Spring Training for Universal Health Care

"Let me talk about health care," President Bush told the cheering audience at the Intercontinental Hotel in Cleveland, Ohio earlier this month, "since it's fresh on my mind...The immediate goal is to make sure there are more people on private insurance plans. I mean, people have access to health care in America. After all, you just go to an emergency room."

If this is what comes out of Bush's mouth when a topic is fresh, I'd hate to hear him riff on a subject that's stale. But I appreciate the president's candor. It's been too long since this town had an argument that was fought on forthrightly ideological terms. And that is what the argument over the reauthorization of the State Children's Health Insurance Program (S-CHIP) is proving -- not an argument over a particular program, but an increasingly desperate rear-guard action by the White House (and the Medical-Industrial Complex that funds it) to block any types of public insurance that could push this country one step closer to universal health care.

The White House is opposing the Democratic bills to reauthorize S-CHIP on, as Allen Hubbard, assistant to the president for economic policy, put it, "philosophical and ideological" grounds, because they cannot quibble with the aims of the program itself. S-CHIP is, literally, health care for children. To oppose it is akin to a declaration of war on cute puppies and kind smiles.

Nor can they argue with S-CHIP's success. Last year, the program extended health coverage to some 7.4 million individuals. If Congress were to let it lapse, the ranks of the uninsured would swell to well over 50 million, and the states’ budgets would crumble beneath the added burden. The question, then, is not whether the White House signs into law a simple reauthorization -- they have already professed a willingness to do that -- but whether they can block efforts from Congressional Democrats to extend the program further.

The Democrats, for their part, have already expressed their intent to make an expansion of S-CHIP “the signature Democratic health achievement” of the Congress. The House, under the leadership of Nancy Pelosi, have offered a plan that increases S-CHIP's funding by $10 billion a year and would extend coverage to more than 5 million uninsured children struggling to get added to S-CHIP's rolls. The Senate bill, a bipartisan compromise emerging from the Finance Committee and supported by Republican Senators Chuck Grassley and Orrin Hatch, would increase spending by about $6 billion a year and extend coverage to 3.2 million children.

These expansions, it should be said, do not amount to radical restructurings of the program. They merely allow it to keep its promises. Currently, the Congressional Budget Office estimates that there are between 5 and 6 million children who are uninsured and qualify for Medicaid or S-CHIP, but are not enrolled. This is largely due to insufficient funding: The program simply cannot afford to cover all who are eligible. The Democrats want to make that funding sufficient. The White House opposes them.

But it is rather hard to oppose fully funding the program that covers uninsured children. So the White House has decided to make this a referendum on government-provided health care instead. This decision is a godsend to Democrats, who should contentedly accept Bush's willingness to equate health care for children with public health care, and allow this to become exactly as grand a battle as Bush appears willing to make it.

Bush, after all, is not a man unacquainted with the wonders of government care. As the San Francisco Chronicle's David Lazarus has noted, this steadfast opposition to public care is "coming from a man who just underwent a colonoscopy performed at the taxpayer-funded, state-of-the-art medical facility at Camp David by an elite team of doctors from the taxpayer-funded National Naval Medical Center in Bethesda, Md." It might be worth it for the Democrats to ask why he should receive such gold-plated care from the government, but the nation's uninsured children should be barred from public coverage.

It might also behoove them to ask why the GOP appears so afraid of public competition. S-CHIP, after all, is not a compulsory program. It is open to those who qualify, but only extended to those who sign up. Any family who believes that private insurance would do better by lil' Johnny can send away for Aetna with nary a word from a bureaucrat. What scares Bush and his financial backers is that they won't.

This, in the end, is what the fight over S-CHIP is truly about. Democrats and Republicans both view this battle as a harbinger for a coming showdown over full reform of the health care system. Rahm Emmanuel likes to call it "spring training for universal health care." Mitch McConnell and Trent Lott wrote warned that expanding S-CHIP "takes a significant step toward a government-run health care system." And indeed it does.

But not because there is a Trojan horse in the bill, or a compulsory element to the insurance it offers. Rather, it's because Americans like their government-provided medical care. Medicare achieves much higher patient-satisfaction ratings than do traditional private plans, but it's available to all seniors already, so there's no rear-guard action to be fought there. But if S-CHIP is also popular, and many parents come to prefer it to private insurance, others will clamor for their children to have access as well. And if you expand public insurance to children, soon it will move to young adults, and then adults more generally. Its expansion, particularly on the eve of a possible Democratic return to the White House, could be the wedge that leads to full, universal health care for all Americans.

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. Just like we do for President Bush.