Mercifully, the same old same old sometimes changes. And you wake up to a world that looks different from the one you thought you knew. Certainly the jaded campaign-watchers who predicted in January that the richest solons with the richest backers would vault to the top of the presidential roster within weeks were wrong. This campaign has shaken up the verities: the old truths do not always hold.
Here are springtime surprises for health-watchers.
President Bush, the conservative darling of the wealthy, who has given tax cuts while cutting social spending, proposes to tie Medicare premiums to income: Wealthier beneficiaries will pay more than most of the rest of us. The proposal makes sense. Practically, unless the government pares Medicare benefits (and it is hard to pare benefits for so large a swathe of the electorate, particularly the oldest, sickest, most disabled swathe), the government must increase revenue. Medicare Part B is subsidized by enrollee premiums. The government could raise premiums across the board. That course, though, would hurt enrollees who are already struggling with high premiums, co-payments and deductibles. Linking premiums to income is the compassionate course. It is the solution youd expect from a Democratnot a Republican. It is also the solution you expect to hear denounced. Several administrations ago, when Congress expanded Medicare with catastrophic coverage, Congress tied premiums to income. But wealthier retirees objected so vociferously that Congress repealed the law. The year 2008 is light-years, politically, from 1989. To date, no maelstrom of protest has arisen for the presidents proposal. Maybe well-off retirees have too much else to decry. Or maybe they have grown more reasonable, if not more compassionate.
Another surprise is the latest clinical trial about type 2 diabetes. For years, physicians assumed that lowering blood sugar was crucial to lowering the risk of heart attacks. The lower the blood sugar, the less the chance for cardiac complications. But the National Institutes of Health launched ACCORD (Action to Control Cardiovascular Risk in Diabetes), a trial that randomly divided patients into two groups. One group used drastic measures to lower their blood sugar levels to normal; the second group aimed for near-normal. Group 1, with the lowest levels, should have fared better. Instead, it fared the worst. More patients died. After four years the NIH stopped the trial. The result was baffling. Blood sugar levels didnt seem to matter as much as physicians had thought. Other trials have suggested that they do matter, but so do cholesterol and blood pressure. Some researchers have faulted the methodology: maybe group 1 comprised sicker people, or the drastic measures to lower blood sugar were too drastic. The conclusion, though, is clear: We dont know everything we think we know. The corollary is equally clear: We need scientists, clinical trials and research laboratories. They cost billions, but they are crucial to our health.
Surprise three: Prison wardens have joined the nutrition mavens. In spite of dire admonitions from physicians, Americans are getting fatter. In the battle over foodnutritious stuff versus fat-drenched, sugary goodieswe are lauding the former, but eating the latter. Even school boards, hungry for soda companies money, have let soda supplant milk in childrens lunches. So the general assumption, tacit if not spoken, is that America has lost its obesity war. New York City jails, though, have joined the battle. (City inmates get healthier diet, Kathleen Lucadamo, NY Daily News, 2/18/08). Prisoners will eat what is good for themincluding tofu. No more white bread. No more cold cuts. Skim milk. Authorities cite economics: nutritious meals, which wont cost any more, should improve inmates healthwhich should lower health-care costs. Maybe schools, businesses, even families will learn from New Yorks jails.
Finally, surprise four lies buried in this seasons rhetoric. There is the hintto be hackneyed in a time of hackneyed rhetoric, the hopethat next spring, a new administration will push through legislation to give Americans comprehensive health insurance.
Joan Retsinas is a sociologist who writes about health care in Providence, R.I. Email firstname.lastname@example.org.
From The Progressive Populist, April 1, 2008
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