Private option and prevention


Only a few hours before a couple of Republican holdouts gave it up and gave their leadership, and the Beebe administration, and about 150,000 Arkansans the private option insurance program — just a few hours earlier the Gallup research organization released its annual survey of obesity in America. Not surprisingly Arkansas was in the top 10, which should be read as the bottom 10. But we always are. We ranked fifth, with more than three of every 10 adults self-reporting their weight and height to an intersection that doctors regard as not simply “full” or plump or “heavy,” but obese. Obese, with every potential for life-threatening or, short of sudden death, life-altering chronic maladies: coronary artery disease, hypertension, diabetes, kidney failure. And others.

Nor should it surprise anyone — certainly health statisticians were not stunned — that four other states in the Dixie of 150 years ago also were in the top five. Nor that border states Kentucky, West Virginia and Oklahoma were included as well. All 10 states at the top (bottom) of the obesity index are traditionally poor, or lately so; the Great Recession. Five of the 10 thus far have declined to engage the Affordable Care Act — the ACA, though you probably know it as “Obamacare” — other than to resist it, and their number includes Louisiana, Mississippi and South Carolina, home to some of the sickest, shortest-lived humans in the United States.

Interesting, that of the 10 states that have the lowest incidence of adult obesity nine have chosen to expand their Medicaid programs, using federal dollars, or to otherwise implement Obamacare’s principal components. Also interesting — that would include Massachusetts, where then-Gov. Mitt Romney implemented a program that (in the 2012 presidential campaign) came to be known as Romneycare. Which is said to have inspired Obamacare. All 10 of the healthiest have been among the healthiest since the Gallup folks began scoring the states on obesity and four of them have been blue ribbon winners every year.

That more of the top (worst) states have not literally rushed to embrace the ACA and perhaps move more in the direction of the ten bottom (best) states — the incidence of hypertension among the former is almost 10 percent higher than in the latter — may startle medical scientists but not political scientists.

Well before the ACA became the law of the land I inquired of the University of Arkansas for Medical Sciences the cost of care differential between early detection of a breast tumor and diagnosis post-metastasis. Treatment at the first confirmation of cancer would run about $10,000, I was told. If the disease had spread significantly before the woman presented, figure on about $100,000. Naturally the lower amount signifies a lower mortality. The arithmetic speaks for itself. So do the morbidity tables, although heartbreak can’t be quantified.

Votes are easy to quantify, once they’ve been cast, as are Private Option participants, when they’ve been counted. The latest count indicates 125,000 Arkansans either have enrolled or are attempting to. They are the working poor, who earn too much to qualify for the traditional Medicaid program but whose incomes cannot possibly provide for health insurance unless rent and groceries are set aside; unlikely. Absent the Private Option their medical care would continue to be financed by those who have coverage and who see their premiums rise because the cost of treatment continues to rise, fueled to no small extent by providers (hospitals, clinicians) who charge more because their services to the poor are frequently, completely uncompensated.

The Republicans who ended the standoff have given the Private Option at least a chance of succeeding, even as amended by those of their caucus who nonchalantly acknowledge that the riders are designed to help kill it in the next legislative session. Whether from compassion, as a couple of the delegates aver, or with an eye to short-term fiscal policy (last year’s tax cuts, the coming year’s budget), or perhaps in exchange for patronage or programmatic favors yet undisclosed, they have done something else as well, something apart from extending a bit of hope to those who had too little. They have reinforced their party’s pledge to govern responsibly, and no matter the howls from its Tea Party subset.

Obesity and its attendant ills, like breast cancer, are most common in the American demographic in which Arkansas’s profile is too high — citizens unable to obtain the sort of preventive health care that predict or diagnose, and thus possibly avert or curtail, extremely threatening maladies and ferociously expensive after-the-fact treatment. May the Private Option prove to be the ounce of prevention. Make it a pound.

• • •

Steve Barnes is a native of Pine Bluff and host of Arkansas Week on AETN.