Paul Krugman: An Immoral Philosophy

Paul Krugman wonders what sort of philosophy allows health care to be denied to children:

An Immoral Philosophy, by Paul Krugman, Commentary, NY Times [Update: full column]: ...Congressional Democrats, with support from many Republicans, are trying to expand [the State Children’s Health Insurance Program (Schip)], which already provides essential medical care to millions of children, to cover millions of additional children who ... lack health insurance.

But President Bush says that access to care is no problem — “After all, you just go to an emergency room” — and, with the support of the Republican Congressional leadership, he’s declared that he’ll veto any Schip expansion on “philosophical” grounds.

It must be about philosophy, because it surely isn’t about cost. One of the plans ... would cost less over the next five years than we’ll spend in Iraq in the next four months. And it would be fully paid for by an increase in tobacco taxes.

The House plan, which would cover more children ... offsets Schip costs by reducing subsidies to Medicare Advantage — a privatization scheme that ... costs taxpayers 12 percent more per beneficiary than traditional Medicare.

Strange to say, however, the administration, although determined to prevent any expansion of children’s health care, is also dead set against any cut in Medicare Advantage payments.

So what kind of philosophy says that it’s O.K. to subsidize insurance companies, but not to provide health care to children?

Well, here’s what Mr. Bush said...: “They’re going to increase the number of folks eligible through Schip; some want to lower the age for Medicare. And then all of a sudden, you begin to see a ... a strategy ... to get more people to be a part of a federalization of health care.”

Now, why should Mr. Bush fear that insuring uninsured children would lead to a further “federalization” of health care...? It’s not because he thinks the plans wouldn’t work. It’s because he’s afraid that they would ...[and] that voters, having seen how the government can help children, would ask why it can’t do the same for adults.

And there you have the core of Mr. Bush’s philosophy. He wants the public to believe that government is always the problem... But it’s hard to convince people ... when they see it doing good things. So his philosophy says that the government must be prevented from solving problems, even if it can. In fact, the more good a proposed government program would do, the more fiercely it must be opposed.

This sounds like a caricature, but it isn’t. ...[T]his good-is-bad philosophy has always been at the core of Republican opposition... Thus back in 1994, William Kristol warned against passage of the Clinton health care plan “in any form,” because “its success would signal the rebirth of centralized welfare-state policy at the very moment that such policy is being perceived as a failure in other areas.”

But it has taken the fight over children’s health insurance to bring the perversity of this philosophy fully into view. ...[D]enying basic health care to children whose parents lack the means to pay for it, simply because you’re afraid that success in insuring children might put big government in a good light, is just morally wrong.

And the public understands that. According to a recent ... poll, 9 in 10 Americans — including 83 percent of self-identified Republicans — support an expansion of the children’s health insurance program.

There is, it seems, more basic decency in the hearts of Americans than is dreamt of in Mr. Bush’s philosophy.

_________________________
Previous (7/27) column: Paul Krugman: The Sum of Some Fears
Next (8/3) column: Paul Krugman: A Test for Democrats

Comments

[gordon]

Prof. Krugman says: "And there you have the core of Mr. Bush’s philosophy. He wants the public to believe that government is always the problem..."

I can understand that given a history of anti-Government rhetoric Bush's attitude could be interpreted that way, but personally I would say "follow the money". Who is benefitting from a "privatization scheme" called Medicare Advantage? Who stands to lose from expansion of the State Children’s Health Insurance Program?

[AJI]

I'm not sure why Krugman and others are under the belief that Bush is interested in limited government. Like any other politician, he will support a larger role for government when it is in his interests.

[James Killus]

I don't see anything in Krugman's piece that suggests he believes that Bush is in favor of limited government. He says

So what kind of philosophy says that it’s O.K. to subsidize insurance companies, but not to provide health care to children?

One can achieve quite a large government if one follows the philosophy that government is in service to the rich and powerful and a method of keeping the masses in their place.

The only people I've seen lately who still buy the "limited government" line are high order fantasists.

[reason]

In fact, the more good a proposed government program would do, the more fiercely it must be opposed.

There you have it. Republicans are not against government spending, they are against government spending that does good.

[anne]

Thanks to Mark Thoma....

http://www.washingtonpost.com/wp-dyn/content/article/2007/07/28/AR2007072801420.html?hpid=topnews

July 29, 2007

Bush Aide Blocked Report: Global Health Draft In 2006 Rejected for Not Being Political
By Christopher Lee and Marc Kaufman - Washington Post

A surgeon general's report in 2006 that called on Americans to help tackle global health problems has been kept from the public by a Bush political appointee without any background or expertise in medicine or public health, chiefly because the report did not promote the administration's policy accomplishments, according to current and former public health officials.

