Single-payer Health Care Works Best for Singles...and Everyone Else

Today, Singletude was going to feature a review of Internet Dating Is Not Like Ordering a Pizza by Cherie Burbach, part of the gift basket giveaway contest ongoing till Sept. 28, 2009. However, with Congress in recess and the fate of the American health care system still up in the air, I feel compelled to address how our current options will affect the single population.

Unless you've been living in a cave and eating grubs with Geico actors, you know that President Obama has introduced health care legislation that would allow the private insurance industry to coexist alongside a so-called public option, which may amount to nothing more than a private co-op that could claim non-profit status but still behave like a for-profit company. (Don't believe me? Kaiser Permanente and a number of Blue Cross Blue Shield franchises are registered not-for-profits.) The proposal might accomplish a number of admirable things. It might make preexisting condition exclusions a thing of the past, forbid companies from dropping policyholders, cap rate hikes and out-of-pocket payments, eliminate gender-based discrimination, and insure single young adults for longer. It might provide a more affordable plan that would be subsidized for those earning up to 400% above the poverty line. But for all the good it promises, this "reform" is just as likely to make a bad situation worse. Especially for singles and, in particular, single women.

Singles are more likely to be uninsured than married couples are, and 49% of single women have no insurance. It's not a coincidence that single adults are also, on average, worse off financially than their married counterparts. Many if not most of these singles simply can't afford health coverage. Yet a main component of the health care reform under discussion would be an individual mandate to obtain insurance.

Although the aforementioned subsidies would help, they would phase out for singles making a little over $40,000 a year. In some areas of the country, a salary of $40k is just scraping by. Certainly in New York, an individual wouldn't even qualify for a studio on that income. What makes the government think that people in that position can afford to pay several thousand dollars a year toward health care? Some may argue that no one needs to live in a metropolitan region, but that's where the jobs are.

Switching gears to the lower end of the income spectrum, unless the government subsidy represents the full cost of the premium, how will people who already can't pay their bills bear the burden of yet another monthly charge? Some low-income adults, especially young, healthy singles, forgo insurance because it's a financial burden that doesn't pay off for them. They can save more money by paying out-of-pocket the few times a year that they need care. An individual mandate would force them to pay full price for a product they underuse. But, as we'll see, the suggested mandate is the least of our possible woes under this new system.

The reason universal health care works in other industrialized nations is because they have single-payer systems. That means there aren't any competing, profit-driven insurance companies, just one organization that covers health care expenses in each country. The people of these nations pay a tax for this, but they don't have to pay premiums, deductibles, or co-pays. Ever. There is no annual maximum on their benefits, after which they'd have to go into debt to pay out-of-pocket. They never have to get pre-approvals, authorizations, or referrals before they can receive the care they need. They don't have to worry that the best physician in town might be out of network. They're not kicked out of their hospital beds the day after surgery or told they can only have 10 treatment sessions, so they'd better hurry up and get well. Perhaps best of all, their health care decisions are made by their doctors, not some overpaid bureaucrats in an office far away. Good single-payer systems put the decision-making power in the doctors' hands because they're public services and, as such, are beholden to taxpayers, not Wall Street investors. To keep costs down, they reward doctors for improving preventive care rather than rewarding faceless managers for denying it. Sounds like utopia, doesn't it?

Single-payer health care works because it creates one enormous risk pool. The bigger the risk pool, the less any individual has to pay. It also works because it eliminates the tremendous expenses incurred by for-profit insurance providers and the medical personnel who have to deal with them, both of whom pass on these expenses to consumers. In other Western countries, the pharmaceutical industry is regulated, too, which prevents price gouging. That's why Americans can get such good deals on drugs from international pharmacies.

