HEALTH CARE/Joan Retsinas

Beach-Time Wisdom of Isabel

"Everybody who wants ice cream raise your hand. Everybody who wants to build a sand castle raise your hand. Everybody who wants to play tag raise your hand."

At age 5, Isabel has peppered this week at the beach with poll-taking.

Her enthusiasm has infused the family vacation with joy.

But it is her wisdom that the nation could use. At age 5, she has tenets to guide all of us as we wrangle with the mess that is the American health care system.

Isabel tenet #1: Speak up. Say what you want. Make others speak up.

Isabel knows the surest route to her desire -- whether ice cream or sand castles -- is democracy. And even though she doesn't know it, the act of making us "raise our hands" forces sometimes reluctant, almost always jaded, adults to leave laptops or mystery novels to do what she wants.

The dilemma of the uninsured could use Isabel's leadership. If citizens want universal health insurance, they should speak up. Too often we relegate decisions to "them," the people-in-charge, the Congress, president, governors. But we the voters are ultimately in charge. At this beach-week, ostensibly the adults were in charge; after all, we make all the decisions, especially decisions for children. Yet, as Isabel proved with her poll-taking, we sometimes surprisingly (to us, not to her) hearken to her will.

So, if you as a citizen want to see everybody insured, tell everybody in sight that that is what you want. Poll-takers (the professional ones) don't put universal coverage high on the list of concerns. A majority of voters do not rank this as a "must-have". But polls are not immutable, and a psychological force can turn a minority into a majority. Isabel understands this.

If you want universal coverage, raise your hands.

Isabel tenet #2: Share.

The beach is a public space, where children share their shovels, pails, and sieves to construct fabulous cities, or, like Isabel, fabulous holes. The surf, the pebbles, the shells belong to no one and to everyone. Whatever socio-economic schisms divide the children from each other -- or the adults for that matter -- at home, at the beach, everybody is there to enjoy the vistas. If a child wants to dig with Isabel, she welcomes him. And vice versa.

Think of our wonderful health care system, with its super-trained specialists, its brave new world gadgetry, its ever-growing pharmacopoeia as the beach.

But in this wondrous system, the uninsured have limited access. And the Americans fortunate to have insurance don't readily take up this cause; instead, many breathe a collective "whew." So the electorate divides into the medical-haves and the have-nots. It is as though the beach were closed to a swathe of children, who could play on limited parts of the beach at limited times. Economists understand this system. Isabel could not.

Isabel tenet #3: Practice common-sense preventive health.

Isabel is so used to having adults slather her with sunscreen, give her lots of vegetables and buckle her into a car seat that if anybody demurred, she would remind them. At home, she gets all the recommended vaccinations. She doesn't drink or smoke. She sleeps for up to 10 hours a night.

Between age 5 and adulthood, Isabel will doubtless lapse. On her own, she may well forget the sunscreen, the vegetables, the seatbelts. Like the oldsters in her life, she may discover the range of intoxicating substances out there.

But for now, she is an exemplar of "preventive medicine."

We adults should follow her lead. The steps, as Isabel would attest, are simple. Seat belts. Nutritious diets. No cigarettes. Screenings and immunizations. Sleep. Sunscreen.

Isabel tenet #4: Enjoy mundane delights.

Isabel loves to race. But unlike the masochistic joggers who plod on, jogging to lose weight or lower blood pressure, she runs for the sheer fun of it. She loves ice cream, especially with rainbow sprinkles. She loves to bury her toes in the sand. She loves the people around her. She loves looking at books. Except for shampoos, she enjoys the daily routines that most adults take for granted.

I don't know what social scientists say about the impact of happiness on health. Are happy people healthier? Are healthier people happier? Is it cyclical? It is one of those questions, like the number of grains of sand at the beach, that nobody will determine absolutely.

Isabel would admonish us to stop trying, to slough off our adult mind-set and embrace the joys of the day.

Isabel's beach-week wisdom is startlingly profound.

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

From The Progressive Populist, August 15, 2007

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