HEALTH CARE/Joan Retsinas

Cainotophobia — an Epidemic

Forget the impending swine flu epidemic. Cainotophobia — fear of change — is endemic among the American electorate. Faced with the prospect of change in the nation’s healthcare modus operandi, many Americans are terrified. Some concede that the current system has major flaws; they also concede the probability that change will bring progress. But even those people are catatonic, suffering from prosophobia, or fear of progress.

In short, a disturbing number of us are clinging to the status quo, frightened to take the next step, wherever it will lead. Their psyches are rooted in cement. And the more that analysts project the benefits of change, the more resistant the cainotophobes.

I have no magic elixir to uproot the cainotophobes, no way to dispel their demons.

But let me alert them to the overriding reality in this season of debate: legislated change is far better than the change that will happen if we as a country do nothing.

The notion that the status quo will remain status is a dangerous myth. Change happens, whether or not we will it; and the changes on the horizon in a status-quo health system promise misery.

In a remake of Frank Capra’s It’s a Wonderful Life, let’s watch It’s a Status Quo Life from the vantage of health policy.

First, if we as a country do nothing, the ranks of the 47 million uninsured people will soar. The ranks of the uninsured were mounting when all the economic indices — employment, credit, the Dow — were healthy. Now that the unemployment is up, credit is tight, and foreclosures continue, even seers with murky crystal balls foresee that an increasing number of Americans will lose insurance. Ironically, some workers who now praise their private-sector policies, who fear any “public” option, may in the next few years lose their wonderful insurance. Ask the workers laid off from General Motors or Chrysler whether they’d like a “public” option for insurance.

Second, as the economy hovers near recession, states have watched their revenue streams shrink. Many governments today are hard-pressed to pay for schools, police, fire, libraries. Medicaid — the safety net, insurance-wise, for poor women and children — is another state liability, even though the federal government picks up roughly half the tab. And the option of extending insurance to women and children who earn too much for Medicaid, yet need insurance, adds to states’ tab. Budget-strapped states will be eager to pare their Medicaid rolls. Those X-ed out enrollees will add to the ranks of the uninsured.

As for the kindness of hospitals, clinics and physicians to treat an influx of even more patients who cannot pay, that happy scenario exists only in Frank Capra movies. Those nonprofit organizations, however noble their mission statements, must remain solvent. All of us — insured and uninsured — suffer from the same maladies. And for many maladies, from diabetes to arthritis to heart disease, we have surgical and pharmaceutical tools to improve our lot. Yet soon we as a nation will divide not just by insurance status, but by sickness status, as the uninsured among us grow sicker.

Finally, the insured among us will face a grim tomorrow. With no federal oversight (cainotophobes would call it meddling), the private sector insurers will do what they were designed to do: make a profit. They will intensify their “profit-maximizing” techniques, the kind that MBA students study: pre-existing condition exclusions, limited provider networks, limited drug formularies, same-day surgeries, denials, caps, exclusions, waiting periods. “Medical” bankruptcies (where the insured person cannot pay all the co-payments, deductibles, and not-covered fees) will rise. At the same time, the insurance CEOs’ salaries will also rise. And in this private-sector nirvana, the unhappy enrollee, appealing a decision, will be left to the kindness of the people who must kowtow to their companies’ bottom lines.

This movie, It’s a Status Quo Life, is a tragedy.

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

From The Progressive Populist, October 15, 2009