Universal Healthcare is an LGBTQ+ Issue

Grey Weinstein (they/he) 

Recently, I’ve noticed that many people (myself included) tend to talk about LGBTQ+ activism as a self contained social issue. That is to say, LGBTQ+ advocacy is at times portrayed as The Gays fighting against The Homophobes, without intersecting with other social issues. But sometimes homophobia and transphobia manifest as high hospital bills or skyrocketing prescription drug costs. That’s right, I’m talking about everyone’s favorite topic, the nightmare that is the American healthcare system. Personally, I would love to see more explicitly queer organizing around healthcare as a human right. LGBTQ+ issues aren’t self contained; queer and trans people interact with other oppressive systems. And nothing screams “oppressive system” like healthcare in the US, where private insurance companies and prescription drug costs create barriers to much-needed care.

Healthcare based triptych by Max Coolidge.

    Take mental health, for example. LGB people are over twice as likely to experience mental illness than their straight peers, and transgender people are four times more likely than cis people. Clearly, then, mental healthcare is an LGBTQ+ issue. Much of the national conversation around mental health seems to emphasize the role of the individual in seeking treatment. This makes sense; after all, therapy and medication are often intended to address mental illness, trauma, or destructive habits, all things which are deeply personal and often unique to the individual. But to some extent, the wider conversation about mental health needs to focus on systems, not individuals.
    Allow me to explain.
    I encounter a lot of mental health advocacy focused on reducing the stigma around seeking help for mental illness. Social media in particular seems saturated with messages like, “It’s not shameful to see a therapist!” and, “You aren’t weak for taking medications!” That is to say, the messaging focuses almost exclusively on an individual’s responsibility to reach out for help. And to be clear, this type of public awareness campaign is important work! According to a 2020 study by the Trevor Project, a large number of LGBTQ+ youth report feeling ashamed and embarrassed for needing mental healthcare. Stigma clearly plays a heavy role in preventing young queer and trans people from getting the mental healthcare they require. Reducing the personal stigma around mental health treatment would thus undoubtedly lead to a greater willingness to seek care among LGBTQ+ youth. 
    However, it’s not enough. Mental health advocacy, especially messaging which targets young people as its audience, seems to center “stopping the stigma” with an increasingly singular focus. And that feels frustratingly tone deaf. That’s because for most young LGBTQ+ people, shame or embarrassment aren’t the main factors preventing us from getting care. The inability to afford treatment is. Of LGBTQ+ youth who want mental healthcare but are unable to access it, 53 percent say that this is due to prohibitive costs. The bottom line is, our nation still treats access to healthcare as a privilege, not a right, and that extends to mental health treatment too.
    For mental health activism to be effective, we need to start addressing systemic barriers to care. Our healthcare system seems the logical place to start. Universal healthcare should be the cornerstone of mental health advocacy. Why? Because we already know it’s effective. States with Medicaid expansion saw the greatest decrease in the number of uninsured residents with mental illnesses in 2018. On the flip side, in 2015 there were 3.5 million uninsured people living with some sort of mental illness in states without Medicaid expansion. These individuals are part of what is often referred to as the “Medicaid Gap''-- without insurance, most cannot afford treatment. A universal healthcare system could ensure that every individual has access to mental healthcare, regardless of their income or ability to pay. (Anecdotally, the ten “happiest countries” all have universal healthcare according to a 2020 study. While correlation does not equal causation, it certainly seems to suggest that readily accessible treatment helps lower rates of depression.)
    In addition to addressing poor mental health among LGBTQ+ folks, progressive healthcare measures have the potential to address other queer and trans health issues. Take HIV/AIDS cases, for example, 69 percent of which occur in gay and bisexual men. At the height of the AIDS crisis in the 1980s, activists worked hard to shift the cultural narrative away from individual responsibility towards systemic change. Yes, it’s important to have protected sex, activists argued, but the government also had a responsibility to help protect its citizens from being infected. This framework allowed activists to successfully make free condoms widely available, speed up the process of testing drugs for HIV/AIDS, and decrease the price of preventative drugs.
    Now, decades later, we have effective medications to prevent and treat (although not cure) HIV/AIDS. But, like access to mental healthcare, access to treatment remains elusive to many. As of 2012, one third of American living with HIV did not have access to treatment. That’s likely due to the prohibitive cost; the National Institute of Health estimates that the average person living with HIV/AIDS spends $326,500 on medical costs over the course of their lifetime. If that price tag sounds ridiculous, that’s because it is. PrEP, the drug that can prevent HIV infection, costs $6 for pharmaceutical companies to manufacture but $1,500-$2,000 for uninsured individuals to buy. Universal healthcare would prevent HIV positive folks from being uninsured, and would help offset those costs. Furthermore, we ought to push our government to pass legislation regulating the price of these life saving medications.
    Similarly, transgender healthcare is often prohibitively expensive. Hormone replacement therapy (HRT) is usually around $30 per month with insurance, but can be as much as $240 per month without it. Gender affirming surgeries can cost up to $30,000. Unequivocally, trans healthcare should be considered a necessity and be made accessible and affordable. Universal healthcare could be a way to achieve this. It should be noted that there are many other issues within trans healthcare that wouldn’t be solved by a universal healthcare system, such as long waiting lists, unnecessary requirements that create obstacles to care, and a shortage of trans health experts. However, it would certainly be a step forward, especially for the 15.5 percent of trans Americans who are currently uninsured.
    There are countless other ways in which LGBTQ+ people would benefit from universal healthcare; queer and trans folks are more likely to have substance abuse disorders, for example, and HRT can increase the risk of getting certain types of cancers. Universal healthcare would make treatment for these health issues easier to access and more affordable to everyone. 
    ​I’ll be honest: I don’t think universal healthcare is going to be implemented any time soon. The Biden administration has certainly indicated that it will not be supporting such policy, and progressives don’t exactly have a majority in Congress. But that’s all the more reason for activists to push for it. Radical, intersectional queer organizing has made immense gains in the past, and there are plenty of people who are currently doing the work. We could, with a great amount of effort, transcend this capitalist hellscape to actually secure healthcare as a human right.

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