Krugman on Bush's Health Care Views

In spite of the fact that almost every other advanced capitalist state has some form of universal health care the US considers it some sort of socialist plot and even most Democrats will not even say straight out they are in favor of some single payer system. The result is a health care system that is the most expensive in the world but far from the best particularly for the working poor. It is so inefficient that even without universal care the public expenditure in the US is greater than that in the UK that has a universal system--as percentage of GDP. But the US also has a huge private expenditure as well.


The New York Times
July 30, 2007

An Immoral Philosophy

By PAUL KRUGMAN

When a child is enrolled in the State Childrens 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. Thats 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, hes declared that hell veto
any
Schip expansion on philosophical grounds.

It must be about philosophy, because it surely isnt 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 well 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 childrens health care, is also dead set
against any cut in Medicare Advantage payments.

So what kind of philosophy says that its O.K. to subsidize
insurance
companies, but not to provide health care to children?

Well, heres what Mr. Bush said after explaining that emergency
rooms
provide all the health care you need: Theyre 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 wouldnt
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?
Its
not because he thinks the plans wouldnt work. Its because hes
afraid
that they would. That is, he fears that voters, having seen how the
government can help children, would ask why it cant do the same for
adults.

And there you have the core of Mr. Bushs philosophy. He wants the
public to believe that government is always the problem, never the
solution. But its 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 isnt. 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 childrens 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
youre 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 childrens
health insurance program.

There is, it seems, more basic decency in the hearts of Americans
than
is dreamt of in Mr. Bushs philosophy.