The family factor in health care

Posted: July 23, 2012

Now that the Supreme Court has decreed that President Obama can impose his massive health-care plan on the American people, the Republicans believe that the controversial Affordable Care Act will help them come November, just as it did in the 2010 elections.

Mitt Romney has promised to act to repeal all 2,801 pages of the president's signature initiative during his first day in the Oval Office. Moreover, conservative policy wonks are offering commonsense health-care reforms that would shift power from the federal government to the states, private markets, and patients.

Yet, even if they pull off a political coup by reversing the central legacy of the Obama presidency, Republicans are painting themselves into a corner if they think that "block-granting" Medicaid to the states, introducing a premium-support option for Medicare, ending tax disincentives for non-group insurance, and allowing consumers to purchase interstate health plans will, by themselves, solve the health-care "crisis."

That's because the explosive growth of the health-care sector has more to do with social and demographic realities than a lack of free-market principles in health-care delivery and financing.

Indeed, family breakdown all across America is the unacknowledged force fast tracking health-care expenditures. The spending surge is not just the consequence of higher quality care, medical-technology advances, third-party payers, or malpractice lawsuits. Rather, spiraling demand for health services of all kinds tracks the marginalization of the bourgeois family that began in the 1970s.

Rarely explored by the media, the retreat from lifelong marriage and the prevalence of divorce — as well as the boom in nonmarital cohabitation and unwed childbearing — has made America dramatically less healthy.

However parsed, living outside the protective bonds of matrimony, bearing children out of wedlock, or being raised in a broken home generates a plethora of risks that drives health-care spending, both public and private.

A 2010 report of the Centers for Disease Control and Prevention confirms: "Research findings consistently document associations between formal marital status and health and well-being. Married persons have generally better mental and physical health outcomes compared to unmarried persons. Married persons also live longer, have higher rates of health insurance coverage, and lower prevalence of cardiovascular disease. … Research also indicates that [parental] marriage is positively associated with the health and well-being of children."

Case in point: In a 2010 study, researchers at the Robert Stempel College of Public Health and Social Work in Miami found that children of single parents were more likely to be overweight than the offspring of married parents, and nearly three-quarters as likely to be seriously overweight or obese. Kids without both parents were also more likely to have higher cholesterol levels and lower HDL levels, indicators of type-2 diabetes.

That's not all. Studies correlating marital status (including that of parents) with other risks are legion. Rates of so-called unintended pregnancies, elective abortion, and STDs, for example, are significantly higher among the unmarried and their teenagers. Unmarried Americans are also more likely to seek costly professional care when ill, largely because they have no spouse to help.

Yet neither President Obama's health-care takeover nor the Republicans pro-market alternatives yank at these roots. At least the GOP since 1980 has called for reversing Roe v. Wade, the Supreme Court edict that turbocharged the sexual revolution. But the party's pro-life plank must be more than a tradition: it must be weaved into its health-care platform, as should repealing no-fault divorce and all federal birth-control schemes.

The reasons are many. The legalization of abortion and no-fault divorce gutted America's exceptional (and health-protecting) marriage culture. Legal abortion eroded the shotgun-wedding custom, the conventional response to "unintended" pregnancies for generations of Americans. By sanctioning a new "choice" for unmarried pregnant women, the court also gave fathers the choice to opt out of the previously unavoidable consequences of their actions: marriage and child support. No-fault divorce — which triggered an immediate and permanent boost in divorce rates — undermined the marital bond by siding the state with marital breakup, not family preservation.

Thanks to this deadly mix, census data indicate that today, the never-married outnumber the married among Americans in their prime (ages 25 to 34).

These policies also tripled the numbers of single-parent and "nonfamily" households between 1970 and 2011, while stunting the growth in the number of married-parent families with dependent children. That number, in fact, has declined by two million since 2001.

Moreover, largely due to taxpayer-funded contraception via Title X and Medicaid, 41 percent of children are now born out of wedlock. As fatherless homes represent the lion's share of the Medicaid caseload, a reality that block grants cannot undo, unwed childbearing overloads the health-care system.

The federal birth-control push also deepened Roe v. Wade's impact on birthrates. Since the two were concocted in the early 1970s, the Total Fertility Rate (TFR) has struggled to reach 2.1 children per woman, the bare minimum replacement level. For 2010, the National Center for Health Statistics estimates a preliminary rate of 1.93.

The birth dearth directly relates to health-care financing woes. According to economist John Mueller, if the TFR would return to its healthy, pre-1970s level of about 2.7, projected deficits of Social Security and Medicare, the largest single-payer of health care in the country, "would be easily surmounted."

The bottom line: America would suffer no health-care crisis if not for the sexual revolution. The solution: Replacing Obamacare must include restoring the married-parent, child-rich household to normative status — and thereby a nation to life, health, and prosperity.

E-mail Robert W. Patterson at

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