Unfortunately, Obama's health plan will do none of these things. It will just add another insurance option to the mix. He's betting that this lower-cost option will force private companies to reduce their premiums. A more likely and frightening outcome is that anyone who can't afford private insurance because they're high-risk (the poor, the unemployed, the unhealthy, and the elderly) will flock to the public option, which will go bankrupt before you can say "bailout." Meanwhile, the insurance industry and big pharma will keep on keepin' on, finding ways to circumvent the law and deny consumers coverage because these are businesses. They run on a business model. That means they can't make a profit unless they take in more consumer dollars than they pay out. That's why 77.9% of bankruptcies due to medical expenses are filed by insured Americans. For-profit insurance is an illusion of protection at best.

In 2000, the last year that the World Health Organization ranked the world's health care, the U.S. health system placed 37th, scoring behind countries like Andorra, Oman, Iceland, Colombia, and Morocco. Isn't that embarrassing? Meanwhile, the rest of Western Europe outlives us and loses fewer infants at birth. It's not because they drink wine with dinner, either. It's because they have access to free health care for everyone. Contrary to what fear mongers would have you believe, single-payer health care wouldn't mean extending the clunky Medicare program to everyone. It would mean totally revamping what we now call Medicare and remodeling it based on proven programs in other progressive countries. Yes, the government would have a hand in it. Just like it does education, law enforcement, the postal service, public transportation, and other services which--fancy that--work pretty well.

At this sensitive moment in time, we singles, both insured and uninsured, have a precious chance to speak up for health care for ourselves and everyone else. That's a big part of what we elected Obama for. Let's not sit by and watch a few greedy, self-centered politicians ruin it for the rest of us! When the House reconvenes, our representatives will finally be voting on H.R. 676, the United States National Health Insurance Act, which would create a single-payer health care system for all Americans. A health care system that doesn't discriminate based on marital status! No longer would any of us have to feel pressured to get married or stay married for access to medical care. No longer would our salaries subsidize the health benefits of married employees. What a monumental breakthrough a single-payer system would be, not even just for health care but as a precedent for dismantling legalized discrimination against singles!

Here's what you can do to spread the word about H.R. 676:
--Call and/or write to your representative.
--Write to President Obama.
--Write a letter to the editor of your local paper.
--Distribute flyers at a busy place in your town.
--Canvas door to door or on the phone.
--Write about it on your blog or web site.
--Leave comments about it on political web sites and blogs.
--Talk to your friends and family about it.
--Sign petitions.

To find out more about H.R. 676, including what you can do to help raise awareness about single-payer health care, check out these links:

Change.org: Free Single Payer Health Care
Dennis Kucinich: Universal Health Care
HR676.org
HR676.org Blog
Healthcare-NOW!
John Conyers, Jr.: Healthcare
SiCKO: What can I do?
PNHP (Physicians for a National Health Program)
Unions for Single Payer Health Care


What kind of health care system would you like to see the U.S. adopt? Why? How do you think the system you prefer would benefit singles?


Fun Link of the Day


Do you have a question for Clever Elsie about some aspect of the single life? Have a rant or rave about singlehood? Write in, and you just might see your question in a Singletude Q&A or your rant or rave in a Singletude Sound-off!

"Marry Well for Better Health" by Dr. Christopher Lillis: A Singletude Response

Those of you who perused last Sunday's edition of "Singles in the News" may remember the article "Marry Well for Better Health" by Dr. Christopher Lillis, which sent me into spasms of singlist-inspired horror. To quote from the Singletude summary:

Written by a doctor who is a self-described "very biased" newlywed (and takes pride in his prejudice, too), it trots out unidentified research studies to "confidently make this claim. Married men survive longer and live healthier lives than their single or divorced counterparts." Although the author admits those results were contingent on how happy the marriage was and cautions single men not to grab the nearest woman and drag her to the altar, he'd still rather advance his pet theory about the miracle drug of marriage than present hard evidence.

So, Dr. Lillis tosses out a few health measures on which married people score well while failing to mention the measures on which singles score better. (Oh, sorry. He mentions one such measure--obesity--but dismisses it since he's sure his new bride will nag him to lose weight. Let's catch up with him in 10 years and see how that's working out, shall we?)

