HEALTH CARE: News Weekly
ObamaCare's assault on the family
, April 16, 2011
With US Republicans pushing to repeal President Obama’s health care proposals, the following analysis by Dr Bryce Christensen, editor-at-large of The Family in America journal, shows how deeply Obama’s health care plan undermines family life in America.
“When it comes to the cost of health care,” President Obama declared in 2009, “this much is clear: the status quo is unsustainable for families, businesses and government. America spends nearly 50 per cent more per person on health care than any other country.”
Americans indeed heard a great many ideas from the Obama administration to reduce the staggering cost of care: establishing a public health-insurance program and then negotiating discounts with medical providers serving those insured by that program; reducing waste and fraud in medical care; investing in wellness initiatives that combat obesity, sedentary lifestyle and smoking; guaranteeing access to preventative medicine; requiring transparent pricing of medical services; reducing unnecessary diagnostic tests; cutting administrative costs — and the list goes on.
The need to rein in health-care costs has indeed grown urgent. National expenditures have risen from US$28 billion in 1960 to more than US$2.5 trillion in 2009. Even if numbers are adjusted for inflation, Americans have witnessed more than just a dramatic escalation of health-care costs. This has been an explosion.
Yet, despite claims to the contrary, the Obama administration and its allies never put all ideas for dealing with this explosion on the table. Indeed, some very good ideas — namely, those that would rein in health-care costs by reinforcing marriage and family life — never appeared on the Obama administration’s list at all.
Moreover, some measures that the Obama team vigorously endorsed — and now is enacting — exacerbate the health-care crisis by further weakening marriage and family life. For close scrutiny of the Obama administration’s effort in championing health-care reform reveals a fundamental animus toward family ties that are essential to safeguarding good health and to providing care.
This animus can only mean that President Obama and his allies care more about enlarging their political power than they do about reducing the burdens of health care.
The possibility of checking health-care costs by renewing marriage and family life would likely strike the Obama administration as absurd and irrelevant. It shouldn’t. A growing body of epidemiological evidence identifies an enduring marriage and an intact family as powerful safeguards of health.
What is more, researchers report that even when illness does strike the married couple or the intact family, those afflicted can often receive care at home rather than in a hospital and in many cases can even do without the costly care of the sort that only professionals can provide. In contrast, researchers find that adults living without a spouse and children living without both parents are often those who most desperately need professional care in the costly setting of the hospital.
Wedlock as ultimate health protector
The sheer volume of research documenting the health-protecting effects of marriage and family life precludes more than a brief summary. Such effects came into view long ago, as soon as researchers began to apply modern statistical techniques to epidemiological data.
As a pioneer in this area, British scholar William Farr recognised in 1885 the significance of wedlock as a safeguard for health: “Marriage is a healthy estate. The single individual is more likely to be wrecked on his voyage than the lives joined together in matrimony.”
Since the late-19th century, Farr’s conclusion has found repeated corroboration among epidemiologists. In 1985, a team of researchers writing in Social Science and Medicine summarised a great deal of research in a ringing endorsement of Farr’s conclusion: “One of the most consistent observations in health research is that married [people] enjoy better health than those of other marital statuses,” adding that “this pattern has been found for every age group (20 years and over), for both men and women, and for both whites and nonwhites”.
At the beginning of the 21st century, researchers from Wayne State and Pennsylvania State Universities strongly confirmed that a “major benefit of marriage is better health, with the best health accruing from long-term stable marriages”. The Wayne State and Penn State scholars acknowledge that marriage patterns have changed as more and more Americans have avoided or postponed wedlock or have terminated their marital unions through divorce. Yet they insist, “The significance of marriage [in affecting health] has not diminished — marriage has powerful and pervasive health benefits.” “The consistency of the health benefit of marriage, across all domains of health, is remarkable,” report the researchers, who note that this benefit holds for men and women and for all ethnic groups.
Any doubt as to the healthiness of the married state should give way before a 2009 study published by researchers from Johns Hopkins and the University of Chicago. This study offers “strong support” for the hypothesis that “the short-term effects of marital status … extend to the long term and accumulate over the life course”. More particularly, this study establishes a clear pattern favouring those in enduring marriages: “Those who have never married have more mobility limitations, rate their health as worse, and show more depressive symptoms than the married. Those who have married once and remained married are consistently, strongly, and broadly advantaged.”
To be sure, epidemiologists can explain some part of the advantage that married people enjoy over unmarried peers as merely the consequence of self-selection: sick people don’t marry or cannot maintain a marital union if they do. But the evidence indicates that such self-selection accounts for only a relatively small part of the advantage.
