HEALTH CARE/Joan Retsinas

Springtime Optimism

Spring! After a winter-without-end, sidewalks piled with snow, and people multi-layered in fleece, the advent of spring signals warmth. Everybody looks for the crocuses peeping out from frozen earth – a harbinger of better times, weather-wise.

So it is time to look for healthcare crocuses, signs of hope. Are we Americans getting healthier? Is our chaotic system of insurance morphing into a more rational, fairer one? Are we all – citizens, business, government – moving in sync towards a healthier populace?

Here are a few optimistic signs.

First, CVS dropped its schizoid approach to profits. In one section, it sells the drugs, over-the-counter treatments, and remedies that keep us healthier. We trust their pharmacists for advice. In another section, CVS pedals cigarettes – the weed that contributes to many of our maladies. This October CVS will drop cigarettes from its shelves. Cynically, CVS may be positioning itself more aggressively as a venue for the drop-in clinics cropping up in retail outlets. Selling cigarettes next to a nurse’s station raises hypocrisy to a Monty Python level. Whatever the reason behind CVS’s decision, though, it marks a step toward discouraging smoking (cigarettes, at least). Admittedly, people can still buy cigarettes easily enough; but optimistically more pharmacies will follow suit. The new reports on the dangers of second-hand smoke emphasize the by-now tired truism: cigarettes harm our bodies.

Second, the federal government recovered $4.3 billion dollars in 2013, $4.2 billion in 2012 from its fraud investigations, or $8 for every $1 spent in enforcement. The Health Care Fraud and Abuse Control Program (run by the Departments of Justice and Health and Human Services) has been around for 17 years; this marks the peak. Tales of fraud-and-abuse crop up every election cycle, as candidates vow to punish miscreants. And periodically the government will issue a press release noting a major bust, but generally, we – not just cynics – have accepted a certain level of fraud as endemic to the Medicare and Medicaid systems, which are large, complex, with loopholes that the savvy can probe. The latest report shows we truly can ratchet down the fraud, tighten some loopholes, discourage the savvy miscreants.

Third, children are slimming down, slowly. The federal CDC (Centers for Disease Control and Prevention) reported declines in obesity among children ages 2 to 4 in 19 of 43 states and territories from 2008 to 2011. Even teenagers – those creatures impervious to adult advice – are slimming down. Consider some data from 35,000 teenagers (a study from the University of Massachusetts and the Eunice Kennedy Shriver National Institute of Child Health and Human Development): the average Body Mass Index rose overall from 2001 to 2009, but declined slightly from 2005 to 2009 – suggesting that teenagers have changed their modus vivandi: they are eating healthier diets, watching less television, exercising more. Pundits proffer explanations: Parents, as well as children, at last understand the danger of obesity; maybe they didn’t believe it before. First Lady Michelle Obama’s campaign to introduce healthier foods into school regimens nudged children into healthier diets. Politicians (notably New York’s former Mayor Michael Bloomberg) put a spotlight on the quantity of “empty” calories we gulp down. A few large restaurant chains now publish the calorie-counts of their meals. Beets and kale are fashionable. Whatever the reason, or reasons, some of us are eating less.

Finally, Americans are signing up for the Affordable Care Act. The sky did not fall with passage of this Act. The roll-out has been bumpy; some states (ironically, those with the most uninsured people) have balked at extending Medicaid; the government has granted some extensions, letting some people keep their substandard insurance policies for a while (until they discover the consequences of substandard policies – consider the touted Christian Heathcare Ministries. You can see Mike Huckabee explain it (http://bit.ly/1iBlSLy). It won’t pay for diseases related to profligate lifestyes (http://www.chministries.org/). Yet the country is inching toward a time when almost all Americans will have an insurance card, when nobody will understand what a “pre-existing condition” ever was, when the industry of hospital bill-collectors will shrink.

Let’s take heart from the crocuses.

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

From The Progressive Populist, April 15, 2014