HEALTH CARE/Joan Retsinas

Alas Pollyanna!

Woe to Pollyanna, as she digs for nuggets of optimism in Trump-land. On the healthcare horizon: cuts in Medicaid; the “privatization” of Medicare; the end of stem cell research; the end of coverage for contraceptives; the end of legal abortions (forget coverage – legal abortions will vanish); the end of alphabet agencies like the Agency for Healthcare Research and Quality (the people battling hospital-acquired infections); the end of subsidies for people to buy insurance (tax credits don’t substitute); the end of stringent clean air and water regulations – in short, the end of a decade of health progress. We are bending back the arc of justice.

It is easy to bend that arc. Think of health insurance. Without repealing the Affordable Care Act, this administration can whack away at it. For instance, the law calls for “essential benefits.” A new administration can revisit those benefits: coverage for mental illness, hospitalizations, substance abuse treatment, as well as contraception, are expendable. The law allows “hardship exemptions” for people to bow out of the “mandate” to buy insurance. This administration can let “higher premiums” constitute a hardship.

But, in the spirit of Pollyanna, I am plumbing for nuggets of hope. Here are a few.

Hope nugget one: Lower prices on pharmaceuticals. This president has pledged to bring down drug prices. Forget the epi-pen boondoggle: the prices of other drugs have nudged up in double-digits. And the prices of orphan drugs remain stratospheric.

This administration might renegotiate the deal with Big Pharma to allow Medicare to bargain for lower prices. When President George W. Bush pushed through Medicare Part D to give enrollees drug coverage (admittedly, a “doughnut hole” made the coverage catastrophic – but Obamacare shrunk that hole), he gave Big Pharma a seller’s market. This administration might revisit that deal. Plus this administration, from its bully pulpit, might push down price increases. Maybe.

Hope nugget two: a national consensus on the legality of abortion. When the Supreme Court overturns Roe v. Wade, the decision over “rights” will fall to states. On that turf, women will have the opportunity – more accurately, the obligation — to speak out. With Roe v. Wade in place, many Americans accepted that the law itself would stand, whatever the incremental attacks on access, from waiting periods to ultrasounds.

Yet those perennial attacks suggest that there is no genuine national consensus on abortions. After all, “pro-life” politicians are not necessarily misogynist, or even determinedly “pro-life,” but are responding to a vocal constituent bloc. Indeed, Donald Trump, the citizen, was avowedly pro-choice; Donald Trump, the candidate, switched gears. On Jan. 21, millions of women marched in a collective angst. If those pussy-hatted women with their husbands, fathers, brothers, and friends march into state capitals, they will make legislators recognize that the often-silent majority does not want to set the clock back 40 years. Maybe.

At the same time, if the “pro-life” contingent loses its battle on the political turf, maybe it will fight on a moral turf, abjuring women from seeking abortions (switching tactics, from limit-supply to limit-demand). And maybe it will argue for income subsidies, decent schools, and universal healthcare to help low-income women raise children. Maybe.

The third nugget: in the wake of a shrinking government, Americans will value Uncle Sam. Americans who today see the government as either a bureaucratic nightmare run by incompetents, or a Machiavellian scheme to defraud taxpayers, will recognize the value in the programs they profess to loathe. In a democracy, the government follows the will of the people. So programs like Medicare, OSHA, Medicaid, Veterans hospitals, Social Security, even the Affordable Care Act, arise to serve the people.

Ironically, in a strange sort of cognitive dissonance, many Americans who benefit from these programs don’t see them as beneficial. Just as crucially, many Americans don’t see themselves as part of government; they see a schism of “us” versus “them.” (Truly, they aren’t. Only 60% of eligible voters in the US vote.; in Belgium, Turkey, Sweden, South Korea, Denmark, and Iceland, more than 80% of citizens vote).

These next four years of retrenchment will boost the nation’s “misery index.” If Medicaid morphs into a block grant, giving states leeway to pare benefits and enrollees, millions of people will find themselves uninsured, or underinsured with “affordable” policies that don’t cover much. Similarly, the demise of the Affordable Care Act will leave millions adrift. Maybe the resultant misery will spur citizens — the “we-the-people” of the Constitution — to act, to see themselves as part of government. Maybe. Optimistically.

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

From The Progressive Populist, March 1, 2017

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