HEALTH CARE/Joan Retsinas

The Subtext of Health Care

The deployment of troops. A faltering economy. Soaring state deficits. Soaring gas prices. Soaring drug prices. Who can think about health insurance?

Yet even while the daily crises have pushed health insurance back, back, back -&endash; to page 26, below the fold (if that) of newspapers &endash;- and to the beyond-recall recesses of legislators' minds, the health insurance problem looms as a subtext behind the major headlines.

Here are some examples.

Headline #1: Retailer (or bank, airline, or manufacturer) X has laid off 20,000 employees. The text traces the impact on competitors, on customers, on employees. It offers tales from the ranks of the pink-slipped: How will this man pay his rent? That woman pay for groceries? This text makes for stories on the business and the human interest pages, as well as on the front page.

Health subtext: 20,000 people will lose their company-subsidized health insurance. The pink-slipped will be able to continue &endash;- for up to 36 months -&endash; their group insurance under COBRA, paying the full tab (admittedly, lower than they would pay as individuals signing up for insurance apart from a group). Because those premiums are high, though, most of the pink-slipped, poorer than in their pre-pink-slip days, will drop coverage.

Headline #2: Corporation X declares bankruptcy. The text mourns the passing of an American "icon," with reasons for the demise.

Health subtext: Employees lose insurance, with no recourse to COBRA, because by definition a bankrupt company doesn't continue to operate. The company may be reborn in a different permutation, but that new entity starts afresh, without commitments to its predecessor's workers.

Headline #3: States confront deficits. Throughout the nation, this is front-page news: Almost all states confront a gap between falling revenues and rising costs -&endash; some states report a gap as high as 20% of their budget. Newly-elected governors have promised to bring "responsible" management to this crisis. No more puff programs, no more gratuitous patronage.

Health subtext: Medicaid, as well as the Children's Health Insurance Programs, will be cut, leaving more working parents, and their children, without insurance. State legislators could cut their own budgets, but that is unlikely. (In Rhode Island, even while the state slipped into red ink, the legislature was spiking staff salaries.) Governors' offices could downsize, cutting numbers and benefits. So could the vast state government workforce. But we need well-paid bureaucrats. Lots of them. And we need to placate unions. Cutting subsidies for health insurance promises less political grief.

Headline #4: States battle to lower Medicare prescription costs for seniors. This text has it all: the savvy states, led by public-spirited governors; the greedy drug companies; the beleaguered seniors, forced to pay as much for a monthly supply of medications as they did for their first mortgage.

Health subtext: Our government can wage one health policy battle at a time; and the voting power of seniors has made this the battle du jour. The fact that 43 million Americans have no coverage for routine medical care, hospitalizations, and emergency room visits -&endash; let alone medications -&endash; gets lost in the indignation over seniors' plight.

Headline #5: War looms. Reporters give us the troop statistics, the timetables, the comments from wise pundits.

Health subtext: To discuss health insurance at a time of looming war is absurd, even unpatriotic. While we ready for war, we have neither the money nor the will for much else.

Read the newspaper. The country still faces a health insurance crisis. In the midst of superb physicians and superb hospitals, too many Americans are struggling to get even routine care. You will find this story as a subtext, hidden behind the headlines.

Joan Retsinas is a sociologist who writes about health care in Providence, R.I.

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