SCHIP Sliding Toward Socialism (Updated)

Matt Yglesias and Megan McArdle, who are on different sides on the merits of SCHIP are nonetheless agreed that President Bush’s veto makes no sense politically since it opens him up to charges that he doesn’t want kids to go to the doctor.

Kevin Drum figures the president’s own explanation is a reasonable starting point:

He says he doesn’t like it because it’s the camel’s nose under the slippery slope on the road to hell of national healthcare, and I think that really is the reason.

After all, Bush is right: we liberals really do think of things like SCHIP as building blocks on the road to universal healthcare, don’t we? It’s hardly a big secret. And one should never underestimate the horror with which conservatives view “socialized medicine.” They’ve fought it like crazed lemmings for decades, and they fight it even when it conflicts their own bottom-line interests.

That’s largely right, I think. Indeed, they’ve we’ve generally lost the fight — winning the occasional battle but ultimately sliding further toward a non-market system — while taking the political hits for insufficient empathy.

Alex Massie homes in on one of the keys: the issue of fairness. Noting Yglesias’ touting of a cigarette tax as a perfectly good means of paying for expanding SCHIP — since it either makes it harder for people to smoke or punishes them for doing so while netting money for the state — Massie cries Foul.

Well, ain’t that a pretty thing: let’s make the poor pay for health insurance for middle-income people. Now you may say that this is fine; poor people should be discouraged from smoking too. Fine. But most of them won’t be and will, consequently, be paying for SCHIP. It’s a very regressive way to do these things. (Indeed, the supposed concern for the poor smoker is bogus: you need them to keep smoking otherwise you can’t fund your program. So the task is to find the optimum level of tax that won’t drive folk to the black market. You need smokers, otherwise how can you exploit them? All of which would be fine if it weren’t accompanied by the sanctimonious tut-tutting so characteristic of the health crusaders).

The current health care payment mix is economically irrational but it’s the status quo and benefits from inertia. Any attempt to change the system will invariably disadvantage a lot of people.

There’s an overwhelming consensus that society should guarantee that those who can’t help themselves — especially children — some minimal standard of health care. But each incremental expansion brings into question where precisely to draw that line. And someone has to pay for it, after all.

Former Senator Phil Gramm (R, TX) used to rely on the Dickie Flatt test, purportedly named after a rather unfortunately named constituent of modest means. The question, Gramm claimed, that he considered when voting for any new government entitlement was, “Will the benefits to be derived by spending money on this program be worth taking the money away from Dickie Flatt to pay for it?” There comes a point, presumably, even when talking about doctors for children, that the answer is No.

In all honesty, I haven’t spent a lot of time fretting over that precise line of demarcation and thus have no strong position on this current squabble. But, surely, the mere fact that the money would be “For the children” is not disposative.

Update (Dave Schuler)

The rhetorical strategy that Democrats will be using to get votes for an override of President Bush’s veto is beginning to emerge:

“Today the president showed the nation his true priorities: $700 billion for a war in Iraq, but no health care for low-income kids,” added Rep. Rahm Emanuel, an Illinois Democrat. “Millions of American children and their families won’t forget that they are on the bottom of the president’s priority list.”

That’s likely to be effective as long as the war in Iraq remains as unpopular as recent polls have suggested.

Unfortunately, at this point it’s just a rhetorical strategy. All of the top tier Democratic candidates have been candid about their plans to leave a sizeable number of American troops in Iraq for the foreseeable future. Although all would like an end to the troop presence there none will commit to a complete withdrawal in the foreseeable future and I don’t know of any specific proposals for reductions.

In the absence of troop reductions in Iraq by any conceivable president for the foreseeable future the plaint about the expense of maintaining those troops is a non sequitur. Under the Democrats’ plan we’ll have the expanded SCHIP program and the war in Iraq. So much for fiscal responsibility.

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James Joyner
About James Joyner
James Joyner is Professor and Department Head of Security Studies at Marine Corps University's Command and Staff College and a nonresident senior fellow at the Scowcroft Center for Strategy and Security at the Atlantic Council. He's a former Army officer and Desert Storm vet. Views expressed here are his own. Follow James on Twitter @DrJJoyner.

Comments

  1. mannning says:

    The definition of child seems to be the operative factor here. My understanding is that 18-year-olds would qualify in this bill, and it isn’t hard to imagine that number sliding up to 21, then 28, then…becoming all inclusive by degrees.

    My other understanding is that those with household incomes up to $80,000 a year would still qualify for the program.

    So we are being asked to pay for not only children, but also teens up to near adulthood, and from families with a high income too.

    I find Bush’s veto quite appropriate.

  2. davod says:

    It is my understanding that the states have not been using the money they already have to enroll poor kids. They have been using it for other uses.

