Paul Krugman on SCHIP and George W. Bush

He puts it well:

An Immoral Philosophy - New York Times: 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... has 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....

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 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...

Comments

[anne]

http://www.nytimes.com/2007/07/30/opinion/30mon3.html?hp

July 30, 2007

The (Offspring of) Motherhood Bill

Congress's Republican minority leaders are picking the wrong fight in suddenly attacking a notably bipartisan push to expand health insurance coverage to hundreds of thousands of children of the working poor. A Democratic plan to renew the highly successful program and enlarge it through financing paid by higher tobacco taxes was understandably attracting support from rank-and-file Republicans — at least until President Bush and their caucus leaders began denouncing it as a foot in the door for some dark government design for socialized medicine.

The expansion is hardly that. It is a needed boost for a proven joint federal-state effort that epitomizes voters' growing concern about the national neglect of health care coverage. Meanwhile, the White House's proposal for only a meager increase in financing — at a time of spiraling health care costs — could lead to hundreds of thousands of children being dropped from the program and provide no help at all for the more than eight million children who have no health coverage.

For the Republican leadership, ideology trumps any such concerns. "Dragging people out of private health insurance to put them into a government-run program is 'Hillary care' come back," cried the House Republican leader, John Boehner of Ohio, defending the profit-centric insurance industry as if it offered affordable coverage for these youngsters in the first place. His Senate counterpart, Mitch McConnell of Kentucky, joined in the alarum, decrying "an entire government takeover" of health care....

[anne]

Paul Krugman:

"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...."

Imagine then, a President who would tell parents that there always have emergency rooms for the care of children. Imagine a Republican Governor of Georgia who tells a poor mother whose diabetic daughter has lost Schip care because of lack of funds to call her Congressman. Imagine the Republican Congressman telling the mother, there is always charity. Imagine though the mother finding there is no such charity. *

* Reported on PBS NOW, this July.

[anne]

http://matthewyglesias.theatlantic.com/archives/2007/07/cant_do_conservatism.php

July 30, 2007

Can't Do Conservatism
By Matthew Yglesias

Paul Krugman describes "the core" of Bush's philosophy:

"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...."

The subject, of course, is the proposed addition of funding for S-CHIP so that the program can, in practice, expand coverage to all the currently eligible children. As Brian Beutler explains, "the SCHIP extension will be paid for with revenue from increased tobacco taxes. The fear for conservatives is that it'll work so well that people will begin to realize that it might be worth paying for broader reforms with broader taxes." Unfortunately, the public opinion data does tend to suggest that Bush's staggering achievements in the field of maladministration have, in fact, boosted public skepticism of government capacity to do anything at all to some extent....

[c.l. ball]

Krugman gets the *Bush* philosophy on domestic social programs fairly right, but he omits much of Kristol's position in the 1994 WSJ op-ed. Kristol went on to propose a number of reforms (not always ideal ones) that would provide for continued coverage and expand coverage by creating new federal regulations on what private insurers could do in lieu of Clinton's much more ambitious program. ( See

Bush offers no feasible alternatives.

[Neil B.]

Speaking of big government, which machine conservatives like when it's their cup of tea: it's easy to forget the waste on the program to return us to the moon, given Iraq etc. BTW, link from Drudge (please can we have back the right to post links?!) says the Captain of the winning Iraqi team wishes the US would leave!

[Bruce Webb]

"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"

My God! He's on to us!

In fact our movement has a snappy, upbeat name, we call it the "New Deal".
________________________

Speaking of which the mid-year numbers are out on the balances in the various Trust Funds and to date Social Security surpluses are coming in 33% better than projections. Where Intermediate Cost projected a surplus averaging $15.7 billion per month or $188 billion for the year, actual results for the first six months show a surplus averaging $20.3 billion for a total of $122 billion or 64% of the projected total. At this rate the year end surplus for 2007 is tracking to be $244 billion, which is $56 billion more than Intermediate Cost and $51 billion more than fully funded Low Cost. Which is to say that we could afford to pay the full five year cost of the Democratic plan out of just this years surplus. Of course it would take some honest accounting.

