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How Can You Oppose Health Care for Children?

December 18, 2007

Tags Free MarketsHealthInterventionism

Congress has again passed an expansion of the State Children's Health Insurance Program (SCHIP), only to have it vetoed again. That has given its backers yet another chance to proclaim how much they care for children and rehash attacks against President Bush, as when Lois Capps (D-CA) called it "denying vital healthcare to some of the most vulnerable in our society," and promise to try again next year. Unfortunately, however, their assertions are less than convincing.

Proponents begin by criticizing Bush's veto because of his previous fiscal profligacy. So critics attack him for spending too much (for policies they usually would spend even more on), then use that to criticize him for spending too little. Unfortunately, while his administration certainly can be criticized for its rapid growth in spending, that is not an argument for him to continue that pattern.

Proponents then cite widespread endorsements by states, medical providers and families who would directly benefit to demonstrate SCHIP's value. But that its beneficiaries like the idea says nothing about whether those subsidies, necessarily at others' expense, are good policy. I would like to take your money for myself, but that is robbery, and robbery doesn't become good policy just because the robbers like the results.

SCHIP proponents then typically ignore or dismiss all the real issues in their "analysis."

They ignore the fact that not having health insurance is different from not getting health care, just as not having food insurance does not mean one will not eat. The uninsured have access to emergency rooms, charitable aid and low-cost clinics, and qualifying children can even be retroactively insured for 90 days.

They ignore that while SCHIP's imagery is of young children, some states already have more adult recipients than children and the proposed expansion does not focus any better on young children.

They ignore how SCHIP would be expanded. It refers to assistance to low-income children, but fails to mention that it would expand coverage to those with three times the federal poverty line ($61,940, for a family of four), which is above the median income in 14 states. Those earning that amount do not need others to be forced to help fund their children's health care.

They ignore that the cigarette tax increases they proposed to fund SCHIP's expansion would redistribute income from poorer people to those who are better off. Tobacco taxes are regressive, taking a substantially larger proportion of income from lower income people than others, so using them to expand subsidized insurance for people with annual incomes as high as $60,000 actually harms many with low incomes.

They mention in passing that SCHIP's expansion may cover some families who could afford private health insurance, but give no indication of how large that crowding-out will be. When some leading academic studies estimate the crowding-out rate at 60%, so that only 40% of the asserted increase in insurance coverage may actually occur, it dramatically undermines claims of how effective the program is, with a majority of beneficiaries replacing coverage they would have had anyway with subsidized insurance.

After ignoring or misrepresenting virtually all the real issues, SCHIP proponents focus on rejecting the claim that SCHIP expansion will be "socialized medicine." But focusing on rebutting one weak argument does not establish the validity of proponents' assertions. When there are multiple powerful arguments against something, rebutting only the least convincing one does not rebut them all. The other arguments need to be seriously addressed, as well.

Those favoring expanding SCHIP trumpet their compassion for children and attack opponents as inexcusably mean. But the Scrooge-versus-Tiny-Tim imagery is neither accurate nor complete. Instead, it crowds out rational consideration of an extremely questionable policy, especially when combined with urgent "we must act now" rhetoric. And if the strongest arguments supporters can make for it require both substantial misrepresentation and high pressure, they have a poor case.

 


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