    Now they want to institionalize what they have been doing.

    It’s not about the kids, it is about spending other peoples money on evrything but the kids.

    It justannoys the heck out of me that nobody in the mainstream will point this out.

  3. floyd says:

    The effect,whether intentional or not, of every liberal program is the destruction of the family.
    Fatherhood is the number one enemy of liberalism. First their programs force fathers out of the home and punish those who stay, then they make a play for sympathy for the “single moms” produced by their very policies.
    National health insurance is just another nail [of many] in the coffin of the nuclear family.

  4. Triumph says:

    Just like we had to fight Viet Nam in order to contain the red menace, we must also fight it here at home. So, kudos to Bush.

    One point that people often miss–Al Quaeda would like nothing better than see us with socialized health care. We need only to look to Britain where socialist Islamofascist doctors set off terrorist attacks recently as a warning. This clearly shows that any form of state intervention into the health care system is a gift to the terrorists.

    In fact, Bush should go one step further and do his darndest to get rid of Medicare and Medicaid. It is not a coincidence that both of these programs were flourishing on 9/11. Had the US let the market take care of health care, we would never have had to deal with terrorism OR communism.

  5. Michael says:

    First their programs force fathers out of the home and punish those who stay

    Examples please, as a father myself I’ve never seen any examples of what you claim.

    Now I am a self described liberal Democrat, but I don’t want to see socialized medicine. I just want to see routine medicine I can afford out of pocket, and affordable insurance for catastrophic medical emergencies. Figure out a way for the free market to provide that and I’m sold.

  6. Steve Plunk says:

    Triumph,

    No offense but it’s not funny. The veto was prudent.

    Michael,

    Check out the archive here for some of Steve Verdon’s posts concerning health care costs. Many free market economists have ideas to get us to where you (and I) want to be, affordable routine care and insurance for the big hits.

    We should allow some pilot programs to work for a time and judge the results. Both free market and socialized solutions should be tested. I know where I would put my money.

  7. Scott_T says:

    I’d like to point out that Medicare isn’t going 100% efficient, like everyone would like. It’s wrought with fraud totalling millions of dollars embezzeled by some doctors.

    Who’s to say a program such as this wouldn’t do the same thing, with low-income family, and their children being used by doctors to bilk the system? The doctor charges for procedures he didn’t perform, pays the family and pockets the differance?

  8. MarkT says:

    Alex Massie homes in on one of the keys: the issue of fairness. Noting Yglesias’ touting of a cigarette tax as a perfectly good means of paying for expanding SCHIP

    I think Alex has misinterpreted Matt.

    Here’s my take on Matt’s position: A cigarette tax is a good thing in and of itself. However, it isn’t the best route to funding health care because it is not sustainable.

  9. Tlaloc says:

    There’s some serious crazy from the wingers in this thread.

    anyway,

    Gramm claimed, that he considered when voting for any new government entitlement was, “Will the benefits to be derived by spending money on this program be worth taking the money away from Dickie Flatt to pay for it?” There comes a point, presumably, even when talking about doctors for children, that the answer is No.

    Fortunately if we replaced the whole shootin match with a *good* single payer universal coverage system it’d still cost us less than we pay now.

    That’s win-win (except for the socialism-o-phobes, but really, who cares?)

  10. yetanotherjohn says:

    Actually the democrats rhetoric has another fallacy. The disagreement with Bush is not on providing health care for “low-income kids”, but on expanding the program to include families making more than $80K and taking kids off of private insurance to put them on tax payer paid insurance.

    But don’t expect the MSM to bother pointing out the democrat’s lies.

  11. Grewgills says:

    To all posting about 80K families
    Do you ever fact check anything you read or hear?
    The bill covers families making up to 3x the poverty level (20650 for a family of four). That would be 61950, not 83000.
    The 83000 number comes from a waiver request by New York to allow in children from families making up to 4x the poverty limit due to their considerably higher cost of living. Once again, 83000 not in the bill. Don’t believe me. Look it up (HR 976).

    The program is and has been for children aged 0-18 (the age at which one legally becomes an adult). There has been no upward move here despite the intimations of some.

    Floyd,
    Perhaps you could explain to us how providing children with health care will harm the nuclear family?

    Scott_T,
    Medicare is nearly a 40 billion program. In any program that size public or private their will be waste and that waste in either case will likely be in the millions. Even 0.5% waste would be 200 million.

