HEALTH CARE/Joan Retsinas

Springtime Optimism for Health Policy

In spring, even the crustiest pessimist sloughs off his carapace of cynicism and warms to the crocuses, daffodils, and hyacinths peeking through the not-yet-raked earth. The sign of indomitable rebirth is a welcome reminder that life revives.

The gardener in me has searched for health policy equivalents of the crocuses—signs that even if the economy spirals down, our health policies may be spiraling up.

Here are a few:

1) The glimmer of national health insurance. The bad news is that as employment falls, more people will find themselves uninsured, and more providers of care, from hospitals to physicians to therapists to drug companies, will see their revenue drop. The good news is that we may need to call Uncle Sam to the rescue. I liken the Wall Street Journal’s grudging recognition of this impending catastrophe (April 12) to a fragile blossom that harsh forces (insurers and their lobbyists for the most part) may squelch. The burgeoning optimist in me, however, expects that this season the bulb, buried deep in government-soil for eighty years, may truly sprout.

2) An end to the bizarre gag rule that enjoins Uncle Sam from funding international family planning programs that—gasp —mention contraception. The international community has marveled at America’s mixture of naiveté and ideology. President Obama ended this strange legacy of the Bush administration. While the “gag rule” met ideological benchmarks, it failed the ultimate test of common sense. Of course, government is replete with programs that fail the common sense criterion, so this president’s decision deserves praise. The “abstinence only” rule for sex education should go too. Ditto for “protections” that let pharmacists refuse to fill prescriptions for contraceptives. This flowerbed, fertilized with common sense, should see some more blooms.

3) Higher federal taxes for tobacco. Policy wonks, as well as scientists, have labeled smoking a public health hazard for decades; researchers have documented the harm that second-hand smoke does to non-smokers. Yet, mindful of Americans’ rights to control their health-destinies, and even more mindful of the clout of tobacco companies, our leaders have demurred from doing much more than preaching. At last higher taxes—the one deterrent that seems to work—is on the horizon. Of course, our solons want to use tobacco taxes to fund the Children’s Health Insurance Program—a strange linkage. After all, if the ultimate intent of the tax is to stop people from smoking, ideally that tax revenue will plummet to zero in the next few years. The Heritage Foundation has estimated that for the tax to fund SCHIP, the nation would have to add millions of new smokers. But in this optimist spring, it is best to look to the short term. A higher tobacco tax would rid more homes, workplaces, and parks of smoke. Another flower for the garden.

4) Stem cells for research. Scientists, physicians, and patients have tried to cultivate this bulb for the past eight years, but the previous administration kept this flowerbed fallow. Science and morality rarely proceed in lockstep, and the science of in vitro fertilization has yielded thousands of embryos that languish in storage. Some are destroyed immediately; some, years later. Some deteriorate during storage. These embryos are not destined to become children. Yet when scientists raised the possibility that cells from these embryos might shed light on Parkinson’s disease, Alzheimer’s disease, diabetes, spinal cord injuries, and multiples sclerosis, an enraged ideological wing yelled “No” and nixed federal dollars for that research. Without federal dollars—the crucial fertilizer—stem cell research could not flourish. This new administration has given the National Institutes of Health a green light to fund research using embryonic stem cells.

This spring the health policy garden sprouts some new flowers. Even pessimists can smell the roses.

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

From The Progressive Populist, June 1, 2009

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