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Gay Men and the Marriage Effect: Are We Doomed to Die Younger?

By Russ Klettke

It doesn’t get more volatile than mixing gay marriage and healthcare into the same discussion. Ramp it up with a few statistics: Married people live longer, as evidenced by 140 years of record keeping, and much of this life extension is due to access to spouses’ health insurance. So are gay men—despite our dedication to exercise and smart nutrition, and knowledge on safer sex practices—basically screwed in the life-expectancy department? 

Maybe yes, maybe no. These statistics represent all ethnicities, income and educational strata, and every individual life situation is unique. But the numbers, as analyzed in research briefs by the RAND Corporation on married vs. single life expectancy for men and women are instructive. These two reports provide the following conclusions:  

  1. Men's marriage benefit: Men who are married, particularly as they get older, benefit from increased “care in times of illness, improved nutrition, and a home atmosphere that reduces stress and stress-related illnesses … [and less] smoking and excessive drinking.” The report also says that never-married men in general forgo the life-extending benefits of social integration (i.e., they have fewer people in their lives to lean in times of stress).
  3. Women's marriage benefit: For women, being married largely brings “improved financial resources” that include “access to better health care, better nutrition, better housing, a safer job, less physical and mental stress, and so on.”
  This second point in particular emphasizes how spouses of either gender have twice the odds of obtaining adequate insurance coverage in an employment-based healthcare system than do singles. In summary, not being able to get married can genuinely limit your lifespan. 

Four Questions
But statistics are not destiny. Gay men can and do incorporate several statistically safer, life-extending components of married men’s lives into our own—perhaps even more so on the exercise and diet front, and in the handful of states where we can now get married. I interviewed therapists, doctors, a lawyer, an academic, and an activist—many of them authors—to see what they thought of this.

The experts include Winnie Stachelberg, senior vice president of external affairs at the Center for American Progress; Lee Badgett, author of When Gay People Get Married and Director of the Center for Public Policy & Administration (University of Massachusetts); Tina Tessina, a licensed psychotherapist and author of more than a dozen books (Gay Relationships for Men and Women); Loren A. Olson, MD, a psychiatrist working on a book about coming out for mature gay men; Richard Gleiner, a psychotherapist and counselor in Chicago’s GLBT community; Nicola Simmersbach, a doctor in clinical psychology; and Dan Clement, a family law attorney. Following are their thoughts on four separate questions.  

Question One: Are men in committed relationships less likely to be substance abusers? 
  1. Simmersbach: I do see this reflected in my work. A legal partner often has more interest keeping a spouse healthy and able to contribute to the relationship emotionally, financially, sexually, etc.  
  2. Tessina: Yes. Two individuals support each other in healthy pursuits, like staying sober. In addition, companionship reduces loneliness, which is a primary driver for drinking.
  Question Two: If the benefit of marriage to men includes having a spouse to encourage you to seek health care more often, does that benefit transfer over to partners? How about very good friends?
  1. Olson: (Citing an article in the Archives of Internal Medicine, July 14, 2008, Wolff and Roter) “Having a companion allows even the frailest and most vulnerable to have more confidence in their doctors’ skills, to feel better about the information they receive, and to have a better relationship with their doctor. Companions facilitated communication, recorded physician’s instructions, provided medical history, asked questions, and explained instructions to patients. In addition they offered moral support, provided transportation and handled details like appointments and paperwork.” 
  2. Simmersbach: I don't think a good friend can do what a spouse can in terms of affecting health care diligence. My partner is disabled and often in very, very bad physical pain. When she hurts I can feel it in my body, but when my best friend hurts, I can't.  
  3. Gleiner: Partners of men with HIV tend to be very involved in their healthcare. This matters a lot when the individual is depressed and feeling hopelessness. 
  4. Badgett: There is a health effect in [officially recognized] gay marriage. It means more social support from families and the government that are conducive to better health. We know for sure that being closeted is not good for your health: There is something called “minority stress” from facing second class status that can translate into higher blood pressure, possibly even cancer. 
Question Three: If a legally defined marriage enables better access to health insurance (i.e., through an employer’s policy), would that improve health for same-sex couples? 
  1. Olson: Yes. I live in Iowa, where marriage is now legal. Many married same-sex couples are now covered by the spouse's insurance, which generally is far less expensive. Through the last 23 years [of his same-sex relationship], I have had to have my own insurance policy, increasingly expensive as I grew older. Before going on Medicare, I was paying about $600/month. In addition, we pay about $500/month for my partner's insurance. A family insurance plan through my employer would have been much less expensive. Since he is a farmer, and self-employed, we had difficulty finding an individual insurance policy for him. Neither of our plans were "premium" plans, but just basic coverage. 
  2. Clement: Access to medical insurance is a reason some couples wed and others put off divorce. New York now considers access to medical insurance as one of the factors that must be considered in dividing the marital assets.
  Question Four: But aren’t gay men better off financially and presumably able to afford better healthcare?  
  1. Simmersbach: I think the myth of the self-sufficient, wealthy gay man has been very harmful to the community. Gay men in the helping professions often sacrifice income in order to follow a dream or to live according to some deeply held values of service. Discrimination in employment, which is still legal in so much of the country, can seriously hamper a gay man's income. Having a stable, legal marriage protects the couple and can keep one partner above water, especially in this current economy.
  2. Stachelberg: Achieving similar legal status to marriage—access to 401(k) benefits and estate planning—through legal documents is complicated and expensive, therefore less accessible to people at lower incomes. Our report, Poverty in the LGBT Community [note: link to downloadable PDF], found that gay male couples are slightly more likely to be in poverty than heterosexual married couples with the same demographic characteristics.
  To sum up the results of these conversations, exercise, smart nutrition, moderate drinking and healthy relationships can only go so far. Much of health and longevity boils down to dumb luck: genetics, accidents, infectious diseases, having the good fortune to work for a company with health insurance—or to be in a loving, perhaps legal relationship with someone whose employer provides partner benefits.  

Tough luck for everyone else. 

 About Russ Klettke: Russ Klettke is a business, health and fitness writer and certified fitness trainer based in Chicago. He formerly served on the Board of Governors of the Human Rights Campaign and lobbied Congress on marriage equality. For more information,