HEALTH CARE/Joan Retsinas

The Land of Unintended Consequences

Welcome to the Land of Irony, otherwise known as the Land of Unintended Consequences, or maybe Intended, in a plot worthy of the old Ramparts magazine.

Every administration has contended with surprise consequences that none of the best-and-brightest anticipated. There are the big ones. “Intervening” in Vietnam in the 1950s was not supposed to spark a decades-long battle that would, in the 1960s, spark riots domestically. The Congressional solons who let the Brady Law’s ban on assault weapons expire (2004) didn’t foresee the home-grown terrorists massacring American schoolchildren. The regulators opening the mortgage floodgates to no-down-payment balloon mortgages didn’t foresee the defaults that would spur the Great Recession.

Those are the biggies.

On the healthcare front, smaller unintended consequences are mounting.

Consider tariffs and drug prices. Economists have warned that tariffs will raise prices for a grab-bag of consumer products. Crucially, while this administration promises that those small consumer sacrifices will revive Big Steel USA and Big Aluminum USA, nobody outside his shrinking sphere of advisers believes that linkage. (Look to Gary Cohn’s resignation.) Yet drugs? This president-as-campaigner promised to bring down the astronomical spike in prices for some drugs. Ironically, the tariffs may raise prices.

Epinephrine? Insulin? Generic drugs? Vaccines? So what if we impose a 25% tariff on goods made in China? The harsh reality – understood by the legions of economists whom the president scorns – is that “made in America” is almost mythic.

In a global economy, goods are produced globally. To blackball one company is to hurt us all – almost like a divorce where the separating spouses vow to have nothing to do with one another, until they face the conundra of children, mortgages and Thanksgiving. Our economy is bound to China. The ingredients contained in many of our medicines come from China; imposing a tariff will add to their cost. (The ingredients that come from India will not incur a tariff; maybe we will shift our trade-dependence.) For expensive drugs, the added cost may not matter; but for those commonly prescribed, commonly used, the price may well rise.

The same holds for MRI scans, hip replacements, knee replacements … Medtronic is a “United States” company. Six years ago it bought China Kanaghui Holdings, which makes orthopedic devices. Will those devices, made in China in a factory now owned by an American company, incur a tariff? Will the resultant hip replacements undertaken in US hospitals cost more? Stay tuned. One estimate holds that 12% of the devices imported into the United States come from China – a $3 billion market (April 6, New York Times, Sheila Kaplan and Katie Thomas, “Why Trump’s Tariffs Could Raise the Cost of Hip Replacements.”).

Apart from costs, the president’s refusal to grant citizenship to the young adults trapped in DACA limbo threatens to reverberate in unhappy ways. Three economists compared the pregnancy rates of teenagers who were eligible for DACA in 2012, against immigrant teenagers who were already citizens. Post-DACA, the undocumented teens were 45% less likely to give birth than they were before. The reason posited: a tangible hope for the future. The girls saw a clear path to integration into this country – which gave them the impetus to study, work and defer pregnancy.

If the government blocks that path, with deportation imminent, the young women may well fall into early pregnancies, where their children will be citizens (unless this administration blocks that route). Indeed, the plight of the poor in the United States shows up in pregnancy statistics: in Mississippi, a teenager is 15 times more likely to be pregnant than her counterpart in Switzerland.

More unintended, but not unforeseen, pregnancies lurk. This president has not embraced “abstinence,” but his administration has plugged “abstinence only” sex-education (an admitted oxymoron) in schools. Not abstinence as part of a curriculum that includes contraception and – horrors – abortion, but just abstinence.

The promoters believe that urging young people to tamp down their raging hormones and simply “abstain” will lead to abstinent teenagers – and, consequently, lower rates of teenage pregnancy. Texas has tested that happy hope. Texas has the highest rate of abstinence-only curricula, and the highest rate of teenage pregnancies. Every teenage pregnancy adds to the state’s social service rolls – another unintended consequence. Yet this administration wants to axe contraceptive education, along with Planned Parenthood.

The oresident bloviates: tariffs, deportation of DACA adults, elimination of funding for sex education in schools. As he translates his bluster into action, we will pay for his naivete, his ignorance, his callousness.

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

From The Progressive Populist, May 15, 2018

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