Health Care/Joan Retsinas

Are We Healthier?

Let’s revisit Ronald Reagan’s “Are you better off now than four years ago?” question, zooming in on health.

President Trump, take a reverse-bow. You have presided over a startling, scary plunge in health.

Measles has resurfaced in pockets of unvaccinated children across the country. You as president didn’t spur parents to bow out of state regulations; but you, who have wielded the bully pulpit as a bully against assorted enemies, from Iran to migrants to the media (even Fox News now falls to your ire), have not used the bully pulpit for good. You have not urged parents to vaccinate their children; you have not shown up at clinics; you have not proudly announced that your grandchildren are vaccinated. Contrast with President Obama’s endorsement of flu vaccines: he got one, in view of the press.

A side-note on the bully pulpit: Theodore Roosevelt coined the term to describe a “terrific” position from which to campaign for progress. You twisted the word to mean “harasser,” which fits your world-view.

Mumps is resurfacing, in detention centers. Why vacccinate those children? We won’t be vaccinating families in detention for the flu either. Do you hope that they will die quickly, echoing Scrooge’s zeal to get rid of the “surplus population.” If we want them to live, why ban these vaccines?

You can take credit for the increase in the numbers of people without insurance. In the aftermath of the Affordable Care Act, people gained insurance. But your decision to cut funding for enrollment, your promise to overturn “Obamacare” and replace it with “something wonderful,” your decision not to urge states to expand Medicaid (after all, that was one undergirding of “Obamacare”) have succeeded. Watch the statistical tale. In 2013, 16.1% of Americans were uninsured; in 2018, 18.8%. With passage of the Affordable Care Act, by November 2016, the number plummeted to 10.9%. In December 2017 your Administration eliminated the individual mandate, and the figure rose to 12.2%. Today it stands at 13.7%. Take a bow.

As for the number of “underinsured,” take a giant bow. The Affordable Care Act allowed short-term policies; you allowed them to expand beyond the short-term. Your Administration touts these “skinny” policies, with premiums as much as 60% lower than the plans under the Affordable Care Act. Nobody touts the benefits: they often exclude hospital stays, maternity care, expensive medications, and diagnostic tests. And while the ACA caps co-pays at $7,350, the “skinny” plans’ co-pays can reach $20,000. Enrollees discover how illusory their great bargain is when they grow sick.

You can’t take total credit for the surge in sexually transmitted diseases: we have the highest STD rates in the industrialized world. Gonorrhea rose by 67% in 5 years. A host of bogeys, from the tinder generation of hook-ups to HIV drugs (that lower condom use) to fastidious reporting, played their part. But the cuts to state and local public health authorities belong front and center: staff need to identify patients, to treat them, to follow up with contacts. You weakened those preventive efforts.

Finally, women have not thrived under your watch. Mammograms, Pap smears, pelvic examinations — many women, especially poor women, have gone to Planned Parenthood clinics for that basic care. But because Planned Parenthood also prescribes birth control (another concern of women) and — gasp — abortions (again, women, not men, get them), you effectively closed the clinics. In some states (Texas, Alabama, and Missouri), women must travel hundreds of miles for care.

What a feat! In a few years of presidential edicts and bullying, you have made us sicker. Let us hope that your successor will reverse this grim slide.

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

From The Progressive Populist, October 15, 2019

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