HEALTH CARE/Joan Retsinas

The Annals of Meanness

Jared Diamond in Collapse: How Societies Choose to Fail or Succeed chronicles several failing societies. Generally a scarcity of food triggered the decline: too many people scrounging for too-little sustenance. Although each collapsing world tells its own story, no society perished from a dearth of kindness. Ours may be the first.

On an individual level we are decent enough -- lending lawnmowers to neighbors, bringing cookies to newcomers, tossing out "have a nice days" to everyone in our paths. And we proffer grief after national tragedies: armbands, prayers, flags lowered to half-mast. But when the body politick must decide whether to spend money to help others, we retreat into the carapaces of our own self-interest, oblivious to the anguish of anybody but ourselves -- and oblivious to our impact on that anguish.

Consider a few news stories about health, from the annals of meanness.

"Should SCHIP cover the Families of Children?" The Urban Institute and The Chapin Hill Center for Children held a forum on April 12 around this question. SCHIP covers children in families who earn too much for Medicaid, yet who can't afford their workplaces' insurance, or whose workplaces don't offer insurance. States vary in the details: children's age of eligibility, the benefits package, the waiting time, and in the decision to cover parents. The humane answer to the question is "Of course." After all, if states don't cover the parents, nobody else will. The parents will remain uninsured, part of the 46 million-strong horde. The more telling question is: Why are we asking the question?

"Specialists want to be paid for hospital on-call service." In the long-ago world when hospitals were nonprofit community institutions and the practice of medicine was a humanitarian calling, specialist-physicians donated their time to emergency rooms, in return for hospital privileges. A surgeon who was "on call" for a night would not bill for that time. With the advent of for-profit hospitals, specialists morphed into entrepreneurial contactors who do bill. Today a third of hospitals, including some nonprofit ones, pay specialists for emergency room call, from $1,500 to $2,000 a shift. (Boston Globe, April 15) Many hospitals stagger under the burden of unpaid bills from the uninsured people who need care. Specialists, who earn more than most Americans, and more than their uninsured patients, are behaving rationally, at least from an economic vantage. They just are not behaving humanely.

"Veterans receive abysmal care." The government sends young people overseas to fight wars; yet when those young people return wounded, the government "outsources" their care to save money. We have been spending millions of dollars on hospitals, doctors and therapists, yet while the bottom lines of the corporate entities responsible for that care may be fine, the care is not. Congressional committees are analyzing what went awry. Maybe they should analyze why the people who authorized the war cared so little about the people who served.

"Infant mortality rises in the South" (New York Times, April 12). More babies are dying in the Deep South than previously. In Mississippi, the infant mortality rate rose from 9.7 in 2004 to 11.9 in 2005; for African Americans, the rate rose from 14.2 to 17 [deaths per 1,000 live births]. Experts cite rising rates of obesity, hypertension and diabetes. Although politicians deny any correlation, common sense points the finger at cutbacks in public health spending: fewer women getting Medicaid, fewer clinics open fewer hours. Health-and-welfare cutbacks relieve the tax burden, but at the cost of human misery. Yet politicians woo voters by promising more tax relief, not less misery.

Maybe the scientists mapping the genetic code should find the one for kindness and do a societal transplant.

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

From The Progressive Populist, June 1, 2007

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