A word about SCHIP
Andrew D. Coates, MD
The recent proposal, vetoed by President Bush, to expand the State Children's Health Insurance Program represents an important effort to defend working families with uninsured children from the grim cruelty of paying out of pocket for the care of a sick child, which can too easily lead to financial ruin for the entire family and impediments, at least, to medical care for the child.
In a recent discussion one person characterized SCHIP as a step toward universal health insurance. Another said that it was a move in the right direction that helps lay the groundwork for a publicly-financed single-payer national health program.
What does SCHIP offer people who are serious about health care reform?
Significantly the call to expand SCHIP offers us some claim to our own humanity as the crisis in American health care deepens, a yawning chasm before us.
Each of us must have wondered how much longer will we find ourselves putting coins and dollars into humble jars and coffee cans at diner counters, supermarket bake sales and church fundraisers to try to raise money for the treatments for an uninsured child with a malignancy. (Money for the broke parents of a child who never did anything to anyone and who, even from the most conservative, fundamentalist, neo-liberal or Malthusian viewpoint, could never be said to deserve his illness.)
Will we find ourselves among those parents, as we spend the quiet hour after putting our child to bed, racked by worries that she might need to see a doctor or a dentist -- but where can we find the money and the time off work? And what if the doctor said there are more tests are needed, or a specialist, or a hospital?
What kind of society do we live in that provides, so readily, such personal desperation and such collective horror when a child is sick?
The SCHIP program not only promises to address this appalling situation by reducing the number of uninsured children but should cost society relatively little since children in America are by and large healthy and require, compared to older people, fewer expensive treatments, hospitalizations and interventions. So (like the 84% in the NY Times poll earlier this year) we can all agree that SCHIP should be expanded to include ALL of the more than 9 million children in America who have had no health insurance.
But what can we ask of SCHIP?
Launched in 1998 SCHIP did help to reduce the number of uninsured children until 2004. (The program gives a block grant to states to fund programs to either augment Medicaid benefits to children or a establish a separate subsidized health insurance for children, or some combination of these two.)
However the number of children losing private employer-based coverage progressively outstripped enrollment in SCHIP. Since 2004 the number of uninsured children has not risen incrementally, but radically, by more than 1 million children, through 2006.
Yet the Democratic Party SCHIP expansion proposal, introduced by Congressman Rangel (HR 976), did not aim to cover all children. It hoped to provide funds to cover 3.2 to 4.2 million children by 2012 -- less than half of those children lacking health insurance now.
Thus as private health insurance fails and ever more children lose coverage under private plans, this SCHIP expansion (as proposed and even if enacted) would struggle mightily to meet the needs. So one step forward, one step back.
Even worse, with the costs of health care progressively skyrocketing, and SCHIP a capped grant given out state by state, funding for those children now covered by SCHIP has become a crisis in many states. More, its delivery would remain widely variable, depending on the state. More realistically then, one step forward, two steps back.
For these reasons the SCHIP expansion proposal should not be called a step toward universal health insurance.
Instead it should be championed as a measure to defend children and families from the vicissitudes of the American health care debacle -- cruelties unleashed because our system is dominated by private employer-based health insurance. We should explain that SCHIP, a laudable social reform that has protected many families from ruin, does nothing -- absolutely nothing -- about the cause of the burgeoning number of uninsured children.
Reforms that rely on private health insurance, including those that set up publicly-financed insurance alongside the existing system (as SCHIP does), will simply not work.
They will be brought down by the harsh realities of health care bought and sold as a modern corporate commodity: soaring costs at every level, widening disparities in access and outcomes, deteriorating quality, lack of choice of provider or clinic or hospital and private health insurance that doesn't provide health security and is increasingly not affordable, even for those who have it.
Proposals for health reform that avoid this fundamental issue may slow or may accelerate the inhumanities of our health care system, but they will not get us across the chasm.
We have all felt the inhumanity of the American health care abyss, a chasm split open under the wedge of corporate health care, led by private health insurance. Standing up for SCHIP is one way to stand up against the social cruelties of our health system.
By advocating in favor of SCHIP but explaining what it can and can't do as well as why it is needed, the effort can indeed help us lay the groundwork for the reform that offers a true step forward, - the proposal for a publicly-financed single-payer national health program like the House Bill HR 676.
The past record of private health insurance corporations has disqualified them from continuing as the central force managing American health care. If we lack mainstream politicians with the courage to say so -- we should also see with confidence that these politicians are out of step with the American people, who recognize that private insurance has got to go.
While the question of what reform is politically possible today from mainstream Democratic Party politicians is important, the question of what reform will actually work should be more important.
We need ideas for reform that have some evidence behind them. Like the SCHIP expansion proposal, we should support a reform not because it might be enacted today, but because it can truly help people.
Single-payer national health insurance offers a clear idea for evidence-based reform that is comprehensive, workable and just. Its time is now.
