John_Maxwell_IV comments on Minor, perspective changing facts - Less Wrong
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There's been a similarly large fuss over gay marriage in the UK, where 1) the NHS provides healthcare to everyone and 2) existing civil partnership legislation gave gay couples all the benefits of straight couples. So I don't think that practical issue is very important.
(Also, there are many far easier ways of getting health insurance than by upsetting arguably the most important institution in the history of the world!)
Interesting paper on monogamous marriage: http://www.gwern.net/docs/2012-heinrich.pdf