000 and the insurance company pays 100% of everything above $5000. My policy is for me and my daughter and is about $100 a month. I love it. I am in complete control of my medical expenses. With my health savings account, I am able to put the $5000 a year into an account which I own, pre-tax. In other words, the spread between the high deductible insurance cost and the “regular” insurance cost is mine to keep… not the insurance company’s. I build equity in my good health.
The problem with the way health insurance is now is that it provides an incentive to overuse or abuse the system. If a person is paying all of these thousands of dollars for medical insurance, they may feel the desire to “get their money’s worth”.
Now granted, having a high deductible policy puts more burden on the insured to budget his money. But I am confident that folks can step up to that task if they need to. We already do that in so many other parts of our lives.
In addition to the great tax benefits, what I love about my HDHP is that I have a completely different dynamic with my medical service providers. They know that they are answering to me and not to an insurance company. There has been a marked improvement in the level of care and interaction since I have switched to HDHP.
I for one want the government as far as possible from health care. They have completely screwed up social security. I want less interference between me and my doctor, not more.
December 30, 2008 at 10:36 am
Rameumptom, #17
You do realize that Catholic Ireland, Poland and Spain, along with Lutheran Germany, all have much more restrictive abortion laws than the US, right?
Same-sex marriage is only recognized in 4 European countries, Norway, Spain, Netherlands and Belgium.
SSM
Abortion
December 30, 2008 at 10:51 am
Employee health insurance is a benefit, it can be negotiated anyway you want.
I work for a large multi-national who is willing to provide all sorts of family benefits. Apart from insurance, as a family we receive a larger travel allowance, a larger, company-provided home and vehicle, schooling allowance, vacation stipend and in our case, paternity leave.
If it wasn’t provided, the same costs would be lost to recruitment and training. The company has an interest in keeping their employees happy. Nor does it discriminate against a single employee, because those same benefits are available should they have a family of their own.
December 30, 2008 at 12:20 pm
MAC (#35),
That is all fine and good as long as the company is required (or even allowed) to raise the salaries of comparable (usually single) employees who either do not need or do not want expensive family coverage.
Now one might say that it is rational for companies to discriminate in favor of married employees because such discrimination is pervasive. That indeed is why there ought to be a law forbidding such treatment.
December 30, 2008 at 3:43 pm
Sorry you feel that you’re taking one for the team MarkD. If you were a good employee and able to make a strong case you would suggest to your company that you are worth at least an extra 2k more than the comparable family employee because he is charging the company $5k more in expenses that you are saving them.
And if you were worth it they would give it to you, or you would go and get that pay somewhere else.
Maybe instead of whining about how things you dislike “should be illegal” you should go out and work as hard as you can and make what you are worth.
Nobody is forcing you to work for this company and nobody is forcing the employers to pay for the healthcare. They do it because they feel their employees are worth it.
And if you want to get controversial, a case could be made that of two employees, with comparable skills and experience, the one with kids is worth the extra premium the insurance pays.
The previous company I worked for had an unwritten, but spoken, policy that people without a spouse and/or children should not be placed in positions of access to very large volumes of expensive products. The reasoning was that a person with a wife and kids had a lot more to lose if they got caught stealing than the one without. Maybe it is discrimination in this case. Of course, if a single, established responsible person was available they would also be given access, but only after clearly proving responsibility.
It’s not perfect and you can poke a dozen holes in it. But generally people with kids, who are decent people, who are responsible, have a different (and dare I say better) experience/skillset than people of a similar nature without kids.
Hopefully this doesn’t offend, and I’ve probably stuck my foot in my mouth with the wording, but I think we can all agree having kids adds something to a person if they are responsible, and that “Something” it adds can be of benefit to an employer.
December 30, 2008 at 4:43 pm
Sam: Much of your comment is unfounded personal supposition. In particular, I don’t work for any such company, and it wouldn’t be relevant if I did.
However, it is worth noting that it in most states it is illegal for an employer to do what you are suggesting. Benefit discrimination is the only area where this sort of thing is generally legal (due to legislated exceptions I understand). Salary, hiring, or promotion discrimination based on marital status could land an employer in a lawsuit in a hurry.
In other words, current laws require employers that pay part of the cost of family plans to discriminate against single employees without children, and forbid them to compensate for the cost differential in the form of extra salary. That is not to say it doesn’t happen under the table of course.
December 31, 2008 at 12:51 am
re: 37
Here in L.A., I see no evidence to support your observations. On the contrary. At the hospital where I work, the mid- to senior managers have very few children. Ditto my partner’s company, where it’s even worse. None of their top execs have large families. Both of us are in a work environment composed almost entirely of divorcees, gays, and DiNKs.
Where do you live, sam? I wonder if this is some red state/blue state thing.
January 1, 2009 at 4:42 pm
Still confused #33 your point about abusing the system is true but as a 40 year old Male with no preexisting conditions my cost was closer to 2000 for the year. How many people do you honestly believe will fork out 2000 dollars or even a 1000 with virtually no payback. How many people will spend for preventive care? Talking to dozens of real people that were in the same situation as I was and none of them chose to carry any insurance at all. None of them would even think of going to a doctor unless they had been ill for a long time or was seriously injured. Health care is still a leading cause of bankruptcy.