WE ALL know something about the explosion in health-care costs and the lack of medical coverage for millions of Americans. But what do we know about the impact of deteriorating family life on American health -- and on health-care spending?
Yale University's Harold Morowitz tells us this: Being a non-smoking divorcee is almost as dangerous to one's health as smoking a pack of cigarettes a day (and staying married).
The fact is that the decline of the American family has had a dramatic impact on health-care expenditures. Given the scope of the breakdown, it's not hard to see why. About 40 percent of all marriages formed since 1980 will end in divorce. In 1960, only one birth in 20 was illegitimate; today more than one-fourth of all births occur out of wedlock.
All of this is taking its toll. Researchers have found that the divorced and separated suffer much higher rates of disease, disability, mental neuroses and mortality than do married men and women, regardless of age, gender or race. Researchers in this country and in Scandinavia have even found that married people enjoy more robust "cellular immune system control" than do the unmarried from the same economic background. Apparently, the emotional and psychological support found in marriage fortifies the body against illness.
As more marriages break up or fail to form in the first place, Americans not only are suffering from increased health problems, but are less likely to have family members to provide or pay for care. All too often they must resort to institutional care -- much of it paid for by the government.
Of the nearly 36 million Americans without health insurance, 45 percent are in single-parent families or living without a spouse or parent. Similarly, 54 percent of all recipients of Medicaid in 1991 lived in households headed by an adult who had never married or one whose marriage had ended in divorce or separation. Nearly all of their health costs are picked up by the taxpayers.
In a two-year study at the University of Michigan, researchers monitored the health of 165 men and women, 55 years old and over, after their hospitalization for various chronic conditions. The unmarried men and women spent significantly longer periods of time in the hospital than the married men and women suffering from similar illnesses.
Children also suffer medical consequences from family breakdown. Those from intact families enjoy significantly better health than children of divorced and never-married parents. This is partly because such families are poorer than those with two parents, but poverty is not the only explanation. A 1988 survey by the Department of Health and Human Services found that, even after accounting for educational and economic status, children in single-parent families are 20 percent to 40 percent more likely to suffer health problems.
Studies at Chicago's Cook County Medical Center and elsewhere have also shown that children born to unmarried mothers are especially likely to be born prematurely, often with conditions requiring surgery, mechanical respirators, incubators, or other costly medical care paid for by the taxpayer -- or, through cost-shifting, by other patients.
Any plan for reforming health care deserves skeptical assessment from American leaders and voters if it ignores or undermines the family. A national health-care system patterned on Canada, for example, would abridge family autonomy and responsibility by turning millions of consumers into clients of a single, paternalistic medical insurer. Such a plan also would discourage ties and commitments among family members.
Only the consumer-choice plan now before Congress, which would allow workers to purchase their own medical coverage, would foster family autonomy and strength. Under such a strategy, immigrant associations, churches and other groups whose members have strong families could offer their own health insurance policies.
The challenge of providing health care requires more than a short-term fix or a campaign slogan. It requires far-sighted vision that recognizes the enduring importance of the family.
Bryce J. Christensen is editor of "The Family in America," published by the Rockford Institute in Illinois.