The report described the link between poverty and poor health, urged the U.S. government to help combat widespread diseases as a key aim of its foreign policy, and called on corporations to help improve health conditions in the countries where they operate. A copy of the report was obtained by The Washington Post.

Three people directly involved in its preparation said its publication was blocked by William R. Steiger, a specialist in education and a scholar of Latin American history whose family has long ties to President Bush and Vice President Cheney. Since 2001, Steiger has run the Office of Global Health Affairs in the Department of Health and Human Services....

[wally]

Writer after writer, economist after economist continue to confuse 'health insurance' with 'health care'.
The marketing job done by insurance companies over the years has worked fabulously well.

[anne]

http://select.nytimes.com/2007/07/30/opinion/30krugman.html?hp

July 30, 2007

An Immoral Philosophy
By PAUL KRUGMAN

And there you have the core of Mr. Bush's philosophy. He wants the public to believe that government is always the problem, never the solution. But it's hard to convince people that government is always bad when they see it doing good things. So his philosophy says that the government must be prevented from solving problems, even if it can. In fact, the more good a proposed government program would do, the more fiercely it must be opposed....

[Precisely.]

[malcolm]

The technical, as opposed to the philosophical, attack
on Schip seems to rest on the assertion that Schip will lead parents to susbtitute Schip for private insurance.
Is there any merit to this claim? Does anyone know the empirical evidence here?

[anne]

There have been continual reports about the falseness of the claim that the availability of government health care insurance for children will cause parents to switch from private to government programs. Simply look to the Center of Budget and Policy Priorities:

http://www.cbpp.org/ .

As usual with Administration and supporting Republican Congressional pronouncements, the idea that all parents of children lacking health care insurance need to do is buy private insurance is absurdly false.

[anne]

http://www.nytimes.com/2007/07/30/opinion/30mon3.html?hp

July 30, 2007

The (Offspring of) Motherhood Bill

Congress's Republican minority leaders are picking the wrong fight in suddenly attacking a notably bipartisan push to expand health insurance coverage to hundreds of thousands of children of the working poor. A Democratic plan to renew the highly successful program and enlarge it through financing paid by higher tobacco taxes was understandably attracting support from rank-and-file Republicans — at least until President Bush and their caucus leaders began denouncing it as a foot in the door for some dark government design for socialized medicine.

The expansion is hardly that. It is a needed boost for a proven joint federal-state effort that epitomizes voters' growing concern about the national neglect of health care coverage. Meanwhile, the White House's proposal for only a meager increase in financing — at a time of spiraling health care costs — could lead to hundreds of thousands of children being dropped from the program and provide no help at all for the more than eight million children who have no health coverage.

For the Republican leadership, ideology trumps any such concerns. "Dragging people out of private health insurance to put them into a government-run program is 'Hillary care' come back," cried the House Republican leader, John Boehner of Ohio, defending the profit-centric insurance industry as if it offered affordable coverage for these youngsters in the first place. His Senate counterpart, Mitch McConnell of Kentucky, joined in the alarum, decrying "an entire government takeover" of health care....

[anne]

From the opening page of the Center of Budget and Policy Priorities,

http://www.cbpp.org/ , on to the health care studies,

http://www.cbpp.org/pubs/health07.htm ,

there is all the research possible described as to how deceiving the Administrative attacks on health care insurance for uninsured but eligible children have been. The philosophy of disdain for health care of uninsured children is all Administration and Congressional Republican abettor philosophy.

[anne]

The point is simple, another $44 billion in the coming budget for the military * is fine, another $5 billion in the budget to provide for eligible children with no health care insurance is socialized medicine. Socialized military spending is however all the rage.

* Not counting spending for Iraq, of course.

[btgraff]

"Like any other politician, he will support a larger role for government when it is in his interests"

when anyone mentions Bush's supprt for AIDS drugs in Africa, this thought always comes to mind - essentially the pharmaceutical companies get to benefit by getting the government to pay for drugs that otherwise they could not sell.

what i don't get is that the big US corporations (particularly the big 3 automakers) have not come to the realisation that they would be better off getting the US government to adapt to a Canadian style single payer system - which would mean that they would save money on health iinsurance costs (particularly for retirees) and have slightly higher taxes - most of which would be paid for by consumers in the end. the big 3 are at a huge disadvantage compared to the US operations of Toyota and Honda - and the only way to level the field is to have the costs pooled across the entire economy.

i get they lack the will and the clout - but one would think that the unions, which support the democratics, would be pushing for this too.

