When Medicare and Medicaid - our government programs to provide health care for the elderly and the poor - were approved in 1965, they were widely seen as a step toward the universal health care that former President Harry Truman had unsuccessful advocated 20 years earlier. The United States was catching up with the rest of what was then called the industrialized world, in creating a more just and humane society.Our leaders then escalated the Vietnam War and drained the funds necessary to expand health care, and as Martin Luther King, Jr. famously noted, for the war on poverty as well. In 1981 the "Reagan Rollback" began and the country embarked upon its project of building a bridge to the 19th century in areas of social policy.
One of the few bright spots over the last few decades in the struggle to extend health insurance coverage was the passage of the SCHIP (State Children's Health Insurance Program) in 1997. This program provided for federal grants to states that wanted to expand health care insurance to children. The children eligible would be those that did not qualify for Medicaid but lived in families with income below twice the poverty level. (The poverty level for a family of three today is $17,170 per year.)
More than 4 million children are enrolled in SCHIP, and most of them would not have health insurance without the program. About 90 percent of these children live in a family with a parent who works. This reflects a major purpose of the program: to help families whose main earner is working full time but still cannot afford health insurance for the children. For example, consider a worker with two children with income is between $1431 and $2862 a month before taxes. She is not eligible for Medicaid. Paying $800 a month to cover her children - even if she is lucky enough to have that option with employment-based insurance - may make it difficult to pay for rent, food, utilities and other necessities.
There are still about 9 million children uninsured in the United States, some of whom are eligible for SCHIP or Medicaid but are not enrolled. The Federal government currently funds SCHIP at about $5 billion a year - just 0.2 percent of the federal budget and less than one percent of all public health care spending. The program comes up for renewal in September of this year, and there will be debate over its funding.
A recent New York Times/CBS poll found 84 percent of Americans want the program expanded so that it covers all uninsured children. The public has it right - the program has been effective and universal coverage for children makes sense.
Of course, universal coverage for all Americans makes even more sense, and this also has majority support and is clawing its way back to the political agenda. The main obstacles are, as always, powerful special interests that corrupt our political system. Number one is the lobby for insurance companies, whose main goal is to insure the healthy and avoid the sick. The resources that they waste in this perverse pursuit help make our health care system the most expensive in the world: we spend about twice as much per person as other high-income countries. And we still end up with 47 million uninsured and worse health outcomes - lower life expectancy, higher infant mortality - than the other countries that provide universal heath insurance at half the cost.
This colossal inefficiency and waste will have to be fixed if any health care advances are to last. And that will undoubtedly mean that the public sector becomes the dominant insurer, as it is now for the elderly and disabled. But until then, expanding children's health coverage is an important step forward.
Mark Weisbrot is Co-Director of the Center for Economic and Policy Research, in Washington, DC
This column was distributed to newspapers by McClatchy-Tribune Information Services on March 31, 2007