[Dialogue] An Immoral Philosophy

Fri Aug 3 12:45:34 EDT 2007

AlterNet

An Immoral Philosophy

By Paul Krugman, The New York Times
Posted on August 1, 2007, Printed on August 3, 2007
http://www.alternet.org/story/58501/

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. That's why
Congressional Democrats, with support from many Republicans, are trying to
expand Schip, which already provides essential medical care to millions of
children, to cover millions of additional children who would otherwise 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 Mr. Bush opposes, the one approved by an overwhelming bipartisan
majority in the Senate Finance Committee, 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, is more expensive, but it
offsets Schip costs by reducing subsidies to Medicare Advantage -- a
privatization scheme that pays insurance companies to provide coverage, and
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 after explaining that emergency rooms
provide all the health care you need: "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 -- I wouldn't call it a plot,
just 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, 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.

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.

This sounds like a caricature, but it isn't. The truth is that this
good-is-bad philosophy has always been at the core of Republican opposition
to health care reform. 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.

There are arguments you can make against programs, like Social Security,
that provide a safety net for adults. I can respect those arguments, even
though I disagree. But denying 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 Georgetown University
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. 

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