US children’s health insurance bill nearer…to veto

An update on this story. Back then (about a fortnight. Americans, that’s two weeks), the news was that the White House was threatening to veto planned legislation that would provide health insurance to around 4.1m uninsured American children – more or less so that the access and outcomes of the children in the richest nation on Earth would maybe catch up to the rest of us in the OECD.

In response, the Senate went ahead and passed the bill.

A proposed expansion of government-funded healthcare for children was poised for approval by the US Senate on Thursday, in spite of a threat by President George W. Bush to veto it.

The bill would give 3m more lower-income children access to the decade-old State Children’s Health Insurance Programme (SCHIP), representing the most ambitious domestic healthcare proposal by Congress for years.

(a) somewhere, there, the number of children affected has changed; (b) it can’t be hard to be “the most ambitious domestic healthcare proposal by Congress for years” – not that I’m knocking the effort. Just every lack of effort until now.

When I first wrote about it, it was relative to the cost: specifically that, if you didn’t give sick little kids adequate treatment, they became sick adults, required a hell of a lot more care. They don’t earn much lifetime income, they aren’t productive. They probably die before using much social security, but they won’t contribute very much to it and they’ll use a hell of a lot of Medicaid before then anyway. My point is, it costs more – you ever hear of an ounce of prevention being worth a pound of cure? It’s true – that’s why drug companies sell neither preventions nor, where they can help it, cures. Because those are worth a tonne of palliative treatment. Just ask Chris Rock (that’s a Bigger and Blacker reference).

New argument, then: socialised medicine is choiceless – like communism:

But Mr Bush and other Republican critics have condemned the measure as the start of a broader push by Democrats to expand “socialised medicine” in the US.

“Their goal is to take incremental steps down the path to government-run healthcare for every American,” said Mr Bush recently. “It’s the wrong path for our nation. Government-run healthcare would deprive Americans of the choice and competition that comes from the private market.”

Two things, both very important. George Bush, lazy C-average scion of bone-idle capital-w Wealth, would not know what “deprived of choice” even means. As I said in an earlier post, this is a man who hears of a woman working three jobs, and thinks she’s marvellous. His mother sees poor people on army cots in the Astrodome and thinks it’s working out well for them. The President will not familiar with, say, your insurer offering the choice between one specific provider of their choosing or no provider at all. He will not be familiar with a choice between medication for your daughter’s asthma or the rent.

I have at least a couple of colleagues who are not sympathetic to this – this is fine. I’m from a social-welfarist country, Americans are not (Americans are misled throughout childhood and onwards, but that’s another matter). Here, then, is the second thing: when Bush, those ‘other republicans’ or any other dip-shit insists that socialised medicine offers you no choice, or is anti-free market, they are lying to you.

First example: my country. Australia has universal health insurance, funded out of general taxation (i.e. not by a specific tax, although there is a surchage on higher incomes). I’ll return to this. We also have: public hospitals, that treat you for free; private health insurance; private hospitals, that get some money from the government, some money from your private health insurance, and money from you, if they want; we have subsided medicine (our Pharmaceutical Benefits Scheme is generally acknowledged as the world’s best. The US’s original Medicare D is consider the dumbest); we have non-subsidised medicine. And if you consider our statistics ex-indigenous, our health outcomes are among the best, as is our quality of care and of life. But, then, so are our education outcomes.

I say ex-indiginous because their circumstances are the result not of health policy, but deliberately racist ones – whichever country you are in, I invite you to send a letter to the nearest Australian embassy, expressing your disgust at my government.

For other versions of the first example, you can look at just about any European country. Second example, Medicare and Medicaid in the US. Once Medicare D is made to make some bloody sense, it too. Specific to which, consider the legislation for the same, the one for which debate was held up for hours while Tom DeLay could earn a rare ethics back-hand, beating and bribing support out of legislators. For legislation which, ultimately, reduced choice because of corrupt concessions to the private market.

The key is the old Republican trick: harp on and on about how bad government is at managing things. It is – when they’re in charge. Put people with brains and a sense of civic duty, rather than fund-raising, in charge, and you’d be amazed at what a government can manage. PhRMA’s interests are not your interests. They’re consistenly the most profitable industry (oil might be, now) – do you honestly think they got that way by offering you choices, for your own good?

Returning to money. As I’ve said, the whole point of insurance for children is that (a) bad things shouldn’t happen to animals or children (fuck you, Ted Nugent), but more relevant to this (b) it’s cheaper for us, as a society, to treat them while they’re young and make them strong, and benefit from that later when they learn, work, make money and pay taxes, not need welfare.

Relative to the cost to you: if there’s one thing that gets on the tits of health economists of my ilk (i.e. non-American, for the most part), it’s the hackneyed old WSJ canard that you can’t afford public health care. I will stack, any day, the tax burden in my country, in Britain, in South Africa, in Holland, you name it, against the private health insurance premia that you pay. And in Australia, health insurance is community-rated. You, there, with the history of sickle-cell, or breast cancer, who can’t even get insurance in the US? You can in Australia! And for the same price as me. Or, don’t, just use public hospitals. You will pay less in taxes, because Medicare, or the NHS, or any other ‘socialised medicine’ sector doesn’t need to keep profits competitive – it doesn’t even need to make profits exist.

So. If moving from the profit motive and K-street to the Hippocratic oath and good government is going to send Americans under when the rest of us prosper in good health, explain these to me:

OECD total expenditure

OECD GDP percent

mortality comparison

expectancies comparison

To the extent that more of your taxes are even needed:


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