1 down, 1137 to go....

One of the 1138 things you get from a $35 marriage license and quick trip to Reno or the local internet-diploma'd preacher is the right to visit your spouse in the hospital and make medical decisions for them. Supposedly, you can get that with a durable power of attorney, but if you don't happen to have that in your pocket when your same-sex spouse is hit by a bus, you don't get to go to the hospital with them, and you may in fact be kept out of their room while they're dying even if you show up with the paperwork.

Now, that won't be the case at any hospital that gets Medicare or Medicaid money. (Of course, you will still need the paperwork...)

President Obama mandated Thursday that nearly all hospitals extend visitation rights to the partners of gay men and lesbians and respect patients' choices about who may make critical health-care decisions for them, perhaps the most significant step so far in his efforts to expand the rights of gay Americans.

The president directed the Department of Health and Human Services to prohibit discrimination in hospital visitation in a memo that was e-mailed to reporters Thursday night while he was at a fundraiser in Miami.

Administration officials and gay activists, who have been quietly working together on the issue, said the new rule will affect any hospital that receives Medicare or Medicaid funding, a move that covers the vast majority of the nation's health-care institutions. Obama's order will start a rule-making process at HHS that could take several months, officials said.

Hospitals often bar visitors who are not related to an incapacitated patient by blood or marriage, and gay rights activists say many do not respect same-sex couples' efforts to designate a partner to make medical decisions for them if they are seriously ill or injured.

The new rules will not apply only to gays. They also will affect widows and widowers who have been unable to receive visits from a friend or companion. And they would allow members of some religious orders to designate someone other than a family member to make medical decisions....

But it is clear that the document focuses on gays. A number of areas remain in which federal law requires proof of marriage, including receiving Social Security benefits and in taxes.

"The General Accounting Office has identified 1,138 instances in federal law where marriage is important," said one gay rights activist, who spoke on the condition of anonymity before the White House formally announced the directive. "We've knocked off one of them."