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 only 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 Bunch.  Good health care should have
nothing to do with wealth or conformance with hetero-patriarchy.