BTW it is kind of a puzzle how we are pulling these real world results (because Treasury tracks these funds to the literal penny) with the economic indicators being put out by BEA and BLS. Not only has productivity fallen off the cliff since 2002, we saw pretty significant downward revisions to productivity with the Q2 2006 BLS release and similar downward revisions to GDP with last weeks BEA release. At some point you would expect there to be effects on employment and/or wages. Instead unemployment is holding steady at 4.5-4.6% and wages subject to FICA are more than maintaining themselves, that is 12.4% of something keeps pouring into Treasury even though economic performance has been stuck near the bottom of the range.

(Interestingly on a month to month basis June actually returned a lower than projected surplus of right at $15 billion, which if sustained through the rest of the year would chop $30 billion out of that $244 billion. Still we would be substantially beating Intermediate Costs $188 billion number pretty handily)

[Ian Maitland]

I have eight questions for Paul Krugman.
1. According to Krugman, Bush would deny basic health care to children whose parents lack the means to pay for it. Aren't families who lack the means to pay already eligible for SCHIP?
2. In fact, were not about 60 percent of the children who were eligible for the original program already covered by private insurance in the year before the program was enacted? If the program is extended up the income ladder, won't even more families drop their private coverage?
3. Is it true that, under the SCHIP expansion, Uncle Sam might wind up paying the medical bills of kids whose parents earn as much as $82,600 a year?
4. Is it the case that some proposals to expand SCHIP (say Hillary Clinton's) might result in three out of every four children becoming eligible for taxpayer-subsidized health care?
5. Does Krugman seriously believe that increased tobacco taxes will be sufficient to fund the increased coverage down the road?
6. Won't tobacco taxes tax the poor to support (some) near rich (including some families who pay the alternative minimum tax)?
7. Isn't it more pressing (and more progressive) to make sure that more families who are already eligible benefit from the program, than to push a crowd-pleasing middle-class entitlement program?
8. For his next act, will Krugman join Chuck Schumer in opposing higher taxes on private equity managers and Nancy Pelosi in opposing stricter caps on farm subsidies?

[anne]

"Aren't families who lack the means to pay already eligible for SCHIP?"

Duh, yes, but duh, that takes, well, spending, and the added $5 billion spending to insure 4 million already eligible children for the coming 5 years is what children loving Republicans are fighting, fighting while they are happily getting ready to spend an added $44 billion for the military in the coming year alone. Duh, and the added military spending does not include Iraq. Duh.

Military, yes, children, no. Suppose we raise all these children as, well, soldiers?

[anne]

"Is it the case that some proposals to expand SCHIP (say Hillary Clinton's) might result in three out of every four children becoming eligible for taxpayer-subsidized health care?"

Duh. Always deceiving mean-spirited rubbish all the time; but, that is what mean-spirited deceivers do, they deceive. Duh.

[George Hearn]

Shorter version-

Marie Antionette- "Let them eat cake."

George Bush- "Let them go to an emergency room."

(The essential difference? Marie Antionette didn't really say that.)

[anne]

Well, we have had a fine lesson in lying in 8, count 'em, 8 questions. The record for lying in questions though is 12, so try try try.

[Ian Maitland]

Thanks Anne. But, if the program is out of money, why is Krugman on his soapbox urging that it be expanded into a middle-class give-away? And why is he selling it using a phony cover story about tobacco taxes?

[anne]

Thanks in turn, and now I will stop being annoyed. From the opening page of the Center of Budget and Policy Priorities,

http://www.cbpp.org/ , on to the health care studies,

http://www.cbpp.org/pubs/health07.htm ,

there is a host of research and history described as to the struggle to include or continue to include already eligible children in the Schip program. That there should be a struggle has, as usual, surprised and saddened me.

[Matt]

I didn't see Paul present his own analysis of costs and benefits, except the old progressive addage that it must be good.

There is a definite downside to federalizing the health provider of last resort for North American children, and Paul can't deny that his morals stop at the southern border.

It is not philosophy which Bush should be concerned about, it is covariance, the idea that we all, in North Amercica, have an intimate connection to the federal legislatur. Remember when a bad shift comes, we all know, the voters shift with the new powers in Washington before they predict a different outcome.

Covaiance with the federals on such a massive scale has side effecs.

[anne]

As for the disgraceful effort by Charles Schumer to protect a discriminatory tax favor for private equity fund managers, that allows the fees taken from profits by managers to be taxed at no more than 15% rather than no more than 35%, I believe the revenue that would be raised by closing the tax law loophole would pay for the health care insurance 3 to 4 million eligible children.