American demographer John E. Murray likewise discounts self-selection as a plausible explanation of the benefits associated with marriage, adducing evidence in another 2000 study that marriage per se does provide “independent protection of health and life”. After reviewing mortality data for a large sample of men, Murray asserts, “Marriage induced lower mortality … even with controls for health status in adulthood.”
Researcher Debra Umberson explains the protective effects of marriage and parenthood when she argues that both wedlock and parenthood exert “a deterrent effect on health-compromising behaviours”, such as heavy drinking, drug use and smoking, by giving spouses and parents a sense of “meaning, obligation and constraint”.
Of course, the health-enhancing effects of marriage and parenthood constitute an integral package: the evidence is clear that unmarried parenthood endangers health. In a 2000 study, data from two national surveys conducted in France suggest that married mothers with children at home enjoy the kind of health improvement predicted by “role enhancement” theory but that, in contrast, single mothers suffer from “very unfavourable outcomes in terms of perceived health and malaise symptoms”.
Nor should it be supposed that marriage protects only physical health. Again and again, researchers identify wedlock as a prime safeguard of psychological well-being. Ohio State researcher Catherine E. Ross reports that “unmarried persons with and without children have higher levels of depression than married persons with or without children”. It is predictable, then, that MacArthur Foundation researcher Corey L.M. Keyes would find that married men and women are much more likely than their unmarried peers to enjoy the optimal state of mental health labelled “flourishing”, while unmarried men and women are much more likely to suffer from the poor mental state described as “languishing”.
Summing up, Keyes concludes that married individuals are significantly more likely than their unmarried peers to manifest “very good or excellent” mental and emotional health. Being unmarried, conclude researchers from Johns Hopkins University in a 2000 study, predicts adverse mental health more reliably than does “high physical job strain”.
Marital status proves particularly decisive in determining the psychological well-being of mothers. In a 2006 analysis of data collected from a nationally representative sample of American mothers, researchers find that “odds of experiencing psychopathology are lowest for married mothers”, with never-married mothers manifesting significantly more vulnerability to such psychopathology and divorced/separated mothers evincing even worse vulnerability.
A 2005 study by researchers from Johns Hopkins reaches similar conclusions, finding that mothers who are “not married or living with the biological father” are “disproportionately” represented among those manifesting depressive symptoms. Mental illness requires treatment, so it is quite understandable that when Canadian scholars scrutinise a data set collected in Ontario in 1990 and a national data set collected in 1994-95, they find that “single mothers are between two and three times more likely to have sought help for mental health concerns in the previous 12 months than married mothers”.
Married parents boost children’s health
Marriage not only protects the health — physical and psychological — of adults but also of children born to, and living with, their married parents.
When researchers from Kent State University examine national data, they find that children of married parents enjoy decidedly better health than peers from broken homes. “Marital status,” remark the Kent State scholars, “is related to the health status of all the family members, including both parents and children.”
When paediatric researcher David Wood examines the impact of “trends in family structure”, he also discerns a sobering trend. As the number of children living in single-parent homes has multiplied, Wood notes, a growing number of them have been exposed to health problems incident to poverty. Wood points out that “55 per cent of children who live in single-parent, mother-only families are poor, compared with only 10 per cent of children in two-parent families”.
Predictably, Wood highlights child poverty as the reason for “higher rates of poor health and chronic health conditions” among affected children resulting in “higher rates of hospital admissions, disability days and death rates”. Even when poverty does not expose children to illness, it typically has “a detrimental impact on [their] intellectual, emotional and physical development”.
What Wood sees impresses an entire research team from Albert Einstein Medical School. Analysing data collected from more than 57,000 children during the 1990s, this team finds that family structure predicts children’s health more reliably than ethnicity or parental education. “Those [children] not living in two-parent families,” the Einstein team acknowledges, “were in poorer health than those in two-parent families.”
Looking specifically at mental health, investigators from the Pittsburgh School of Medicine limn a similar pattern, calculating that “children from single-parent households were roughly twice as likely to be identified with psychological problems” as were children from intact families.
ObamaCare’s assault on the family
Given the epidemiologically indisputable importance of marriage and family-based home life, policy-makers serious about reducing health-care costs ought to be concerned with safeguarding and renewing both marriage and family life. But even a casual look at the initiatives put forward by the Obama administration and its Democratic allies in Congress will establish that, if anything, they seem intent on weakening marriage and family life yet further!