The recent proposal, vetoed by President Bush, to expand the State Children's Health Insurance Program represents an important effort to defend working families with uninsured children from the grim cruelty of paying out of pocket for the care of a sick child, which can too easily lead to financial ruin for the entire family and impediments, at least, to medical care for the child.
In a recent discussion one person characterized SCHIP as a step toward universal health insurance. Another said that it was a move in the right direction that helps lay the groundwork for a publicly-financed single-payer national health program.
What does SCHIP offer people who are serious about health care reform?
Significantly the call to expand SCHIP offers us some claim to our own humanity as the crisis in American health care deepens, a yawning chasm before us.
Each of us must have wondered how much longer will we find ourselves putting coins and dollars into humble jars and coffee cans at diner counters, supermarket bake sales and church fundraisers to try to raise money for the treatments for an uninsured child with a malignancy. (Money for the broke parents of a child who never did anything to anyone and who, even from the most conservative, fundamentalist, neo-liberal or Malthusian viewpoint, could never be said to deserve his illness.)
Will we find ourselves among those parents, as we spend the quiet hour after putting our child to bed, racked by worries that she might need to see a doctor or a dentist -- but where can we find the money and the time off work? And what if the doctor said there are more tests are needed, or a specialist, or a hospital?
What kind of society do we live in that provides, so readily, such personal desperation and such collective horror when a child is sick?
The SCHIP program not only promises to address this appalling situation by reducing the number of uninsured children but should cost society relatively little since children in America are by and large healthy and require, compared to older people, fewer expensive treatments, hospitalizations and interventions. So (like the 84% in the NY Times poll earlier this year) we can all agree that SCHIP should be expanded to include ALL of the more than 9 million children in America who have had no health insurance.
But what can we ask of SCHIP?
Launched in 1998 SCHIP did help to reduce the number of uninsured children until 2004. (The program gives a block grant to states to fund programs to either augment Medicaid benefits to children or a establish a separate subsidized health insurance for children, or some combination of these two.)
However the number of children losing private employer-based coverage progressively outstripped enrollment in SCHIP. Since 2004 the number of uninsured children has not risen incrementally, but radically, by more than 1 million children, through 2006.
Yet the Democratic Party SCHIP expansion proposal, introduced by Congressman Rangel (HR 976), did not aim to cover all children. It hoped to provide funds to cover 3.2 to 4.2 million children by 2012 -- less than half of those children lacking health insurance now.
Thus as private health insurance fails and ever more children lose coverage under private plans, this SCHIP expansion (as proposed and even if enacted) would struggle mightily to meet the needs. So one step forward, one step back.
Even worse, with the costs of health care progressively skyrocketing, and SCHIP a capped grant given out state by state, funding for those children now covered by SCHIP has become a crisis in many states. More, its delivery would remain widely variable, depending on the state. More realistically then, one step forward, two steps back.
For these reasons the SCHIP expansion proposal should not be called a step toward universal health insurance.
Instead it should be championed as a measure to defend children and families from the vicissitudes of the American health care debacle -- cruelties unleashed because our system is dominated by private employer-based health insurance. We should explain that SCHIP, a laudable social reform that has protected many families from ruin, does nothing -- absolutely nothing -- about the cause of the burgeoning number of uninsured children.
Reforms that rely on private health insurance, including those that set up publicly-financed insurance alongside the existing system (as SCHIP does), will simply not work.
They will be brought down by the harsh realities of health care bought and sold as a modern corporate commodity: soaring costs at every level, widening disparities in access and outcomes, deteriorating quality, lack of choice of provider or clinic or hospital and private health insurance that doesn't provide health security and is increasingly not affordable, even for those who have it.
Proposals for health reform that avoid this fundamental issue may slow or may accelerate the inhumanities of our health care system, but they will not get us across the chasm.
We have all felt the inhumanity of the American health care abyss, a chasm split open under the wedge of corporate health care, led by private health insurance. Standing up for SCHIP is one way to stand up against the social cruelties of our health system.
By advocating in favor of SCHIP but explaining what it can and can't do as well as why it is needed, the effort can indeed help us lay the groundwork for the reform that offers a true step forward, - the proposal for a publicly-financed single-payer national health program like the House Bill HR 676.
The past record of private health insurance corporations has disqualified them from continuing as the central force managing American health care. If we lack mainstream politicians with the courage to say so -- we should also see with confidence that these politicians are out of step with the American people, who recognize that private insurance has got to go.
While the question of what reform is politically possible today from mainstream Democratic Party politicians is important, the question of what reform will actually work should be more important.
We need ideas for reform that have some evidence behind them. Like the SCHIP expansion proposal, we should support a reform not because it might be enacted today, but because it can truly help people.
Single-payer national health insurance offers a clear idea for evidence-based reform that is comprehensive, workable and just. Its time is now.
posted by Andy at Sunday, November 18, 2007
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