Thought Theater

President Bush Says No To Insuring More Children genre: Little Red Ribbon-Hood & Polispeak & Six Degrees of Speculation

Sometimes comparison proves to be the best means to understand the intentions of those who have been elected to public office…especially since the spoken word is often the tool by which politicians manipulate voters. When it comes to understanding President Bush, comparison is necessary…and the results offer a string of contradictions that defy the rhetoric of compassionate conservatism.

In a New York Times article, Paul Krugman provides readers a look into the position of the President with regard to the expansion of programs to cover uninsured children…programs that the President supported in the past…but programs that the President is opposed to expanding despite their success.

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.

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.

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."

Looking at this particular situation offers ample opportunities for relevant and informative comparisons. First, let me suggest that the President’s position is neither conservative nor compassionate. There has been little disagreement that George Bush’s Medicare prescription drug program was the largest expansion of entitlements in recent memory and most analysts believe it will cost far more than the original estimates.

On its surface, one might argue that adding a prescription drug benefit was an act of compassion…and to a degree that conclusion has some merit. However, this is where comparison becomes an enlightening tool.

It is well known that the President is in favor of privatizing entitlement programs and one could argue that the prescription drug benefit was a logical step in that direction and likely the only means by which he could initiate such a plan…given that is has the appearance of compassion. One can look at the high costs of the program as the essential seed money for turning the corner towards privatization.

As we know, the program has been viewed to have achieved mixed results but there is no doubt that it provided insurance companies with a subsidized entrée into the living rooms of millions of Americans. Let me attempt to explain. The prescription drug benefit allows those on Medicare to purchase the benefit from an array of private providers…a move that begins to put in place a ready made structure for further privatization.

Such a plan achieves two important goals for a President in favor of privatization. One, it begins to give insurance companies an expanding role in providing care for the millions of seniors on Medicare…a move that is good for large corporations in the business of health care…including drug manufacturers. Two, it is an important incremental step in taking the government out of the health care business and entitlement programs.

Coming back to the Schip program, one can begin to use comparisons to uncover actual motivations. The number of uninsured Americans is well documented as a politically charged issue. In approving a plan to cover a number of uninsured children, the President achieved points for compassion just as he did with the prescription drug benefit. These programs also helped to hold off calls for universal government health care…a direction which this President opposes.

When one looks at the Bush administration position on the relative costs for the Schip plan and Medicare Advantage, we see that compassion and conservatism are secondary to the ideology of privatization. Granted, one could argue that the ultimate goals of the measures endorsed by the President have conservatism at their core…meaning less government and more market determined programs and costs.

In that regard, perhaps these spending measures…which are seemingly incongruent with conservatism…and which have raised the ire of traditional conservatives…have been shrewd considerations and calculations on the part of the President intended to push the country towards more privatization.

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.

Krugman’s analysis is valid but perhaps it stops short of identifying the ultimate misconceptions that underlie such a philosophy. George Bush is no doubt a product of privilege and in that reality his ability to comprehend the struggles of those at the opposite end of the spectrum is undoubtedly insufficient.

There is an inherent risk for those who "have" to infer that those who "have not"…deserve not…that what they lack results from their lack of effort and that if they are coddled by the government, they will never demonstrate the necessary initiative to alter their situation absent the assistance of the government.

Clearly, there have been situations that have given such arguments credibility…particularly the welfare reform seen in the 1990’s (though one could argue that the strong economy played a larger role in that success than the simple act of refusing to toss people a government subsidized lifeline).

Regardless, refusing to provide care to needy children seems to be punishing the innocent amongst us for all of the wrong reasons. Ideology aside, children lack the ability or the autonomy to effect their status. Allowing them to be political pawns seems wrong by whatever comparative means one may choose to employ.

Sadly, I view this situation as one of many examples whereby George Bush has demonstrated his predisposition to implement and impose his absolute ideological views despite the detrimental impact they may inflict upon those who do not serve to advance his narrow objectives.