When pundits talk about Medicare for All, they often depict it as strictly a health-care issue. Discussions are limited to whether the policy will make our health-care system more efficient and cost effective, and whether it would bolster economic growth.
But the benefits of Medicare for All extend far beyond reducing health-care costs. Since marginalized groups like the LGBTQ community face some of the greatest difficulties in affording health care, we should view Medicare for All as more than just a health-care plan—we should also see it as a social-justice issue and LGBTQ-justice issue.
Barriers to Health Care in the LGBTQ Community
LGBTQ individuals face an array of discriminatory barriers that can lead to lower quality of life and worse health outcomes, according to a Kaiser Family Foundation report from May 2018. The unique struggles that LGBTQ individuals face within the health-care system include the expensive nature of hormonal therapy for transgender individuals, and the costs associated HIV/AIDS medications, which is perpetuated when private insurance does not cover the cost of essential services, such as PrEP.
These health-care disparities also extend to mental health, an area where members of the LGBTQ community have faced systemic gaps. For instance, lesbian, gay, and bisexual high school students are nearly five times as likely to attempt suicide as their heterosexual peers, according to a study from the Centers for Disease Control and Prevention. Furthermore, nearly half—48 percent—of transgender adults have attempted to take their own lives, compared to 4 percent for the general population. As a result of these striking gaps in health care, University of Texas–Austin researchers Stephen T. Rusell and Jessica N. Fish concluded that mental health care is a crucial component to the long-term well-being of young people in the LGBTQ community, and the disparities between sexualities can ultimately lead to elevated rates of downstream issues, like alcoholism and substance abuse. Thus, mental healthcare is an important part of the health-care conversation and it one of the many reasons why LGBTQ individuals care a lot about the issue as a whole.
LGBTQ Americans Care a Lot About Health Care
Given that LGBTQ individuals face disproportionate levels of mental and physical health barriers, it’s no surprise that health care is one of the top issues in the LGBTQ community. According to an analysis of Buzzfeed survey data from May 2018, the two political issues that the LGBTQ community found to be most important were gun violence and health care (which was ranked first among the 2019 data).These issues, along with abortion which was ninth on the list, constitute important aspects of public health.
This ranking of health care as a top priority in the LGBTQ community appears to be consistent across most of the US. The majority of states in the US had more than 30 percent of their respective survey respondents rank public health as the most important set of issues. This support for health-care reform isn’t just popular with members of the LGBTQ community living in cities. Research on this subject clearly shows that LGBTQ individuals within rural states often have worse health outcomes and must deal with many issues of equity and access within the health-care system. This highlights the common (if not greater) struggles that rural LGBTQ folks have within the health-care system compared to their urban and suburban counterparts.
Overall, the LGBTQ community is passionate about health care, but those LGBTQ individuals with mental illness are especially likely to view public health as important. According to the same survey, 33 percent of LGBTQ individuals report that they are both facing mental-health issues and rank issues of public health as the most important political issues facing the United States.
A Marginalized Community That’s Ready to Fight Back
The exciting news is that LGBTQ Americans, including those with mental illnesses, are highly engaged in politics. Across all age ranges, a majority of LGBTQ respondents experiencing mental illness identify as politically involved Democrats, according to the Buzzfeed survey. These people are engaged and are holding their representatives accountable for establishing a system with affordable medical treatment that includes physical and mental health care.
Members of the LGBTQ community are also highly likely to be politically engaged if they have experienced health discrimination. According to the survey, 77 percent of LGBTQ individuals who have faced health-care discrimination identify as politically engaged. This is telling because academics have previously bemoaned the lack of progress in developing methodologies within the health-care system that improve the cultural sensitivity to LGBTQ individuals. Additionally, studies have elucidated that among cancer survivors, sexual minorities have a deficit in healthcare compared to their heterosexual counterparts.
Again, this engagement is a cause for optimism: since those reporting that they directly experienced discrimination within our for profit healthcare system ae engaged in the fight to reform it.