  12. Charles J. Neilson MD says:

    Bush’s veto against the SCHIP program, that would include financial support for medical care of illegals as well as non-poverty stricken children, is a vote for the American taxpayer. Unfortunely, health care of illegals and the uninsured will continue to rely on the doctors, nurses, and hospitals who do not receive raises nor fair compensation for their being overburdened by the federal unfunded mandate to care for 20 million illegals and the uninsured. What is missing here is the fact that within a few years, 40 million illegals will further overburden American hospitals (the majority of which are NOT receiving public funding) such that the feds will have to raise taxes to obtain funds to infuse into bankrupted hospitals forced to care for all of these non-paying patients. YOU, the taxpayer, will see more federal taxes just for the healthcare, while experiencing the everpresent raise in local and state taxes to fund school growth, bussing, bilingual teachers, prisons, etc. Bush’s veto is only delaying the ultimate need for massive taxation to fund health care and can only be ameliorated by his firm stance on securing our borders and punishing employers for hiring illegals. Otherwise, we all will be paying big taxes for the social welfare of these so-called “slave-laborers” while we are being fooled to believe we are enjoying lower prices for goods and services. You can control your purchasing but not the government’s upcoming tax hikes. Thus, call George up and demand he secure the border and punish businesses who hire illegals.

  13. floyd says:

    Grewgills;
    Yes; of course I could!

  14. Grewgills says:

    Floyd,

    Then do.

  15. bob in fl says:

    It is my understanding that the states have not been using the money they already have to enroll poor kids. They have been using it for other uses.
    posted by davod

    Wrong. The states have to account for how the money is used. Florida lost some of theirs about 2 years ago because it wasn’t used.

    Fortunately if we replaced the whole shootin match with a *good* single payer universal coverage system it’d still cost us less than we pay now.

    That’s win-win (except for the socialism-o-phobes, but really, who cares?)
    Posted by Tlaloc | October 5, 2007 | 07:25 pm

    I believe that to be true. When we talk about the costs, we need to include all costs, not just the cost from taxes. It doesn’t necessarily have to be single payer, but it does need to be a cohesive, coherent universal set of guidelines rather than umpty different programs with umpty different bureaucracies with umpty different sets of guidelines like we now have.

  16. anjin-san says:

    My other understanding is that those with household incomes up to $80,000 a year would still qualify for the program.

    So we are being asked to pay for not only children, but also teens up to near adulthood, and from families with a high income too.

    I don’t know about anyone else, but when I look at a 17 year old, I see a child. Maybe the GOP’s position is that 17 year olds should be working fast food jobs to pay for their health care. As for the 80k figure, that is just more nonsense from Rush. Do any of the parrots want a cracker?

    If you live in the Bay Area, 62k for a family of 4 is not much of an income.

    Pollibly the saddest thing of all is Bush, possibly the most out of control spender in history, trying to hide this denial of care for American children behind a facade of “being a good steward of the people’s money”.

  17. Tlaloc says:

    It doesn’t necessarily have to be single payer, but it does need to be a cohesive, coherent universal set of guidelines rather than umpty different programs with umpty different bureaucracies with umpty different sets of guidelines like we now have.

    How would you do that without a single payer system?

    I’m genuinely asking.

  18. m says:

    My understanding is that the Fed provides full coverage (pays between 65% and 85%) up to 300% of poverty, and additional coverage (at lower rates) for up to 400%. In addition, coverage, once proposed to include up to 25 year old “children” has been reduced to “only” 21. In addition, in some circumstances, this children’s insurance program has provided insurance coverage for parents of enrolled children, and, appallingly, for childless adults.

    In other words, like the ADA, this legislation takes a good idea, and expands its scope and scale to become another huge government program by redefining words (“child” and “poverty”) in a truly Orwellian (or even Humpty-Dumptian) manner.

    This bill abundantly deserved to be vetoed.

  19. Andy says:

    It’s wonderful seeing the right wing shoot themselves in the foot with a very large howitzer. The more y’all keep arguing against providing health care to children in poor and middle class families (through an interesting combination of lying and ignorance, I might add, in particular the mythical 80k figure) the more likely it is that President Hillary is going to ram through an even bigger program in 2 years with Dem majorities in both houses of Congress.

    Keep up the good work!

  20. bob in fl says:

    It doesn’t necessarily have to be single payer, but it does need to be a cohesive, coherent universal set of guidelines rather than umpty different programs with umpty different bureaucracies with umpty different sets of guidelines like we now have.

    How would you do that without a single payer system?

    I’m genuinely asking.
    Posted by Tlaloc | October 6, 2007 | 03:05 am

    Our health care system is already in place, as well as competitive payer systems. What is lacking is making health care universal & a single core set of eligibility requirements & minimum standards of care.