[anne]

http://delong.typepad.com/sdj/2007/07/paul-krugman-on.html

Paul Krugman on SCHIP and George W. Bush
Edited by Brad DeLong

He puts it well:

An Immoral Philosophy - New York Times: When a child is enrolled in the State Children’s Health Insurance Program (Schip), the positive results can be dramatic. For example, after asthmatic children are enrolled in Schip, the frequency of their attacks declines on average by 60 percent, and their likelihood of being hospitalized for the condition declines more than 70 percent.

Regular care, in other words, makes a big difference....

[robertdfeinman]

Gilded ages always come to an end. The forces of greed eventually cause the core of society to weaken enough that civil unrest and/or economic collapse happens.

One can go back to the French Revolution and the subsequent uprisings which eventually eliminated real monarchical rule as the beginning of the modern era of social upheaval.

The first US gilded age resulted in the Progressive movement and the beginnings of consumer protection. The second gilded age ended in the economic collapse of 1929. That full-scale revolution didn't break out as a result is something that psychologists or sociologists will have to explain.

We are now in the last act of the third gilded age drama. More and more people are taking a neo-populist postion. So far this is going after the low hanging fruit of excessive CEO compensation and tax breaks for the super wealthy. The more serious problems caused by the shortchanging of our infrastructure and the distortions of runaway militarism have still to be addressed.

It is possible that the new populist movement will be defused by throwing some bones to those who decry the gross inequality in society, but the underlying problems will still remain. Even this is not a sure thing. Chuck Schumer, the "liberal" senator from NY, has come out in favor of maintaining the favorable tax treatments for hedge fund managers. He knows which side his bread is butter on, despite his daily rants in front of the cameras.

Resource shortages, infrastructure neglect and militarism won't change if all that happens is that some tax rates get tweaked. Where are the leaders who are willing to face the big issues?

[anne]

Paul Krugman:

"For example, after asthmatic children are enrolled in Schip, the frequency of their attacks declines on average by 60 percent, and their likelihood of being hospitalized for the condition declines more than 70 percent...."

Imagine then, a President who would tell parents that there always have emergency rooms for the care of children. Imagine a Republican Governor of Georgia who tells a poor mother whose diabetic daughter has lost Schip care because of lack of funds to call her Congressman. Imagine the Republican Congressman telling the mother, there is always charity. Imagine though the mother finding there is no such charity. *

* Reported on PBS NOW, this July.

[anne]

http://matthewyglesias.theatlantic.com/archives/2007/07/cant_do_conservatism.php

July 30, 2007

Can't Do Conservatism
By Matthew Yglesias

Paul Krugman describes "the core" of Bush's philosophy:

"Now, why should Mr. Bush fear that insuring uninsured children would lead to a further 'federalization' of health care, even though nothing like that is actually in either the Senate plan or the House plan? It’s not because he thinks the plans wouldn’t work. It’s because he’s afraid that they would. That is, he fears that voters, having seen how the government can help children, would ask why it can’t do the same for adults...."

The subject, of course, is the proposed addition of funding for S-CHIP so that the program can, in practice, expand coverage to all the currently eligible children. As Brian Beutler explains, "the SCHIP extension will be paid for with revenue from increased tobacco taxes. The fear for conservatives is that it'll work so well that people will begin to realize that it might be worth paying for broader reforms with broader taxes." Unfortunately, the public opinion data does tend to suggest that Bush's staggering achievements in the field of maladministration have, in fact, boosted public skepticism of government capacity to do anything at all to some extent....

[Laura Andros]

Couldn't agree more, anne:

"The point is simple, another $44 billion in the coming budget for the military * is fine, another $5 billion in the budget to provide for eligible children with no health care insurance is socialized medicine. Socialized military spending is however all the rage."

Perhaps we could appeal to those "moral, child-loving" (at least in blastocyst form) this way:

The Tall Dutch
http://cosmos.bcst.yahoo.com/up/player/popup/index.php?cl=3102292
Hope this vid is still active...

This was a very interesting video showing how Dutch children far outpaced Americans in height. Part of it is due to early childhood intervention and healthcare services.

HEY USA: Want the tallest army in the world? Then provide universalised healthcare for those precious little kiddies you family values types all claim to "love" so much.

[dchavern]

The SCHIP debate is not about kids (no one seems to be acnowledging that the expansion proposals would cover a lot of adults too) -- it is about cost, and the backdoor development of a single payer system without being upfront about what you are doing. I don't think that anyone is worried that that a huge expansion in an otherwise good program would "work too well".

Everyone seems to be hung-up on insurance when the real issue is cost. Everyone doesn't get everything they need now (and a lot of people don't get a lot of what they need). You really think that would change under single payer? There aren't enough "administrative costs" to go around, I am afraid.

