Your Independent Journal from the Heartland
President George W. Bush wants to take a hard line on children's health coverage.
He continues to threaten a veto of a bipartisan expansion of the State Children's Health Insurance Program -- known as S-CHIP -- because of his ideological bias against government-run health plans.
While the president's threatened veto is callous -- it would leave nearly 10 million children without coverage -- it points to the problem with programs like S-CHIP, which attempt to address our faltering healthcare system on a piecemeal basis.
S-CHIP is a useful program and its expansion is necessary to deal with the changing healthcare landscape. It is designed to provide coverage to families who earn up to 200% of the federal poverty level, but too much to qualify for Medicaid -- families who generally cannot afford their own private health insurance.
The program, which was due to expire Sept. 30, is rather flexible, giving states leeway to define income in ways that allow them to raise the threshold and cover more children, as the New York Times pointed out in a September editorial.
Several states with high costs of living -- New York, New Jersey, California, among them -- have crafted income rules that allow coverage for children from families that earn as much as four times the poverty level, a move that the Bush administration considers an abuse.
Health and Human Services Secretary Mike Leavitt announced new federal rules designed to limit the ability of states to extend the reach of the program on their own. The rules, according to the Washington Post, would require that "families with incomes at or above 250% of the federal poverty level" be uninsured for at least a year before they could qualify for the program.
The Senate Finance Committee approved legislation this summer both to reauthorize the program and extend it. Approved by a 17-4 margin, it would provide $35 billion more for the program over the next five years, expanding the number of eligible children by about 50%.
The Times endorsed the expanded S-CHIP, citing "alarming deterioration in private insurance coverage all across the country as employers have reduced health benefits or charged more for them" and "premiums for family coverage (that) have soared far faster than wages in recent years, so that even middle-income families are feeling the pinch."
The reality is that the S-CHIP program, as useful as it is, will do very little to address a growing problem. A US Census report issued in late-August offered a glimpse into the intractable nature of the healthcare crisis. A total of 47 million Americans now lack health insurance, or about 2.2 million more than in 2005, according to the report, even though the percentage of Americans living in poverty actually decreased slightly.
"In all, 15.8% of Americans lacked coverage last year, up from 15.3% in 2005," the Washington Post reported. "Children fared worse. Last year, 11.7% of people younger than 18 lacked health insurance, up from 10.9% in 2005. The percentage of uninsured children has increased two years in a row after declining for at least five years, according to the census data."
And this is with a decently functioning S-CHIP program. Similar problems exist with state-run attempts at universal coverage, most of which rely to at least some degree on private insurers.
In Massachusetts, the state is considering limiting access to the state's health-care safety net to boost enrollment in higher-priced plans. Benjamin Day, executive director of Mass-Care: The Massachusetts Campaign for Single Payer Health Care, wrote in an August op-ed in the Boston Globe that the proposal would "cripple the state's only program that guarantees that low-income, uninsured residents have a place to land when all else fails" in an effort to boost enrollment of other plans. He says the plan will punish the poor without accomplishing the goal of providing health care to all.
He pointed to what he called a "long and unfortunate history" that "has led to the erosion and, at times, the vilification of our economic safety net institutions."
"In the United States, the only developed nation without a national universal health plan, the health safety net is targeted as a means of corralling the uninsured into traditional insurance plans," he wrote.
"There is little evidence that eroding safety net programs actually helps improve participation in the labor market or the healthcare market. This does, however, succeed in punishing the poor, throwing low-income communities back on their own resources, and increasing the stigma upon safety net recipients."
The answer, then, is not to rely on Band-Aids and do what Michael Moore, US Rep. Dennis Kucinich (a Democratic presidential candidate) and others advocate: Create a national system of universal coverage, administered by the government and paid for out of our taxes.
Will this be simple? No. But health care needs to be treated as a right and not as an economic benefit of employment. The current system is expensive, inefficient and detrimental to our economy -- as General Motors knows.
It is time we joined the world's other industrialized nations on this.
Hank Kalet is a weekly newspaper editor. Email grassroots@comcast.net. His blog, Channel Surfing, is at www.kaletblog.com.
