On the Right, Public Healthcare for Children is a Socialist Plot

By Paul Krugman, The New York Times. Posted August 27, 2007.

Suppose, for a moment, that the Heritage Foundation were to put out a press release attacking the liberal view that even children whose parents could afford to send them to private school should be entitled to free government-run education.

They'd have a point: many American families with middle-class incomes do send their kids to school at public expense, so taxpayers without school-age children subsidize families that do. And the effect is to displace the private sector: if public schools weren't available, many families would pay for private schools instead.

So let's end this un-American system and make education what it should be -- a matter of individual responsibility and private enterprise. Oh, and we shouldn't have any government mandates that force children to get educated, either. As a Republican presidential candidate might say, the future of America's education system lies in free-market solutions, not socialist models.

O.K., in case you're wondering, I haven't lost my mind, I'm drawing an analogy. The real Heritage press release, titled "The Middle-Class Welfare Kid Next Door," is an attack on proposals to expand the State Children's Health Insurance Program. Such an expansion, says Heritage, will "displace private insurance with government-sponsored health care coverage."

And Rudy Giuliani's call for "free-market solutions, not socialist models" was about health care, not education.

But thinking about how we'd react if they said the same things about education helps dispel the fog of obfuscation right-wingers use to obscure the true nature of their position on children's health.

The truth is that there's no difference in principle between saying that every American child is entitled to an education and saying that every American child is entitled to adequate health care. It's just a matter of historical accident that we think of access to free K-12 education as a basic right, but consider having the government pay children's medical bills "welfare," with all the negative connotations that go with that term.

And conservative opposition to giving every child in this country access to health care is, in a fundamental sense, un-American.

Here's what I mean: The great majority of Americans believe that everyone is entitled to a chance to make the most of his or her life. Even conservatives usually claim to believe that. For example, N. Gregory Mankiw, the former chairman of the Bush Council of Economic Advisers, contrasts the position of liberals, who he says believe in equality of outcomes, with that of conservatives, who he says believe that the goal of policy should be "to give everyone the same shot and not be surprised or concerned when outcomes differ wildly."

But a child who doesn't receive adequate health care, like a child who doesn't receive an adequate education, doesn't have the same shot - he or she doesn't have the same chances in life as children who get both these things.

And insurance is crucial to receiving adequate health care. President Bush may think that lacking insurance is no problem - "I mean, people have access to health care in America. After all, you just go to an emergency room" - but the reality is that the nine million children in America who don't have health insurance often have unmet medical or dental needs, don't have a regular place for medical care, and frequently have to delay care because of cost.

Now, the public understands the importance of health insurance, even if Mr. Bush doesn't. According to a recent New York Times/CBS News poll, an amazing 94 percent of the public regards the fact that many children in America lack health insurance as either a "serious" or a "very serious" problem.

So how can conservatives defend the indefensible, and oppose giving children the health care they need? By trying the old welfare queen in her Cadillac strategy (albeit without the racial innuendo that made it so effective when Reagan used it). That is, to divert public sympathy from people who really need help, they're trying to change the subject to the supposedly undeserving recipients of government aid. Hence the emphasis on the evils of "middle-class welfare."

Proponents of an expansion of children's health care have, as they should, responded to this strategy with facts and figures. Congressional Budget Office estimates show that S-chip expansion would, in fact, primarily benefit those who need it most: the great majority of children receiving coverage under an expanded program would otherwise have been uninsured.

But the more fundamental response should be, so what?

We offer free education, and don't worry about middle-class families getting benefits they don't need, because that's the only way to ensure that every child gets an education - and giving every child a fair chance is the American way. And we should guarantee health care to every child, for the same reason.


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