He also neglects to inform his impressionable readers that, in many cases, the differences that do exist between marrieds and singles who have never married are marginal. If anything, he exaggerates the differences by lumping in people who have always been single with those who are divorced or widowed, two groups that sometimes do show a marked difference on health measures as compared to marrieds. (Singletude's information, by the way, comes from the CDC study "Marital Status and Health: United States, 1999-2000" by Charlotte A. Schoenborn and "Is There Something Unique About Marriage? The Relative Impact of Marital Status, Relationship Quality, and Network Social Support on Ambulatory Blood Pressure and Mental Health" by Julianne Holt-Lunstad, et al., discredited here by Dr. Bella DePaulo. Lillis doesn't say where his comes from.)

Even worse, Lillis takes some of these correlations and makes causal statements about them, asserting that married couples are "healthier" because they have a sense of responsibility to each other or because "getting married reduces depressive symptoms." The fact is we have no way to measure whether marriage causes any of these minor health differences or, if it does, how or why. If studies of singles and marrieds do show significant differences in, say, risk taking, perhaps that's because single people tend to be younger, and youth is associated with risky behavior. If singles do have slightly higher resting blood pressure than marrieds, maybe that's not because they're alone in their beds but because they worry more about things like health care or social security, which are more accessible to married couples.

No matter what, we can't talk about what marriage causes or doesn't cause because marriage is not a variable you can manipulate like an electric shock to get an experimental result (though some would say divorce gave them quite a jolt). See, marital status is similar to traits like age, ethnicity, religious affiliation, and sexual orientation in that the researcher can't change them. In order for a researcher to claim that something causes an effect, he or she has to be able to add or remove it at will to demonstrate that it was solely responsible for the outcome of the experiment.

To use a nonsense example, if a researcher wants to prove that everlasting gobstoppers turn kids blue, then she has to take two groups of kids that have never eaten everlasting gobstoppers and make sure that one group eats them and the other doesn't. In addition, she has to make sure that there are no other dietary, environmental, genetic, or medical differences between the two groups that might explain why some kids look like they fell in a blueberry bush. If, after determining that there are no differences between the groups except that one is getting gobstoppers, the researcher finds that the kids who eat gobstoppers turn blue, then she can tentatively state that gobstoppers may cause kids to turn blue. Why tentatively? Because, as careful as she was, maybe there was some other difference between the groups that she missed. That's why studies are repeated over and over again for confirmation and why most scientists are very, very careful when they talk about causation.

However, let's say the researcher is faced with two groups of kids, one that's already blue and one that's not. She wonders why some kids are blue, and she asks all the kids a bunch of questions and notices that the blue kids all used to eat gobstoppers. Well, that's interesting, and the researcher can say that she found a relationship or correlation between gobstoppers and blue kids, but she can't know with any certainty that the gobstoppers caused the kids to turn blue. Maybe the kids who turned blue were also eating snozberries, and maybe it was actually the snozberries that did the damage. Or maybe the kids who turned blue were suffering from a rare, unknown sugar deficiency that affects skin tone, so they craved lots of sweet gobstoppers.

Saying that marriage causes anything is like saying that kids who are already blue definitely got that way because they ate gobstoppers. We just don't know. And even if we could randomly assign some people to be married and some to be single and observe the results, it would still be hard to make causal attributions because, just like the researcher in the first example, we might've overlooked something.

For some reason, though, when marriage is the subject, researchers and clinicians fall all over themselves with eagerness to make causal statements. I'm not sure why that is. Maybe it's because marriage is popular and relatively easy to enter into, so it encourages people to hear that something they perceive as desirable and ubiquitous is good for their health. It's also possible that the reasons are more sinister and revolve around a research agenda that favors the status quo for economic or political reasons. Whatever it is, medical professionals like Lillis are highly irresponsible when they jump on the bandwagon and repeat these fallacies to patients and readers who don't know any better.

