Grace-Marie Turner: Should Congress Expand Health Insurance To Cover All Children? No
Some thoughts to chew on from Grace-Marie Turner:
But expanding SCHIP to cover all children would be a mistake, for four reasons:
1. First, Congress should make sure poorer, uninsured children are covered first. At least two-thirds of uninsured children already are eligible for SCHIP or Medicaid but aren’t enrolled. If SCHIP were expanded to cover children in higher-income families, their parents would rush to the head of the line to get the taxpayer-subsidized coverage. When a “free” government plan is offered, it’s nearly impossible to resist. Poorer children would be left behind as states focus on enrolling higher-income kids.
2. Second, expanding the program would “crowd out” the private insurance many higher-income kids already have. Hawaii offers proof. Earlier this year, the state created a new taxpayer-financed program to fill the gap between private and public insurance in an effort to provide universal coverage for children. But state officials found families were dropping private coverage to enroll their children in the government plan. When Gov. Linda Lingle saw the data, she pulled the plug on funding. With Hawaii facing budget shortfalls, she said it was unwise to spend public money to replace private coverage children already had.
3. Third, putting many millions of children on a government program will quickly lead to restrictions on access to care. A young boy died in Baltimore not long ago from an untreated tooth infection, even though he was enrolled in SCHIP. Few dentists can afford to take SCHIP patients because the program’s reimbursement rates are so low. The boy’s mother couldn’t find a dentist to see him. In Massachusetts’ move toward universal health coverage, more people have insurance, but they are finding that physicians’ practices are often filled, with waiting lists for a new patient appointment at 100 days and counting. Putting more children on SCHIP will add to the program’s financial pressures, making it harder for poorer kids to get care.
4. Finally, government insurance means that politicians and bureaucrats, not parents, make decisions about the care children receive and about what services will or will not be covered.
Interesting but I think Ms. Turner may miss some nuances. Extrapolating limited anecdotal experience out into a condemnation of all SCHIP expansion isn’t the soundest reasoning. I think there are ways to cover all children in this country while limiting, if not eliminating, the flight from private insurance by middle class families which some fear.
1. I concede that the number of eligible, but unenrolled, children is unacceptable. Earlier this year the NIHCMF put the number of uninsured children in the United States at 6.1 million. The majority of those children were indeed estimated to be eligible for some sort of coverage but not utilizing such. Public policy research clearly demonstrates the challenges in encouraging those of lower socioeconomic means to make use of public health resources and we absolutely need to be working to enroll those already eligible. Still, that leaves more than 2 million children who are uninsured and currently with inadequate health care access.
That is completely unacceptable.
Now, I worked on Dr. Ron Paul’s campaign for President in Iowa and clearly, in many respects, I am very libertarian in my political views. Yet even I find fault in the public not rising up to help those who are the truly helpless in our society; the ones who truly bear no responsibility for their condition.
Incentives can be placed on states’ use of matching federal SCHIP grants to encourage them to enroll the most economically disadvantaged children first; to bolster the marketing of their SCHIP programs to those currently eligible. It isn’t hard to imagine how that might work and the oppurtunities are numerous for each individual to imagine how such a program might work.
2. As I said above, and imagine it, incentives can promote enrolling individuals from the ‘bottom up’. But more specifically, I find fault in Ms. Turner’s use of Hawaii as an example. Hawaii’s example is far from applicable to the whole of the U.S.
First, consider that before the implementation of the Keiki Care program Hawaii already boasted an very respectable level of coverage for all individuals under the age of 18. Per the Census Bureau nearly 11% of American children lack some sort of coverage while in Hawaii before “universal” coverage the percentage was HALF that. It is likely that Hawaii’s program was overaggressive and perhaps even over funded and encouraged more middle class families to abandon their private insurance than an “ideal” SCHIP program would. But Hawaii’s experience isn’t a condemnation of all foreseeable efforts to expand SCHIP. Indeed, the Keiki Care program is hardly analogous to any the experience of any other state in the union considering Hawaii’s demographics. A poor example to bring up to be sure.
Second, it is doubtful, whatever the number of children dragged off the private insurance rolls, that the program would’ve been cut except for two facts: Hawaii’s already good coverage of it’s pediatric population without the program and the economic downturn. Yes, with so many states’ facing major budget deficits, SCHIP expansion may be difficult at present. That certainly isn’t a philosophical argument against it however. Hawaii abandoned the program largely based on the current economic climate; at such a time as states regain their footing in the black SCHIP expansion should be placed back on the table.
3. This is the most frustrating argument by Ms. Turner. First, in the right economic climate we can appropriately fund SCHIP and Medicaid so that reimbursement rates maintain access. The relatively poor reimbursement rates of these public programs reflects the lack of political capital of the people they cover. Children have no voice. But with the right people on board (say the incoming administration) this is a very simple thing to remedy.
The fact that currently many Medicaid and SCHIP fee schedules provide poor incentives for pediatricians to take those as reimbursement is hardly a legitimate argument against the expansion of SCHIP coverage.
Besides, some coverage is better than no coverage!
Finally, I want to throw in one little tangent. I think I’ve made my point above but this is an important thing to consider when talking about health care reform in this country. Too many imagine that physicians are holding some sort of stick in this ‘battle’ over the future of health care.
The truth is, as the income gap grows in this country (and don’t kid yourself; it is and very rapidly) more and more families will rely on government subsidization of health care for them and their children. Increasing government involvement in health care funding limits physician’s options.
I always love it when physicians scream that they will abandon Medicare en masse if reimbursement doesn’t improve. Medicare expenditures already account for more than a fourth of health care spending. As long as reimbursement at least covers costs where are physicians going to go? To the declining number of privately insured patients? It is a physician population battling for fewer and fewer privately insured patients. Providers have no leverage, despite all their high rhetoric, in this debate. You will never get enough physicians to abandon Medicare, no matter what organized medicine claims, to create a true national health care access crisis because there is no true alternative but to be a Medicare provider. What else are so many doctors going to do?
The point is, with time, as the income gap grows in this country, such will also become true of government programs to insure children. Then the argument over poor reimbursement becomes moot; even if you don’t concede my points above.
“4. Finally, government insurance means that politicians and bureaucrats, not parents, make decisions about the care children receive and about what services will or will not be covered.”
How is this different from what is already often the case with (non-government) insurance companies?