I have no intellectual problem with single payer, I just hate the view that it would be a free lunch that will magically give everyone all of the access they could ever want to every type of healthcare they could ever want.

You want to fix healthcare for every one -- worry less about insurance and more about cost.

[anne]

Laura, perfect. All we have to do is figure out how to pitch healthy children as a military necessity and add them to the cares of the defense department.

[anne]

Always craziness, all the time. We are worried about affording the health care insurnace of 4 million children, yes, children, over the coming 5 years for what it costs to pay for about 10 days of tragedy in Iraq, and there we have the crazy complaints.

I love children, but they cost too much and besides parents will pretend they are children too, and each insured child is another step to socialism and we know where socialism leads.

Cost cost cost; any cost for the military is fine fine fine, but the cost of a child's health is, shudder, the cost of our freedom to be ridden with asthmatic children. Me, I have a thing for the cost cost cost of asthmatic children.

[anne]

Sanity....

Paul Krugman:

"For example, after asthmatic children are enrolled in Schip, the frequency of their attacks declines on average by 60 percent, and their likelihood of being hospitalized for the condition declines more than 70 percent...."

Craziness....

"The SCHIP debate is not about kids...."

Me, I say, asthma builds character. Cough, cough. Now, let us return to the costless $2 trillion plus war in and occupation of Iraq. There is no cost for Iraq, no cost for the military, only a cost for a single children with asthma.

What is the cost over 5 years for insuring 4 million poor children, compared with the cost of 10 days in Iraq? Me, I love a parade.

[Lee A. Arnold]

Dchavern is onto it, although I believe that he or she is wrong to assume that G. Bush cares whether it's backdoor or upfront. No, with those guys it is just massive cynicism... But the opposition is starting to develop two major propaganda arguments, although we won't see the final concretions until early next year: (1) "the free market is always better," and (2) cost. Leaving aside #1 for a moment, (which entails directing the tender intellect away from Miltonian Friedmannian platitudes into the gentler waters of institutional economics,) the issue is going to be cost -- or rather more precisely, budget. Congress reaches a dollar number politically, and payouts are then managed, in order to stay within that annual appropriation. In the U.S., universal health coverage is going to see the same constraint, and there will be an insurrection. WHAT WE NEED TO KNOW IS, how the British, French, and Canadians do it? Do they write an open tab?

[evagrius]

Another point about children and health care is that "conservatives" oppose any notion that children have "rights". The U.S. still hasn't signed the U.N. Declaration of Rights of Children.
One reason is that children are like pets- they are "property", the property of parents and therefore the responsibility of only the parents. Society does not have any responsibility towards someone else's property.
Child Protective Services only exists because of cruelty to animal laws. Conservatives have loathed such protection of children as big government intrusion ever since those agencies began and have always sought to undermine their funding.
It may be hard to belive but I think the subtext of much of the opposition to SCHIP originates with the view of children as property.

[S Brennan]

PTgraff,

The CEO's of the big three are of Republican [Bush's meaning] philosophy and that prevents them from looking out for their shareholders/employees best interests. They will ask for a government bailout [corporate welfare - good], but not for fixing the fundamental problem healthcare [general welfare - bad]. Lawmakers ignoring the constitution seems to be all the rage these days.

"...the big 3 are at a huge disadvantage compared to the US operations of Toyota and Honda - and the only way to level the field is to have the costs pooled across the entire economy."

[James Killus]

First of all, dchavern, health insurance is a large part of the cost. The administrative costs of U.S. health insurance companies are quite high, especially when one realizes that the money is being spent for such things as figuring out who to exclude from coverage, and how to renege on "prexisting conditions," "elective treatments" etc.

Second, although health insurance companies are big enough to bully individuals, medical groups, and some hospitals, they are not large enough to take on the large hospital chains (there have been various charges of fraud, with the attendant legal actions, thereby raising the costs of both for both the insurance companies and the hospitals) and pharmaceutical companies. So prescription medication remains overprescribed and overly costly.

Finally, the idea that reformers must always be forthright and above board in all political dealings ("the backdoor development of a single payer system without being upfront about what you are doing") is a little amazing, considering the massive cloud of distortions and outright lies that are used to support the current system. Are you sure you're being upfront about what you're arguing and why?

[donna]

I believe the solution is for the government to offer a basic care, pre-natal care, and catastrophic coverage plan for everyone, and let insurance companies provide coverage for all optional care. The questions are in what is covered, not in that it is needed. Health care is too expensive for everyone, and this is the only real option that makes any sense for insurers, companies trying to cover workers, children and every else.

