SCHIP Is About Uninsured Children

George Will shares his thoughts on SCHIP,

SCHIP is described as serving "poor children" or children of "the working poor." Everyone agrees that it is for "low-income" people.

It is described this way... by whom? Because when I look at the U.S. Department of Health and Human Services SCHIP website, I read this:

CMS Administers the State Children's Health Insurance Program (SCHIP). Program benefits became available October 1, 1997 and will provide $24 billion in federal matching funds over 10 years to help states expand health care coverage to over 5 million of the nation's uninsured children.

The State Children's Health Insurance Program (SCHIP) is jointly financed by the Federal and State governments and is administered by the States. Within broad Federal guidelines, each State determines the design of its program, eligibility groups, benefit packages, payment levels for coverage, and administrative and operating procedures. SCHIP provides a capped amount of funds to States on a matching basis for Federal fiscal years (FY) 1998 through 2007. Federal payments under title XXI to States are based on State expenditures under approved plans effective on or after October 1, 1997.

Not one mention of the word "poor". Perhaps what offends Will then is that states are actually afforded the right to share in the determination of who qualfies to participate in the SCHIP program? He lauds Bush's veto because it pares back the rights of states? And he has to "make stuff up" to make his argument more compelling?

Will whines about families who he believes to be too wealthy to be in need of help obtaining health insurance for their children:

Under the bill that Democrats hope to pass over the president's veto tomorrow, states could extend eligibility to households earning $61,950. But America's median household income is $48,201. How can people above the median income be eligible for a program serving lower-income people?

Well, Gee, George - perhaps you have forgotten your years of prattle about how employment-based benefits are part of a "welfare state" that should be eliminated, and the resulting rise of the working uninsured. Perhaps you have totally overlooked what decent health care coverage costs these days - and how if you're not part of a decent group plan you can pay an extraordinary amount of money while getting very little actual coverage. And no matter how much you keep repeating "low income", while nobody has disputed that the SCHIP program has income limits which lead to that result, that does not appear to be among the program's actual goals or elements.

During my last period of being between employment-based insurance plans - during which I was paying COBRA benefits to maintain coverage probably inferior to that Will receives for free from his employer - I priced out "group" plans available through the State Bar. For my family, I found plans which charged $1,200 or more per month, and offered very poor coverage with significant deductibles. I paid my COBRA premiums quarterly, and they were rising several hundred dollars each quarter. The last bill, right before my wife obtained coverage through a new employer, was not far off from $20,000.00 per year.

Will has a lot more concern for the financial plight of the rich, but those are "his people". When do you suppose was the last time he spoke to somebody who works for a living, other than perhaps to explain to his cleaning lady, "Next time I want this toilet bowl to sparkle."

Brooks On Entitlements

I don't know if it's worth the effort or not, but... a few days ago David Brooks wrote a rather silly piece on entitlement spending:

They [does he mean "I"] bombard you with alarming statistics about unsustainable entitlements. The U.S. government has $43 trillion in unfunded liabilities, or $350,000 for every taxpayer. Standard & Poor’s projects that in 2012, the U.S. will lose its AAA bond rating.

Okay... so how exactly is this "alarming" statistic derived? What period of time does it represent - a century? What assumptions does it rely upon? Is it a deliberately alarmist "worst case scenario"? And what does it mean for an entitlement to be "unfunded", anyway? I'm all for fiscal responsibility, but based on facts, not silly made-up numbers.

Presidential candidates vow to offset the cost of health care plans through “cost savings” measures, and everybody pretends those savings are actually real. Republicans promise tax cuts and people pretend those pledges are not absurd. Democrats vow to pay for their grand spending plans by raising taxes on the rich, even though each one percent increase in the top tax rate only produces $6 billion in revenue.

We're returning to reality, with some valid concerns about present tax policy and promises... although why does Brooks think that the rich (a class notorious for not paying income taxes, as their revenues are derived largely from other means) can only be taxed on their income? Has he somehow missed the furor raised by the wealthy any time somebody hints at, for example, a capital gains tax increase?