    Three example of what I am talking about is the Massachusetts, California, & the Clinton plans. There are others; I’m just not familiar with them. They offer what I see are the best chances for choice of provider & payer, competition of ideas for both care & payment methods, & the advantage of trying what works in one setting in others.
    Under these plans, we can use to advantage system wide the medical records technology of the VA, cost cutting methods of the HMOs, & – I’m stuck but there are many others. With one set of eligibility & minimum treatment standards, we can eliminate much of the bureaucratic red tape & personnel costs by eliminating SCHIP, Medicaid, & all of the under the radar govt programs offering spotty coverage & roll them into Medicare. The VA & military systems I would leave intact at least for now because they each have expertise unique to them that can be used in other settings. However, most stateside military hospitals would no longer be necessary if a GI could access their health care anywhere w/o penalty.

    Single payer, we have seen, does not work well in Canada & the UK. Well, it still works better than what the US has now, but we can do better.

  21. Grewgills says:

    m,

    Your understanding here is incorrect. I have detailed some of this above. I suggest you read HR 976. A summary is also available here.

    There are currently some waivers for people over the age of 18. This law would have prohibited further waivers of this type and terminated existing waivers by 30 Sept 2008. This is under section 2111. (The term adult in the context of the bill is 19+)

    An example of a current waiver program for childless adults: In Michigan adult waivers are currently available for those with countable incomes below 35% of the federal poverty level. That would be less than 8000 a year for a family of four. This will no longer be available in the new bill and those people will once again rely on the ER for their health care. This of course means that the hospital or the tax payers will pay for this at a much higher rate than if the waiver were to continue. This is probably financially a step backwards, but it was a compromise necessary to bring on more Republicans and make this a bi-partisan bill.

  22. Tlaloc says:

    Three example of what I am talking about is the Massachusetts, California, & the Clinton plans.

    I’m not familiar enough with them to understand that detail. I thought Clinton’s plan involved expanding medicare while also having private insurers available. That means it still has all the various redundant bureaucracies that cost us so much money.

    Single payer, we have seen, does not work well in Canada & the UK.

    True but it DOES work fantastically in France for instance. You can certainly do single payer badly, the thing is there doesn’t seem to be any way to do multipayer private insurance well.

  23. Dave Schuler says:

    Tlaloc, France doesn’t have a single payer system. It has a government insurance program and it also has private insurance programs largely paid by employers.

  24. G.A.Phillips says:

    If you live in the Bay Area, 62k for a family of 4 is not much of an income

    lol I wonder why?

    could it be that your taxes are to high?

    you should have gone to plan-o-parenthood for help with your budget, mabee you could have made it a little more easy on yourself with a family of 3 on 62K.

    62k, lol, must be nice to be rich.

  25. Tlaloc says:

    Tlaloc, France doesn’t have a single payer system. It has a government insurance program and it also has private insurance programs largely paid by employers.

    I’ll have to check it out more thoroughly, from my talks with a french coworker it sounded like they had a single payer system.

  26. Dave Schuler says:

    Here’s the description from the French Embassy. The most relevant paragraph is:

    In France, health insurance is a branch of the Social Security system. It is funded by workers’ salaries (60 percent of the fund), by indirect taxes on alcohol and tobacco and by direct contribution paid by all revenue proportional to income, including retirement pensions and capital revenues. On the surface, it appears that health insurance reimburses medical care providers less in France than in other European countries. However, more than 80 percent of French people have supplemental insurance, often provided by their employers. The poorest have free universal healthcare, which is financed by taxes. Additionally, the treatment costs for those who suffer from long-term illnesses are completely reimbursed.

    Germany’s system is more a single-payer system than France’s but I think that the French system is a good one and the one most worth emulating. I don’t oppose healthcare reform in the direction of something like the French system but, as I’ve written frequently, I think it’s critical that we not adopt such a system in isolation from measures to control costs other than by fiat (which many assume is the unstated plan of those who advocate healthcare reform). The American experience at the state level has been that political support for subsidized healthcare erodes as costs rise.

    Note, specifically, that France has a higher number of physicians per 100,000 population and the median physician salary is about 1/3 of what it is in the U. S.

  27. Tlaloc says:

    I think it’s critical that we not adopt such a system in isolation from measures to control costs other than by fiat

    What sort of cost controls are you suggesting?

    The American experience at the state level has been that political support for subsidized healthcare erodes as costs rise.

    True but state budgets are far more limited than the federal.

  28. Steve Verdon says:

    Tlaloc,

    The French system is like the U.S. system in that it is a mix of public and private. The gov’t provides a basic health care package and anything above and beyond that one has to turn to a private insurer for insurance coverage or pay out of pocket. The French system is probably one of the best, but that isn’t saying much given that it, like all the rest, is on an unsustainable growth path in terms of expenditures and their growth over time.

    Your co-worker might think it is a single payer system if he is generally healthy and utilizes just the basic package.