Towards the end of the article, Lillis plays devil's advocate for a minute, but even his counterargument, which posits that healthier, "more genetically appealing" people are more likely to get married, is insultingly singlist. No, Dr. Lillis, the problem is not that we singles are all Quasimodos compared to you strapping, married bombshells. It's that we singles are less likely to have health care. It's that we can't take time off work to heal from illness or injury because we have no second income. It's that we have more financial woes in general because we earn less and pay more than you marrieds do, and that's stressful. It's that we face a lot of social discrimination (the kind of discrimination you're guilty of right now), and that's stressful, too.

Unfortunately, I'm not sure Lillis can understand this logic because in the most presumptuous statement of his presumptuous article, he demonstrates an appalling lack of it. Check out this statement in all its singlist glory:

There is no real way to prove this [that marriage does not cause better health]; it is just a bitter, jealous theory of a loveless set of scientists who spend too much time in the lab to find true love.

Oh, dear, dear, dear. Doesn't Dr. Lillis realize that the burden of proof is on him? The scientific method always assumes no cause-effect relationship until one is proven. To return to our blueberry bunch, the researcher must assume that gobstoppers don't turn kids blue unless she can prove conclusively that they do. In direct contradiction to universally accepted research practice (and logic), Lillis says the exact opposite--that gobstoppers must turn kids blue unless we can prove that they don't. Good news for quack researchers everywhere! Now you can assume Santa Claus, the Loch Ness Monster, and spontaneous human combustion exist until someone proves that they don't!

Lillis's lapse in logic might be forgiveable if it wasn't laced with all that singlist rhetoric. I'll tell ya what, Dr. Lillis, let's invert your statement so that it's both logically valid (instead of fallacious) and anti-marriage (instead of singlist) and see what we get:

There is no real way to prove that marriage causes better health; it is just an ignorant, narrow-minded theory of a codependent set of scientists who spend too much time at home to get out and see what the real world is like.

Here's another good one:

There is no real way to prove that marriage causes better health; it is just a desperate, envious theory of a bored-stiff set of scientists who spend too much time tied to the old ball and chain to have any fun.

Just gotta do one more! Here we go:

There is no real way to prove that marriage causes better health; it is just a sad, pathetic theory of a lonely set of scientists who've wasted too much time in loveless marriages to admit they'd be happier alone.

Now, do any of those statements sound appropriate to make to a married patient? Would you, Dr. Lillis, want someone to make such a statement to you? Then why, I wonder, do you believe it's appropriate to talk that way to your single patients and readers?

Even if Lillis's interpretation is right on the money and marriage is the fountain of youth (which I don't think it is), I'm not sure what would be the point of saying so. A marriage certificate is not a drug that you can dispense when a single person straggles in with the flu, and if it were, it would have a pretty poor track record. If you think of marriage like a drug (thanks, Bella DePaulo, for this analogy), it doesn't work for at least half the people who try it (those who divorce), not to mention the unknown percentage who stay married unhappily. What doctor recommends a drug that's effective for less than half the people who take it?

In conclusion, I want to state for the record that I am single and in good health. I don't smoke, drink heavily, or have other substance abuse problems. I'm not a risk taker. I am not depressed. My blood pressure is so low that it actually causes problems occasionally. Despite what Lillis says about singles who don't take care of themselves, I go to the doctor when I'm concerned that something's wrong.

Interestingly, my dad, who is married, does not. In fact, when I noticed a worrisome skin lesion on his back awhile ago, my mom, his wife, said that she'd been after him to get it looked at for months. You know who convinced him to go to the doctor?

Me. His daughter.


What do you think about Dr. Lillis's article? Do you think married people are really healthier than singles?


Fun Link of the Day


Do you have a question for Clever Elsie about some aspect of the single life? Have a rant or rave about singlehood? Write in, and you just might see your question in a Singletude Q&A or your rant or rave in a Singletude Sound-off!