Start saving up for the future health care burden of the un-SCHIP’ped
Or, rather, the non-SCHIP’ped.
House Democrats were unable Thursday to override President Bush’s veto of their pre-election year effort to expand a popular government health insurance program to cover 10 million children.
The bill had bipartisan support but the 273-156 roll call was 13 votes short of the two-thirds that majority supporters needed to enact the bill into law over Bush’s objections. The bill had passed the Senate with a veto-proof margin.
The expansion by another 4 million young people of the State Children’s Health Insurance Programme (SCHIP) fails. Implications? First, 30-40 years from now, the US health care system (such as, or however, it will exist) will be treating these people as much sicker – and more expensive – adults.
In the case of health, an ounce of prevention most certainly is, generally, worth a pound of cure. The human is more or less able to accumulate health and maintain a given stock of health. But. There is a social gradient to this. Poor people don’t tend to nourish their children as well. They have less income, live in worse areas, they tend to smoke and drink more. They eat and feed their kids high-caloric, low-nutrient diets. Those kids don’t develop as well. Those kids, packed with sodium and high-fructose corn syrup, won’t benefit as much from education (of any standard) – they won’t turn into adults that are efficient at building and maintaining health, they won’t earn as much, etc. It’s not called a ‘trap’ for no good reason.
So to SCHIP. It has been opposed on the grounds of the ideology of welfare, but that was just plain asinine. SCHIP was intelligent not because it expanded socialised medicine, or because market-based solutions for health care are inefficient, wasteful and fraught with terrible distributional outcomes. SCHIP was intelligent because for relatively little money now the government could have (a) saved a lot of money by not having to sort these people out once they’re (more likely to be) poor, sick adults, and (b) ensured greater economic growth through the increase in human capital and social capital that would have resulted from increased health status.
Not for nothing does the US have such terrible health status. The US government, unlike those of the rest of the OECD, does not pursue health. We’re so caught up in the debate about universal health care (or insurance) that we miss the actual difference. The US government (or the politicians posing thereas) does not pursue health for the American people. If it did it would invest in SCHIP, invest in school lunches, invest in sports programmes, ban shitty advertising of crap food to children. It would have a No Child Left Behind policy that made some goddamn sense.
The rest of us employ broader bases of/for socialised medicine as part of a greater pursuit: equality of opportunity to reach this basic health-producing/maintaining level of health in our citizens. Make them healthy enough that their bodies can basically take care of themselves until they get cancer and need our primary care sectors again.
Here, not so much. Here, we use emergency rooms for basic care – or for emergency care that could easily have been avoided with some relatively inexpensive preventive health interventions by the state. SCHIP would have done that – it already does that, for Cliff’s sake. It only makes sense to save more money by doing it for more people.
The whole affair just angers me, as a health economist (the more so, as a welfarist one).
The second issue was, of course, that which likely contributed to bringing it down:
To pay for the increase, the bill would have raised the federal tax on cigarettes from 39 cents to $1.00 a pack.
“This is not about an issue. It’s about a value,” House Speaker Nancy Pelosi, D-Calif., said just before the vote. “For the cost of less than 40 days in Iraq, we can provide SCHIP coverage for 10 million children for one year.”
I had to make this point to an audience last night. Our countries don’t pay for our socialised medicine by taxing people to hell and back. We do it by not letting our government waste our money on nonsense we don’t want (to as great a degree, shall we say). Governments exist because we invented them. We invented them to do things that we could not, efficiently, do. That includes health care and providing incentives to certain sections of the population to engage in healthy behaviours with positive externalities for the rest of us.
Expanding SCHIP should not be done via increasing the burden of government (certainly not in this country, where each level of government acts without any due regard for the overall burden of all three levels of government on taxpayers). It should be done by making our government a government once again – a body of elected representatives (not leaders. Not politicians) who provide administration for our chosen allocation (and, in the case of SCHIP, investment) of resources.
Like Hillary Clinton’s old shot at universal health insurance, this was done, foolishly, in a manner that just invited opposition. Pelosi should not have been saying this “just before the vote” – it should be the catch-cry of all such legislation. The democrats should trot Ben Cohen out onto the floor of both houses with a box full of Oreo cookies.
The last thing the US government needs is more of our money. What it needs to do (or, what we need to start re-learning how to make it do) is spend it on the things for which we hired this government in the first place.
Opinions differ, of course.