Christmas shopping with a friend

First of the week, a friend called to ask if I had any Christmas shopping to do. I tried, without success, to persuade him that gift buying isn’t fun unless it’s oh, December 22nd . He told me I was nuts and I agreed. But it’s sort of like going to the races, I observed — the fun is in watching all the other nuts.

“Pick you up in an hour?” It was a slow, late afternoon, and I hadn’t that much going on, so I gave in despite the suspicion that my buddy had more in mind than the perfume counter or the toy store. I prepared to be lobbied.

My friend has a personal interest in the outcome of the Medicaid debate in Arkansas —whether to expand coverage —because he works in a health-related field. He always is attuned to how even the smallest changes in public policy would affect the clinical professions and ancillary enterprises. And how those changes, tweaks or seismic shifts, would effect consumers, beneficiaries, patients. The affluent, the poor, children, the elderly. Not The Compleat Wonk, he, but mindful of the broad perspective.

His own corner of commerce, however, has always seemed to me bigger, different, than most chambers of commerce, which are concerned less with attracting new businesses than holding down taxes and regulations on existing ones. A mutual friend once described him, and not disparagingly, as a “trickle-up conservative.” (Sure enough, when I related that to him later he took it as high praise, “right on the money —no pun intended”).

There was sunshine but it was fading fast and so to cut the chill we stopped to get a go-cup of coffee en route to the shopping mall and our rendezvous with the other nuts. Naturally there was one clerk on duty and a half-dozen customers ahead of us. My friend nudged me and nodded to the check-out counter, to what I already was watching. A line of young people, primarily, already overweight, most of them; and their quarters and dimes and dollars were buying pork rinds and potato chips and candy bars and magnum-sugared sodas —the after-school snacks that have helped create the $300 million Medicaid deficit that awaits the Arkansas legislature in January.

“Well, there’s ARKids,” I sighed, settling into the car and pulling the lid from my coffee. ARKids is the state health insurance program for teens and younger whose parents don’t have health care coverage.

“Tip of the iceberg,” my driver commented, and I knew what he meant —that plump kids become obese adults, and that’s when the bills start coming due. The fat kid may have to tolerate fat kid jokes but usually not what being a fat kid eventually summons: diabetes, kidney failure, heart disease. Add alcohol and cigarettes to the pot and the witch’s brew threatens to bankrupt a state that is second only to Alabama in the stringency of its requirements for public, programmatic health care. Kids get colds and chicken pox and break their arms, ailments that cost peanuts to treat compared to the six-figure tab for a single case of coronary artery disease or lung cancer.

My friend took his hand off the wheel long enough to pluck a sheaf of papers from inside his jacket and offer it to me. And now the lobbying, I thought.

Not exactly; the documents were an advance copy of a national non-profit organization’s annual report ranking the states by the health of their citizens. It didn’t take me long to find Arkansas because I started at the end of the list. It’s really not a thing you want to thank God for, but Mississippi was lower than Arkansas, and Alabama, too, which still left us in 48th place. The table of states showed us slipping from 47th in the previous survey.

In southwest Arkansas “I’ve got a hospital on life support,” my friend said, and if it went under it would eliminate the primary source point for health care used by several thousand people, a good many of whom cannot pay for services the government, and conscience, demand they be given. If we lived in a smarter world, he told me, they might not need a hospital, or the one they have, the one they’re trying to keep; an emergency center for lower-level highway or farm trauma and heart attacks might suffice.

I knew there were other hospitals in similar vises, and I thought to mention a couple, but we were at the mall now.

My friend took the papers back and tossed them into the back seat. “Let’s go in with the rest of the nuts,” he said.

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