A Heartless "Philosophy"

After six-and-a-half miserable years, it is hard to tally up the worst abuses of the Bush administration.Narrow the field, and focus only on abuses related to the economy. That's the universe of all the favors that the Bush-Cheney cabal has done for Big Business, so it is still a very competitive contest.

A case can be made that the administration's effort to block expansion of the State Child Health Insurance Program (SCHIP) should top the list.

SCHIP is a complement to Medicaid, and provides health insurance to uninsured children from low-income families, typically those making up to 200 percent of the poverty line ($34,000). It has had enormous success in its 10 years of existence. Four million children receive health insurance through SCHIP. It has reduced the number of children in families at or slightly above the poverty line who are uninsured by about a quarter.

This has very real and concrete meaning. As the Center for Budget and Policy Priorities has shown, children with insurance get more preventative care, get better treatment for chronic conditions like asthma, have far fewer unmet medical needs, and get better dental treatment.

SCHIP is now up for reauthorization. Because of medical inflation, the program needs more money to provide insurance to the same number of kids. Because the program has been a clear winner, members of Congress from both parties want to provide this needed funding, and to expand the program further.

But President Bush says no.

He has a "philosophical" objection to expanding SCHIP.

"I believe government cannot provide affordable health care," Bush said at a media event last week. "I believe it would cause the quality of care to diminish. I believe there would be lines and rationing over time. If Congress continues to insist upon expanding health care through the SCHIP program -- which, by the way, would entail a huge tax increase for the American people -- I'll veto the bill."

Here's what is most remarkable about this philosophical objection from the White House: It isn't shared by the for-profit insurance industry.

Last week, the Senate Finance Committee, by a 17-4 vote, approved a reauthorization of SCHIP that would enable the program to cover an additional 4 million children without insurance. Most of these children -- 85 percent -- would already be eligible under existing standards, but would not be covered for lack of funds. The Senate proposal is funded by a 61-cent-a-pack cigarette tax increase, which would have health benefits of its own: deterring almost two million children from taking up smoking, encouraging more than a million adult smokers to quit.

America's Health Insurance Plans (AHIP), the trade association for the health insurance industry, "supports the Senate package," says Mohit Ghose, AHIP Vice President of Public Affairs.

"Kids coverage come first" in the effort to get all Americans covered, he says.

Isn't it strange that the administration is trying to protect the industry, but your position is supportive of the Senate approach?

It's about a "philosophical point," not protecting the industry, says Ghose.

"I defer to the White House on what is government-run healthcare."

The Bush administration's position is that an expansion of SCHIP will mean that some covered children otherwise would have received private insurance, and that the government program will therefore "crowd out" private insurance.

It is true that, under the Senate program, about a third of kids newly covered would otherwise have had private insurance. But as the Center for Budget and Policy Priorities emphasizes, this is unavoidable (if you are in fact trying to avoid it): the patchwork nature of U.S. private health insurance makes it impossible to cover any group outside of the very poorest and not also provide coverage to some who would otherwise have some private insurance. Moreover, says the group's Matthew Broaddus, any parent switching their child from private insurance to a public program is doing so either because they have to pay too much out-of-pocket, or because they think they can get better care from the public program.

Where the private insurance industry does line up with the administration is in opposing a bolder plan moving forward in the House of Representatives. The House plan would cover more uninsured children, which does start to worry AHIP, and it would pay for the expansion both with a cigarette tax and by collecting excess payments to private insurers in the misnamed Medicare Advantage program. Medicare Advantage lets seniors opt for a private insurance plan in lieu of traditional Medicare. These private plans are collecting at least 12 percent more per covered person than it costs to treat a person under Medicare. The industry is adamantly opposed to efforts to stop these overpayments.

As against expanding SCHIP, the administration proposes a preposterous tax credit to help pay for individual insurance coverage. Because individual insurance coverage is both the least efficient component of the health insurance market and the one most rife with abuse, it is a certainty that the administration plan would be a failure.

One benefit of having already suffered through the long reign of President Bush is that he no longer commands the authority he once did. The vast majority of people in the United States oppose his position and -- in a change -- a strong majority in Congress oppose him, as well.

But will Bush veto SCHIP expansion? Will enough Republicans break from the administration to override (or prevent) a veto? That depends on how loudly the public insists its elected officials choose healthcare for kids over twisted philosophies.

Take action now via the Families USA website.

Robert Weissman is co-director of Essential Action, a corporate accountability group based in Washington, D.C. that focuses especially on international issues and has been very involved in the access to medicines campaign. He is also editor of Multinational Monitor magazine. With Russell Mokhiber, he is editor of a weekly column, Focus on the Corporation, archived at https://lists.essential.org/pipermail/corp-focus.

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