These habits infect everything they touch, even a straightforward and successful program like the State Children’s Health Insurance Program, or S-chip. According to the Centers for Disease Control, the number of uninsured children has been declining steadily for years. It shouldn’t be that costly or hard to insure the ones that are left.

The number of uninsured children has been declining... since the 1997 introduction of SCHIP. A modest expansion of SCHIP should help insure even more of them. So, of course, recognizing the success of the program, David Brooks opposes any expansion.

First, it perpetuates a smoke screen of obfuscation between who pays and who chooses. States have an incentive to ramp up benefits because they know that most of the cost will be borne by taxpayers somewhere else. Second, it entices children out of private and into public insurance, even though after 2012 it cannot cover the cost.

So which is it, David - will states use the additional money to increase the benefits offered, or to insure more children? Which children are enticed out of private insurance (answer: not many), and why would SCHIP be preferable to private insurance for those children? There's a category of insured people commonly described as "underinsured". If Brooks can demonstrate that the private insurance coverage is comparable or superior to SCHIP coverage, he has a point. If not, there should be no surprise in that people will leave an inadequate private health plan for another (from any source) which is superior and comes at the same or a lower cost. Sad to say, private health insurance plans are often grossly inadequate.

And suddenly Mr. "Oh no, don't tax the rich!" is concerned about regressive taxation:

Third, it creates a fund-raising mechanism cowardly in the extreme. Politicians in Washington like to talk in the abstract about shared sacrifice. They could go to the American people and say: We need to insure more children and to do that we’re going to raise broad-based taxes slightly.

But that’s honest and direct, and therefore impermissible. Instead, this program is funded by raising taxes on smokers, who generally are much poorer than average Americans and much less educated. High school dropouts smoke at roughly three times the rates of college graduates.

Let's see... Congress could ask the President G.W. Bush to make a statement about "shared sacrifice" and sign into law a bill which modestly increased taxes. (Have you stopped laughing yet?) And Brooks' new-found concern for regressive taxation.... has he ever before complained about the regressive nature of cigarette taxes? Has he ever proposed cutting or eliminating those taxes due to their effect on the poor? Let's see where he stands on tax policy....

Seventh, raise taxes on carbon emissions and use the revenue to make the tax cuts on capital gains and dividends permanent.

He is consistent on the whole - don't raise income taxes for the rich; cut capital gains taxes for the rich; cut tax on dividend income for the rich. His concern about tax on the poor is situational - there's no evidence that he cares a whit about regressive taxation, but here he thinks a feigned concern will help his argument. (Cruch the numbers and... even an analysis meant to support Brooks' claim of regressive taxation demonstrates that, in fact, the benefits of SCHIP inure to the poor at a level which vastly exceeds their share of the increased cigarette tax - making the tax regressive in the abstract, but progressive in implementation.)

Deficits, obfuscations and trickeries that were once unthinkable are now the norm.

But enough about the New York Times editorial page.

When Ideology Clashes With Reality

In the mind of a Robert Novak, ideology always trumps reality:

Most of the dwindling contingent of Republican governors have abandoned conservative principles to embrace the Democratic-sponsored extension of SCHIP (State Children's Health Insurance Program) to people who are neither children nor poor. Only three -- Indiana's Mitch Daniels, Mississippi's Haley Barbour and South Carolina's Mark Sanford -- resist the lure of federal dollars.

If you embrace a form of "conservatism" where it is automatically "bad" for the government to take steps to ensure the availability of health insurance, primarily to low-income children already eligible for the program, even if there is no net increase in taxes.... You're a peculiar animal. Novak apparently has no beef with the fact that private insurance companies receive subsidies in order to "compete" with Medicare - for somebody like Novak it's apparently better that government money be wasted on subsidies in one public health insurance program, than that they be used to provide greater benefit to a greater number of people through another public health insurance program.

Meanwhile, governors looking at what it may presently mean to be "fully insured" can legitimately question the public cost of having uninsured children treated through emergency rooms, or leaving hospital bills unpaid, as compared to the public benefit of insuring a greater number of children. If they're not locked into ideology, it doesn't seem like that hard of a choice. To a Novak, there is fear that the greater success of public health programs over private could cause people to reconsider our system of private insurance, so it is better to subsidize private inefficiency and deny health care to children.