Why we are still fighting over this is really just beyond me. This country desperately needs to grow up already.

[Bruce Webb]

Ezra makes an excellent point over at Prospect (paralleling Matt's above)

"This is what the White House, and the insurers and pharmaceutical companies who fund it, fear. Not that S-CHIP won't work, but that it will. And that extending affordable, high quality public insurance to children will leave some adults wondering why we don't extend affordable, high-quality public insurance to everyone."

Which mirrors what I have been insisting about Social Security. The Right doesn't fear that it will go broke, in fact they rather hope it does, they fear that it will prove to be solvent as is. And speaking of which, and of how to fund S-CHIP, I just did a little checking on how Social Security receipts were tracking compared to projections and in context the numbers are staggering.

Under Intermediate Cost assumptions the combined OASDI Trust Fund was projected to rise from $2.048 trillion to $2.236 trillion over the course of the year, which works out to an average increase of $15.7 billion a month for a total surplus of $188 billion. Well the Treasury actually tracks the various Trust Funds to the literal penny and report those numbers each month. Well the June and thus half year numbers just were released last week and they show that the Trust Funds are currently sitting at $2.170 trillion, which represents an average increase of $20.3 billion per month which if sustained works out to a surplus of $244 billion which is $56 billion more than projections.

Which is to say that we could pay the five year cost of the Democratic S-CHIP plan out of just the excess Social Security surplus of this year alone. Now for those that object that we will be needing that $56 billion down the road I could just point out that fully funded Low Cost only projected a surplus of $193 billion, $5 billion more than Intermediate Cost, which still leaves us $51 billion. This year alone. And there is no reason to believe that similar numbers won't continue to roll in in future years, these results having been produced in the face of a Q1 productivity number of 0.6%

Social Security Solvency is the Invisible Elephant in the room. No one is even grappling with the concept that given the trends of the last decade that the currrent combined 12.4% FICA cannot not only fund Social Security as is but also backfill the projected gap in Medicare Part A. I know it all sounds like a drug induced fantasy but the numbers are there. The combined budget picture going forward is much brighter than anyone is willing to acknowledge and both Right and Left have reasons to not address that fact. On the other hand - Voila!

http://www.ssa.gov/OACT/TR/TR07/trLOT.html
The relevant tables are IV.A1 (OAS 2002-2016) IV.A2 (DI 2002-2016) IV.A3 (Combined OASDI)
You can simply compare the year end projections with the half year numbers at Treasury:
http://www.treasurydirect.gov/govt/reports/tfmp/tfmp.htm

We can pay for S-CHIP and for that matter Universal Single Payer. Arguments to the contrary are purely ideological and not economic, at least opponents never bring actual numbers to the table. Instead they are scrambling. Their worst fears are coming true, the time is coming when the response to "Tax and spend liberal!" will be "So? It's working better than the old system."

That rumbling you hear? That's the New Deal coming back to life. And opponents don't have to like it.

[lLysistrata]

If parents move children out of private insurance to SHIP does it not speak for itself? A caring government is better than profit oriented private insurance!

When Bush was Governor the state feared children from MEDICAID would be moved to SHIP and would cost the state more. Texas left hundreds of millions $$$ of federal money go unused and had to return the funds to the federal government. Now Senator Kay Baily Hutchison is for SCHIP but against funding the program.

When the state had no money because of tax cuts Bush pushed through many children where dropped off the enrollment list and Republicans proudly said that 20% of the children would be on MEDICAID. They were stone silent about the 80% who had no coverage. Texas has the greatest number of uninsured children. And Bush is proud of the state.

[btgraff]

s brennan: The CEO's of the big three are of Republican [Bush's meaning] philosophy and that prevents them from looking out for their shareholders/employees best interests. They will ask for a government bailout [corporate welfare - good], but not for fixing the fundamental problem healthcare [general welfare - bad].

exactly - having universal care WOULD be a government bailout of the obligations that the big 3 have taken on through past union contracts. even though they probably all are republican, they would benefit immensely as individuals when their stock options increase in value.
i think they would put greed above idealogy.

[James Killus]

btgraff,

The sole value that the modern CEO brings to a company is the ability to deal with other CEOs. Because the actual management of large companies is in a complete shambles (owing to a combination of "lean and mean" staffing targets plus a series of fadish management techniques like "metrics management" and outsourcing/offshoring), it is essential that, from time to time, one CEO calls another and says, "Make this happen," which then focuses some attention on a problem. It is "crisis management" in the sense that the only time there is management is when there is a crisis. (Mergers and acquisitions may be viewed as a means of promoting perpetual crisis, as well as switching off certain accounting procedures).