First, consider the sizable marriage penalties built into the health-care reform packages initially passed by the Democrats in both congressional chambers. Under the initial House of Representatives version of this reform, if a cohabiting couple earned $50,000 ($25,000 each), they would pay only $3,076 for health care, compared to $5,160 for a married couple with the same income.
But it gets worse: no government subsidies would be available for married couples once their household income reaches four times the official poverty level. So if a hypothetical married couple earns $64,000 ($32,000 each) in 2016, their health insurance premiums under this plan are projected to be approximately $15,000, compared to just $5,684 for an unmarried couple with the same income. Washington Times editorialists found it “impossible to imagine a policy any more anti-family than that”.
The Senate version of health-care reform — the basic framework of what Congress eventually passed — did reduce this marriage penalty somewhat (making the married couple earning $50,000 pay only 48 per cent more than their unmarried counterparts, rather than the 68 per cent penalty in the House plan).
The Washington Times editorialists are on-target in labelling these marriage penalties “worse even … than [President Obama’s] broken promises” because “by discouraging traditional marriage, ObamaCare would further undermine the single most important building block of stable communities. That’s about as unhealthy as policy can get.”
Just as unhealthy — even toxic — have been the Obama administration’s initiatives on day-care. Instead of framing a policy reflecting an understanding of the health dangers inherent in day-care and the health advantages of maternal child-care and breastfeeding, the Obama administration has announced that it is increasing by $1.6 billion the federal day-care block grant, which helps pay for out-of-home childcare. The administration has also proposed doubling the child- and dependent-care tax credit, giving two-income households a bigger tax break for using out-of-home childcare.
What do couples who somehow manage to care for their own children — often at considerable sacrifice — receive under the administration’s new policies? Nothing whatsoever.
Charles A. Donovan of the Heritage Foundation complains that these new policies “represent more tilting of the tables in favour of only one set of family decisions about child care”. Donovan indeed calculates that the Obama administration may soon be putting as much as “$900 into the pockets of families that purchase institutional day-care while offering nothing to couples that sacrifice time with each other, or added income, to raise their own children”.
Anyone who reads the medical literature knows that the family decisions favoured under President Obama’s policies neither foster good health nor help hold down health-care costs.
It would appear, tragically, that leading Democrats were at best disingenuous when they said that in the effort to improve health care, “All ideas are on the table, even the bad ones.” It seems that while bad family-and-marriage-harming ideas were scattered all over their table, not one solid family-strengthening idea was anywhere to be found.
Sociologist David Popenoe warns that “the inherent character of the welfare state by its very existence help[ed] to undermine family values or familism — the belief in a strong sense of family identification and loyalty, mutual assistance among family members, and a concern for the perpetuation of the family unit”. Consequently, those who have advanced their political careers through enlarging the welfare state — and those leading the Obama effort to reform health care clearly belong in this category — have done so by harming the family and imperilling all of the health-care benefits that only the family can provide. If any policy-makers are indeed serious about health-care reform that affirms and protects the family, thereby genuinely safeguarding health and reducing health-care costs, they must look elsewhere.
They might, for instance, consider the Heritage Foundation’s sane proposal for “chang[ing] laws and regulations at the federal and state level to enable individuals and families to own and control their own health-care policies and to take them from job to job without tax or regulatory penalties” and for allowing “individuals and families [to] be free to choose health plans that accommodate their own ethics and morals”.
This, Heritage analysts explain, “means we must also transform Medicare, Medicaid and State Children’s Health Insurance Program (SCHIP) so that individuals and families have a broad choice of health plans and providers and that those providers are directly accountable to patients for their quality of care”.
Tax relief for families?
Also suspicious by its absence are health-reform ideas advanced by family scholar Allan Carlson. Carlson has outlined an entire package of family-friendly tax proposals, including the helpful recommendation that “taxpayers … be granted a 25 per cent credit against their total Federal Insurance Contributions Act (FICA) tax for each elderly parent or grandparent residing in the taxpayers’ home”. In the longer run, Carlson recommends “prudent steps to dismantle the Medicare-Medicaid regime, so that the real benefits and advantages of life within the natural family can come back into play”, suggesting that “expansion of private medical accounts” might start this process.
No doubt conscientious policy-makers can formulate other family-friendly ideas for health-care reform. But these few make a good start.
They certainly should replace the bad family-subverting policies that President Obama and the Democratic Congress have advanced.
Bryce Christensen is editor-at-large of The Family in America Journal.
Bryce J. Christensen, “Prescribing poison: Why ObamaCare delives the wrong family medicine”, The Family in America (Rockford, Illinois: The Howard Center for Family, Religion and Society), Vol. 24, No. 3, Summer 2010.