Medicare for All: An Essential Part of the Struggle for LGBTQ Justice
Broadly speaking, these are very encouraging findings. LGBTQ individuals—especially those dealing with mental health issues and health-care discrimination—are politically engaged and ready to battle for real solutions in health care. It is therefore necessary for policymakers and political candidates to focus on solutions that provide the best remedies for the health-care struggles in the LGBTQ community.
The most comprehensive and impactful of these solutions is Medicare for All. The World Health Organization ranked the U.S. as tenth in the Americas for deaths due to noncommunicable diseases—4.8 percent higher than Canada, which has a single-payer system. Meta studies have also concluded that single-payer systems are the best health-care systems in terms of risk pooling, administrative costs, health-care equity, and negotiation—all of which is in the direct interest of the LGBTQ community, who are often the most at risk to high treatment costs and prescription-drug prices. But when testing the political feasibility of Medicare for All, a new survey of 2000 likely voters from Real Clear Politics found that 55% of Americans support Medicare for all, even when they are told that it would eliminate private insurance, which has been devastating LGBTQ Americans in many cases.
Since LGBTQ individuals experience significantly worse health-care outcomes in the American health-care system, these benefits of Medicare for All would benefit the LGBTQ community in many ways. Perhaps most importantly, the policy would provide every American with free access to mental-health treatment without the fear of medical debt or medical bankruptcy, while saving the US healthcare system 2 to 2.93 trillion dollars. With depression, suicide, and mental-health crises proving to be some of the most devastating challenges for members of the LGBTQ community, enacting Medicare for All would be a revolutionary improvement in the standard of living and happiness—and possibly a lifesaver—for LGBTQ individuals.
Now, contrary to the claims by Mayor Pete Buttigieg in the September 2019 Democratic debate that Medicare for all would eliminate freedom of choice, actually Medicare for all would expand healthcare freedoms in 4 ways. First, under Medicare for all, a minimum benefits package would be provided that would give the LGBTQ Americans the ability to utilize any healthcare provider of their choice and see any doctor. Secondly, Medicare for all would eliminate administrative costs that represent over 25% of US hospital expenditures. This would free up hospital staff to spend more time providing care to the LGBTQ community instead of keeping a multi-payer system that would continue to infringe on the freedom of healthcare workers to fulfill their mandate to the patient. Third, in the case of prescription drug prices, Medicare for All would offer the most comprehensive solution by driving a hard bargain in the negotiation of prices for the entire healthcare system as opposed to a system with multiple payers.
From the period of 2008 to 2016 drug prices in the US rose above inflation with a 4.4 and 7.3 percent increase for oral and injectable generics, a 9.2 and 15.1 percent increase for oral and injectable brand name drugs, and 20.6 and 12.5 percent increase in prices for oral and injectable specialty drugs. This is despite the fact, the price increases have almost nothing to do with the research and development spent on these drugs and a majority of the recent innovations produced by this R&D were minor modifications to existing drugs on the market. Finally, overall healthcare policy would be set by the American people through democratic institutions as opposed to allowing health insurance companies to do so where their cumulative CEO salaries reached 9.8 billion dollars in the 7 years after the Affordable Care Act was passed, and spent over 5 billion dollars in lobbying the US government. In other words, incrementally improving a multi payer system does not expand true freedom to the LGBTQ community, but rather preserves the biopolitical influence of avarice over situations of life and death.
Medicare for All should not be seen as just a health-care policy. It should also be seen as a social-justice policy and an LGBTQ-justice policy. If we want to truly uplift those who have been systematically marginalized across the United States, we need to pass Medicare for All to make health-care affordable for every American. Given the immense amount of political engagement on health-care issues in the LGBTQ community, it’s time for the entire Democratic Party to represent its most vulnerable constituents and fight for Medicare for All.
Nicholas Golina (@GolinaNick) is a freelance data scientist and activist who does work for multiple progressive campaigns and organizations including Ohio for Bernie, the NAACP, and WolfPAC Ohio. He is also a graduate student at Kent State University in Data Science with his Bachelor's degree in Labor Economics from the University of Akron.