Without the ability to make that phone call, the CEO has little value, certainly not enough to deserve the compensation packages that are tossed about. Therefore, no CEO can afford to be the odd man out on any given ideological question. Ostracism would mean a sudden loss of the only real capability they have.

[dissent]

I think this points out an important successful innovation of contemporary Republican politics: being seen as the champion of 'family values'.

The Republicans have portrayed themselves as defending the American family and predatory capitalism in the same breath. Of course the two are more in opposition than in sync, and the welfare of American families declines under Republican policies.

But equally the Dems have been incompetent in attacking the Repubs for undermining the welfare of the American family. Krugman chose a very good example of the true cost for Americans of Repub advocacy for unregulated markets, starving social services, and tax cuts for the rich.

The Dems have to stay on the attack on this one.

[paul dunn]

So a tobacco tax is going to fund childrens' health care. Now let's be clear. This is a tax on all tobacco and not just cigarettes. Initial proposals in the House were talking about 50% of full retail. One cigar goes from $1.00 to $1.50 . But not too many cigars are just a dollar, especially after the State gets its percentage (e.g. 40% in Colorado). And there would also be a tax on standing inventory as well. The result would be that a number of small businesses would go under, cigar makers in Honduras, Nicaragua, and the Dominican republic would face layoffs and so it goes. By the way, its not just the upper classes that smoke cigars or pipes. The number also includes working class people who just like to relax with a good cigar. Finally isn't directed taxation on items like tobacco unstable over the long term. How can one so glibly guarantee tax revenues five years out
To be fair, I now understand that the tobacco tax has been considerably reduced. The question is how much ?
Odd that an economist should be so imprecise when talking about numbers. Everyone is in favor of childrens' health care. The question is how do we get there. Certainly not by way of Mr. Krugman's usual moralizing cant.
Paul Dunn

[wogie1]

Clearly, insuring uninsured children is a societal responsibility -- one that should be covered by the general public. It's a cheap dodge to lay the funding on tobacco users instead. Of course, it's an easy out for solution of the problem that many will endorse if it doesn't touch their pocketbooks. How noble.

[anne]

"Everyone is in favor of childrens' health care."

Obviously, lots of Republicans surely are not in favor of childrens' health care. Also, obviously the commenter crying "save the cigar makers of Nicaragua" is not in favor of childrens' health care either. No more Nicaraguan cigars for me. But, no cant there.

[lLysistrata]

Senator Sanders knows how to finance SHIP, "collect the inheritance tax," and there would be money left over.

C-Spann had the secretary of HHS as a guest today. He spouted the usual Republican lies. As a trusty he knows all entitlement programs MEDICARE and MEDICAID are in trouble,he took care to only imply it includes SS. He proceeded to tell how taxes would go up and people would have to stay in line and the government would assign the physicians in case of universal health care. Of course he had no facts and conveniently did not mention the premiums paid to the private sector instead of taxes.

[Icarus]

So, children are brought into the planet, and the responsibility for ensuring their health care lies not with the parents who chose to do this, but, instead, for the "society" (ie, the rest of us) they are born into?

I can't understand the ire and disgust of all of those who complain that we don't provide enough health are for children. Why is none of the ire directed at parents who have children when they don't have the financial ability to ensure their health?

While a good society should have a certain amount of health care guaranteed for all, the issue is how much. Primary health care, yes...it is more cost effective to provide it to all, as opposed to living with the results of not having it. But, the issue is more expensive care. Spending hundreds of thousands of dollars (and countless hours) on a few is the bigger question...how do we do it, and at what cost, and who shares this cost?

[evagrius]

"So, children are brought into the planet, and the responsibility for ensuring their health care lies not with the parents who chose to do this, but, instead, for the "society" (ie, the rest of us) they are born into?

I can't understand the ire and disgust of all of those who complain that we don't provide enough health are for children. Why is none of the ire directed at parents who have children when they don't have the financial ability to ensure their health?"

As I've argued...children are the property of parents.

[Jim in Chicago]

Has anyone thought about the money we save as a society by having healthy children who don't have to go to the (taxpayer funded) emergency room for their belated primary care?!

Vermont has health coverage for virtually 100% of it's minors (thanks to Howard Dean). I haven't noticed that state hurting economicly or having an unusually high tax burden.

As a society, we are paying for a universal health care system 2 to 3 times over without the actual benefits of such a system. Our cost per patient is c. $7000 whereas it's between $2000 and $3000 for vastly BETTER care in most other industrialized countries.

