The relative silence of a queer – or even a gay – voice in the health care reform debate of the last six months is confounding. As someone who spent my 20’s and 30’s dealing with close friends and colleagues dying of AIDS, who watched many people become impoverished by their disease, and saw first hand how pre-existing conditions clauses rendered health insurance coverage useless when it precluded any coverage for HIV-related care, it strikes me that the lgbt community knows as well as any other group of people why these reforms – including a public option – are necessary.
But the implications of health care reform for the lgbt community extend well-beyond HIV – because the employer sponsored health insurance regime we live with is, essentially and unavoidably, hetero-patriarchal – it assumes the nuclear family as the typical unit needing and deserving insurance coverage. By insuring not only the employee but his spouse and minor dependents as well, our employment-centered health insurance paradigm imagines a male employee/head of household with a wife (who is not employed and therefore does not have her own insurance) and kids, all of whom were covered incident to the male adult’s employment. The family wage brought with it family benefits.
Rendered invisible, or at best marginal, in these policy choices around health insurance are those of us who cannot or will not get health insurance on account of a relationship to a husband or father who brings home both the bacon and a health insurance card. But gaying the story doesn’t quite fix the problem. Marriage equality advocates’ demands that same-sex couples be allowed to marry so that we too can get on the insurance policies of our well-employed partners somehow fails to get at the underlying problem of what is at bottom a health care delivery system that presupposes the nuclear family.
A queer approach to the issue would question the norm of a health care delivery system that privileges those people who are willing and/or able to organize their lives into a traditional household, with a head who is working a good job that includes health care coverage for all the rest in the family. Just as it is wrong to make better health care available to those who can afford it, so too, the queer argument goes, it is wrong to make health care coverage turn on one’s ability to line up your life like the Brady family. Good health care should have nothing to do with wealth or conformance with hetero-patriarchy.
Katherine Franke, cross-posted from Gender & Sexuality Law Blog