Remember that the taxes paid in fees from profits by private equity fund managers are not only taxed at the 15% level, but the tax can be deferred by re-investment for years, a sort of wildly permissive retirement allowance where retirement is not the issue.

[anne]

"There is a definite downside to federalizing the health provider of last resort for North American children, and Paul can't deny that his morals stop at the southern border."

What the heck is this sneering comment supposed to mean? What have Paul Krugman and Brad DeLong supposedly forgotten? What morals are being questioned?

[David Lloyd-Jones]

As George Hearn points out above, Bushlet thinks the poor should get sick before they get medical care, then go to an emergency room.

Quite apart from the fact that emergency rooms are extremely expensive places to carry out routine medicine, the point Bushlet misses is that medicine is supposed to be about caring for our health, not waiting for us to get sick and then treating the emergency thus created.

Health care. What a notion!

The more general point to be made is that America's array of disciplines, industries, trades, professions and individuals engaged in health care are overall pretty damn good. Some are world class, and most are right up there with the other industrialized societies'.

America's problem is that it sets aside about 5% of GDP to finance insurance companies, not to provide insurance but to act as gatekeepers, carrying out the nasty job of decreeing who *doesn't* get health care.

[anne]

"I didn't see Paul present his own analysis of costs and benefits, except the old progressive addage that it must be good."

Notice the sneering at "Paul" and what "Paul" supposedly did not do in the way olf showing what it means for a child to be allowed proper health care.

Let me think, in my stupidity, how much is the health of a child worth? How much is the health of 4 million poor children worth for the coming 5 years? Say, as much as 10 days of the cost of Iraq? Say what?

"Paul" and "Brad" somehow seem to think we can afford the health of a child, the health of 4 million poor children. I suppose others think we can only afford to occupy Iraq. Like my cost benefit analysis?

[c.l. ball]

The CBO estimates that about 30% of the *new* enrollees to SCHIP would have some form of *private* coverage under the House bill. So most of the new enrollees are *not* covered by private programs. Hardly a middle-class give-away.

"3. Is it true that, under the SCHIP expansion, Uncle Sam might wind up paying the medical bills of kids whose parents earn as much as $82,600 a year?"

Only if it was a household of 8 and they lived in Alaska, based on going 200% above the federal poverty rate.

[anne]

Paul Krugman:

"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."

There's my kind of cost benefit analysis. Remember though we have already decided to raise all these children for soldiers, just for the justification. Then we can add a billion dollars this year to the $44 billion dollars we are already adding for the military * and be assured 4 million child soldiers in training.

* Not including Iraq.

[anne]

CL Ball is referring to the broader bill in the House of Representatives, however the narrower Senate bill has been the target for a veto.

[anne]

http://www.cbpp.org/policy-points7-27-07.htm

July 27, 2007

Five Myths Regarding Congressional Efforts to Strengthen Children's Health Coverage

Myth #1: The bills before Congress to renew the State Children's Health Insurance Program (SCHIP) would vastly expand program eligibility.

Fact: According to the nonpartisan Congressional Budget Office: 4.6 million of the 5.1 million otherwise-uninsured children who would gain coverage under the bill the House Energy and Commerce Committee is expected to approve in the next few days have incomes below states' current eligibility limits; and 3.5 million of the 4 million otherwise-uninsured children who would gain coverage under the bill the Senate Finance Committee approved last week have incomes below states' current eligibility limits....

[There is much more here, and from CBPP.]

[nattybumpo]

"But President Bush... has declared that he’ll veto any Schip expansion on “philosophical” grounds"

Philosophical--Hah!

Remember back in 2000, when Bush said his favorite philosopher was Jesus. What a pandering hypocrite.

[rea]

"Philosophical--Hah!"

"Remember back in 2000, when Bush said his favorite philosopher was Jesus."

Well, he reads that Jesus said, "Suffer the little children" (Matthew 19:14) and thinks he's following Jesus' instructions . . .

[Barbara]

Sick children don't tend to grow up to be good soldiers. You can defend funding SCHIP from any side of the political divide. And that absent cost benefit analysis . . . I thought that was what the fewer hospital admissions and emergency room visits was trying to do. Oh well. Maybe the NYT will give PK an entire edition to himself, and then, I'm pretty sure, he will more than address the technical aspects of cost benefit analysis.