Those who say we couldn't design a single-payer system that improves our health care while reducing overall costs are saying we can't do what every other industrial (and even some not so industrial) country in the world has done. Personally, I find that kind of defeatist attitude un-American!

[reason]

evagrius...
Being angry at the parents doesn't help the children. And as a Catholic your should keep quiet about this, you are part of the problem.

P.S. In principle, I agree with you we need more responsible parents. But unfortunately, children tend to copy their parents so without external role models things won't get better.

[Icarus]

Reason...

Solving problems like health care (even children's) and other social maladies with government solutions centered on money, or, by creating mal-incentives to productivity, are problematic. The solution, in the long run, has to involve people having transparent information about the cost of health care (their cost) for each additional member of society, and then, the responsibility to take care of that cost, if/when a child is added to the community/state/nation.

[reason]

Icaras,
have you never made an incorrect forecast? Or experienced an uninsured accident? Get real.

[JRossi]

Right on, reason. Icarus seems to have an inadequate understanding of normal human behavior.
dchavern makes some good points. It is mostly about costs. Actually it is about current costs (which would be lower if insurance companies were out of the picture and if doctors [and I myself am one] were paid less), but, more importantly, and in the longer run, it is about the rate of increase in health care costs. This high rate of increase is of course driving the current access crisis. The only way to come to grips with this problem is to have cost-control measures in place. Very difficult and unpleasant, but necessary. If this problem is not solved, the health care system might eventually collapse.

[Holly W.]

I thought this exchange on NOW about the SCHIP program managed to highlight several issues that are tangled together and muddy the waters a bit - sorry for the length, but it's all pretty pertinent:

HINOJOSA: Leslie Norwalk is the acting administrator at The Centers for Medicare and Medicaid Services. She says that states themselves are responsible for the S-CHIP crisis, because they expanded the program to include people it never intended to—like adults.

NORWALK: If we're going to spend more money on S-CHIP than we do on other federal programs, then let's focus on what S-CHIP should focus on. That's kids, particularly kids who have lower incomes. Let's make sure that they get the insurance that they need. And that's exactly what we're intending to do here.

HINOJOSA: Georgia doesn't have any adults on the program, but fourteen other states do. The reasoning was that those states could reach more uninsured children if they enrolled their parents.

But now that over 670,000 adults are being covered by the state children's health insurance program, the Bush administration and its allies, like Georgia Republican Congressman Nathan Deal, are saying "enough."

You've been quoted as saying that, "Petty and not so petty dishonesties erode taxpayer's trust." What do you mean in regards to the SCHIP program?

CONGRESSMAN DEAL: Well, yes. States that try to manipulate the programs, you know about four states that insure more adults than they do children. That's not the purpose of this initial legislation. And we ought to—refocus it on children.

HINOJOSA: But there's another reason S-CHIP is in trouble. The administration is alarmed at what it says are a growing number of parents who are dropping more expensive, private coverage, for the lower costs and better benefits of S-CHIP.

In short, Republicans are worried that S-CHIP could be bad for the private medical insurance business. Congressman Deal says it's human nature that if someone can get the government to pay for something, they will.

CONGRESSMAN DEAL: ...unfortunately, we see many people take the attitude that even though they don't qualify for taxpayer supported healthcare—they want to expand the debate to say, "Well, we should be provided with this." I think there's a degree or personal responsibility that cannot be overlooked in this—discussion.

HINOJOSA: Deal is co-sponsoring a bill for the future funding of S-CHIP, but he's asking for big changes: that no new adults are enrolled, and that the states cover the cost for adding any families making more than $41,000 a year.

CONGRESSMAN DEAL: One of the debates that is going to be going on in the reauthorization for this bill this year, is how high the poverty level should be set. You're going to find that it then becomes a way for the wealthier states to raise the level of poverty up to include more of their population because they get a higher percent of federal money than they would get under Medicaid. And then the poorer states are struggling to pay their part of Medicaid, having great difficulty, continuing to participate in the S-CHIP program.

[Icarus]

Reason/JRossi,

An incorrect forecast, and accidents which arise are surely a part of normal life. But, to expect society to insure me for it is the problem.

And, we have to differentiate "accident's" like hurricanes, which can be insured, and children born without proper planning, where there is no possible insurance. Having a child has to be considered a form of politics now, given the issues with costs, and the claims for redistribution of income based on a child's needs.

[reason]

Having a child has to be considered a form of politics now, given the issues with costs, and the claims for redistribution of income based on a child's needs.

Icarus, come back when you've thought this one through. On average clearly the value of a child exceeds its cost (otherwise the whole economy would be in much deeper shit than it is).

[reason]

Icarus...
seriously you don't want to go the path you've started on.

