We’ve had plenty of gloom-and-doom news about health care lately, but as we near the year-end holidays that focus on giving thanks, let’s look at some positive trends in health care for which we can all be grateful.

Here are five welcome trends.  They all come with caveats, but are still worth celebrating.

Lawmakers and regulators, starting in 2022, will put a stop to insurance companies and health providers sticking patients in the middle of fee fights with “surprise” medical bills.  This infuriating situation exploded when insurers, seeking to hold down costs, steered patients into narrow networks of pre-approved medical providers, with whom big companies and insurers negotiated favorable rates. But providers rebelled, asserting that insurers were shutting patients out from care by experts and institutions with big reputations — and often higher charges.

Patients suddenly found themselves forced to deal with mind-numbing bureaucracies to determine which of the caregivers they wanted to see were covered under their policies. Providers also started hitting them with big bills — which insurers declined to cover — because the patients had not picked, or could not pick, practitioners in networks covered by their insurers. But how were patients supposed to determine the network status of the likes of emergency room doctors, anesthesiologists, pathologists, consulting surgeons, and other specialists — many of whom declined to join insurer networks because it might slash their fees?

The public frustration finally prompted Congress, in a surprise of its own, to pass a law barring surprise medical bills, and federal regulators have issued new rules on how this ban will work. Here is another pleasant surprise from the impending federal action: It may help to hold down medical costs overall, by requiring insurers and providers to arbitrate billing disputes (among themselves and not involving patients)— and to avoid settlements in which the expenses exceed rates normally paid for in-network services.

Caveats: Consumers still may be hit with big surprise bills for ambulances and other urgent medical transportation, especially if they must be airlifted for emergency treatment. Congress, alas, discovered that the nation has a messy patchwork of systems to transport patients in a hurry. In some areas, the business has been privatized, while in other areas it remains a costly local government function and federal officials were reluctant to complicate it further. By the way, those with health coverage also should be clear that, while experts are dismantling surprise medical bills, insurers may still require patients to seek pre-approval or prior authorization for certain medical services, especially if they are costly, complex, or considered experimental.   

After years of partisan battling, the Affordable Care Act (aka Obamacare) is more than here to stay: It is providing affordable health coverage for record numbers of poor, working poor, and middle-class Americans.

This includes more than 11 million enrolled in plans offered on public exchanges (with federal subsidies), 14.8 million newly benefiting from the ACA’s Medicaid expansion, and 3.9 million who were eligible for Medicaid programs but didn’t participate until new outreach. The Biden Administration has welcomed the news that 31 million people are covered under the ACA, which has been bitterly opposed by Republican leaders.

Under the Trump Administration and GOP efforts to kill Obamacare without providing bona fide alternatives, 2.3 million Americans became uninsured. Experts estimate that 10% of the population continues to lack the important financial and health safeguard of medical insurance coverage. Despite the huge toll inflicted by the coronavirus on people’s health, employment, and finances, the uninsured rate — as some experts feared — has remained static. Biden officials, working with the Democrats in Congress, created special, pandemic-related expansions of enrollment programs and outreach for Obamacare during the pandemic. They provided increased financial help for those seeking ACA policies — notably “gig workers” and middle-class recipients.

Caveat: For the enhanced ACA to sustain its outreach, subsidies, and more, Congress must renew the added health coverage funding. President Biden has said this should occur as part of the sizable “Build Back Better” Biden Administration social programs package that lawmakers are considering now. Or it might happen just as the ACA money runs out before the midterm elections.

Important reminder: This is the time of year for workers who get their health coverage through their employers to receive key information and to make crucial decisions about their insurance for 2022. Nov. 1 is when open enrollment starts for ACA coverage. Don’t get intimidated by the jargon or the complex presentations by your company or insurer. Focusing on details can save you money and ensure you and your loved ones get the best, most affordable coverage you need.

With all the noisy disinformation that extremists have spread about the coronavirus shots, ordinary folks may not appreciate that medical historians may regard recent times as a watershed moment for vaccines as a major tool for preventing disease.

Late in 2019, public health officials welcomed a vaccine to battle Ebola, a scary hemorrhagic fever. It took scientists cooperating across three continents, combined with the threat of a major outbreak of the rare but lethal viral infection, to allow at least a wider deployment of the Ebola vaccine — and to prove that it worked.

Public health officials recently have reported success with a vaccine against another huge harm in the tropical and developing world: malaria. The chronic, debilitating, and too often deadly illness — spread by mosquitoes and a blood-borne parasite — kills 500,000 people annually, half of them children in Africa. The novel vaccine tackles a big problem in a regimen of multiple shots, attacking one of the major parasites (Plasmodium falciparum) that makes malaria such a scourge. The vaccine is imperfect. But, combined with disease-fighting programs, such as campaigns to provide poor people with low-cost mosquito netting, the relatively low-cost, easily carried out vaccination program will go far to slash malaria’s harms, experts say.

As for the advances underlying several of the prominent coronavirus shots, the innovative mRNA technology rapidly may yield progress against other illnesses. Getting the body’s own immune system to target key ways that diseases attack human cells may soon provide weapons aimed at the annual killer influenza, and, yes, certain types of cancer.

Let’s not forget that, relatively recently, researchers (in 2006) developed a vaccine that can prevent a half-dozen types of cancer, notably cervical and other female reproductive cancers, by targeting and blocking infections by the human papilloma virus (HPV). That vaccine needs wider use and acceptance in young women and men.

Caveat: Vaccines have been legend for being difficult to develop. Despite decades of intensive research around the globe and the spending of large public and private sums, a safe, effective, and affordable vaccine against HIV-AIDS remains elusive.

Important reminder: Tens of millions of Americans still have not had the safe, effective, and free coronavirus shots. While all medical interventions carry risks, the benefits of vaccinations far outweigh these, especially with the contagious, debilitating, deadly coronavirus. Public health officials are pleading with the public to get shots not only against the coronavirus but also the flu — to prevent already overwhelmed health systems from collapse in a “twindemic.” Patients should talk to their doctors to ensure they and their loved ones are up-to-date with the range of vaccines that can safeguard them from illness.

Medical educators are expressing guarded optimism about a surge of interest in health careers among young people.

Medical schools have reported an 18% increase in 2021 applicants, while public health graduate programs have had a 40% spike in year-over-year applications. Programs preparing registered nurses (RNs) with bachelor’s degrees have had enrollment increases of 5.6%.

Experts have forecasted that the nation — rapidly graying and with huge looming needs for medical caregivers — may have shortfalls of as many as 125,000 doctors by 2034 and 1 million nurses by 2030.

Even if the interest in health professions stays high, it takes considerable time and effort to fully educate medical personnel and to see them get their vital clinical experience. The slots in schools and programs (internships and residencies, for example) to do so are spare, more than competitive, and costly. Educators and students say the coronavirus pandemic changed the application process, potentially for the better, by allowing aspirants to conduct extensive interviews virtually — saving them big money on travel and lodging and permitting more institutions to look over more hopefuls.

Caveat: Health care, particularly in the time of the coronavirus pandemic, has become an unacceptably politicized field, with partisan extremists attacking staff in public health, infectious diseases, emergency care, nursing, and other medical areas. The failure of huge segments of the U.S. population to follow evidence-based, common sense, relatively easy measures to battle the pandemic — including vaccination, face covering, testing, and distancing — has resulted in health systems from coast to coast getting battered and at times overwhelmed by desperately sick patients requiring intensive care. The toll on doctors, nurses, first responders, and others in health fields has been profound and sustained. Worst-case scenarios project that health worker burnout will worsen shortages of qualified personnel.