An Immoral Philosophy

By Paul Krugman, The New York Times. Posted August 1, 2007.

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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