What do you want that people have to have a certificate of insurance before they are allowed to have a child. Otherwise what exactly? Compulsory abortion? No services, even in emergencies or where the rest of the population is endangered by inaction?

And what about the unanswered moral dilemma of punishing the child for the sins of the parent.

Don't get me wrong. I think there is nothing more important that encouraging responsible parenthood (and responsible citizenship in general). It is just the wrong way to go.

[Icarus]

Reason...

Sorry to sound so harsh, but, perhaps I am so here. Children raised in disciplined environments, and reared to contribute to society are clear positives. And, some of those costs are socially subsidized (schooling, for example).
But, children born into environments without proper discipline, and who don't develop the skills to succeed in the modern economy, are not net positives.

And, no, I don't want 'certificates', as, I tend to have a libertarian attitude towards social woes. I just want the expectation set, such that having a child is a willing embrace of the costs and rearing involved. If a person cannot properly support a child, then yes, a free abortion would be ideal.

[me]

http://www.ajc.com/search/content/opinion/stories/2007/08/02/healthed.html

HEALTH CARE: Insurance boondoggle hits even the wealthy

By Janette Berne
For the Journal-Constitution

Published on: 08/02/07

My husband is a self-employed attorney. I help him, and I am also a part-time private school counselor. Due to a partial physical disability, I am unable to work full time. Since my husband is self-employed, we have not been able to get affordable health insurance. That's not a problem for an upper-middle-class family, right?

Wrong.

We have had our share of health problems and are now labeled "high risk," by the health insurance industry. This year, we will pay more than $25,000 in out-of-pocket expenses. We can absorb that. In fact, we'll be OK for the next three or four years. After that, it's going to hit the fan for us.

By law, our insurance provider can increase our premiums annually without explanation. Being the smart business people that they are, they have exercised that right each and every year, regardless of whether we've had a healthy year.

If this continues, in 10 years, when we have reached the age of 55, our cost for insurance will be more than $60,000 annually. And that doesn't include co-pays, deductibles, dental or vision care.

Being the tough Americans that we are, we have made some tough decisions. Starting right now, we are officially middle class, not upper-middle class.

Besides changing our vacation venues from Europe to Myrtle Beach and shopping excursions from Bloomingdales to Target, we are going to have to significantly reduce or eliminate other expenses and save every available penny.

After 2008, we are giving up our Falcons tickets (a mixed blessing), Braves tickets and Atlanta Opera membership.

We had envisioned being able to contribute to worthy charities, the arts, our retirement, our children's future, etc. But these things are out of reach for middle-class Americans these days. I say this with sadness, but now that this health care crisis is affecting the wealthy, maybe something will be done about it.

> Janette Berne lives in Atlanta.

[me]

http://www.aflcio.org/corporatewatch/walmart/upload/walmartreport_031406.pdf

GEORGIA
Wal-Mart is at the top of the list of employers
whose workers’ children receive health coverage
in Georgia through PeachCare for Kids, the
state’s health care program for low-income children.
In September 2002, the Georgia Department
of Community Health found that 10,261
kids (6.2 percent of all Georgia children who
participated in PeachCare) had parents working
for Wal-Mart.48 PeachCare coverage for children
of Wal-Mart employees costs state taxpayers an
estimated $6.6 million per year.49 The number of
Wal-Mart children in PeachCare was more than
14 times greater than the next highest-ranking
employer, Publix Supermarket, whose employees
had 734 children in the program.50 And the ratio
of children participating in PeachCare per number
of employees was far greater for Wal-Mart
than for the three next highest-ranked employers.
Wal-Mart had approximately one child in
PeachCare for every four workers in the state.51
The ratio of children participating in PeachCare
per number of employees for the next highest
ranking employers are as follows: one child for
every 22 employees for Publix Supermarkets; one
child for every 30 employees at Shaw Industries;
and one child for every 26 workers at Mohawk.52
Even as Wal-Mart forces taxpayers to pick up
much of the tab for worker health care, the company
has benefited from almost $20 million in
taxpayer-financed economic assistance in Georgia
since 1987.53
Medicaid spending accounts for 19 percent of
state spending in Georgia.54 In the 2005 legislative
session, Georgia had to address an $80 million
deficit in the state’s Medicaid program.55
Medicaid will continue to be one of the top fiscal
problems for the 2006 legislative session.56 Over
the last two fiscal years, Georgia has frozen
provider payments, implemented pharmacy controls,
and imposed other cost-containment measures
to rein in Medicaid spending.57

[reason]

Icarus...
you didn't even attempt to answer my points. Ideology trumpts pragmatism everytime when someone chooses an "ISM" for a label.