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Posted by on Jul 19, 2009 in Economy, Health, Politics, Society | 29 comments

“Universal” Health Care Is Debatable, Children’s Health Care Is Not

childrens-health-insurance

Although it is very difficult to remain unemotional when the health and welfare of our most precious individuals—children—are involved, I’ll give it a try.

The New York Times has a heart-rending article this morning.

It’s about how some states have been reluctant to repair the safety net, improve health insurance, for their most vulnerable ones, and how other states, 13 of them, “despite budgets ravaged by the recession… have invested millions of dollars this year to cover 250,000 more children with subsidized government health insurance.”

First, some background.

The Children’s Health Insurance Program (CHIP) is a program enacted in 1997, administered by the U.S. government, that provides matching funds to states for health insurance to families with children with incomes that are low, but too high to qualify for Medicaid.

States have flexibility in how they design and implement their S(tate)CHIP; they set their own eligibility levels and some have received waivers to also cover some parents of SCHIP eligible children.

When Congress attempted to reauthorize and expand funding for CHIP, towards the end of the Bush administration, Bush fought such tooth and nail, including vetoing the legislation twice. Congressional Democrats kept the program alive through temporary extensions.

In February 2009, President Barack Obama signed the Children’s Health Insurance Reauthorization Act of 2009 that extends the program through 2013, provides $32.8 billion in new financing over that period, and thereby expands the program to cover an additional 4 million children and pregnant women.

Five months after President Obama signed the legislation and encouraged states to increase enrollment in the program, at least 13 states have done exactly that, “despite budgets ravaged by the recession.”

The states that have expanded health coverage for children are, according to the New York Times:

Alabama, where “Democratic legislators overrode the veto of Gov. Bob Riley, a Republican, to extend coverage to 14,000 children at an additional cost to the state of $8 million.” Democratic State Senator Roger H. Bedford said, “Our economy is tough here, but our decision was to fund the health care needs of our children because a healthy child learns better and they don’t show up at the emergency room needing acute care.”

Kansas, where, “in one of her final acts as governor of Kansas in April, Ms. Sebelius, a Democrat, signed a two-year expansion worth $4.4 million that had been approved by her overwhelmingly Republican Legislature.”

Colorado, where Democratic Governor Bill Ritter Jr. said, “In a downturn, the number of people who need the safety net increases”

Washington, where the broadening of eligibility has now made 8-year-old Sarah, “who endured lung surgery at 3 and heart surgery at 6 and now has asthma,” and who had been uninsured for a year, eligible for the program. According to the Times, Sarah’s mother, Ms. McIntyre, 41, who works part time in a store to supplement her husband’s income as a welder, said: “We were into credit card debt and payday loans…Her medicine at one point was $880 a month, and we had to pay cash, so we were struggling. It is such a relief now that I can just take her to the doctor if I need to and get her medicine.”

The other states expanding eligibility are Arkansas, Indiana, Iowa, Montana, Nebraska, North Dakota, Oklahoma, Oregon, and West Virginia. Ohio’s expanded eligibility has been approved by the Legislature, but its implementation depends on the results of a pending court case.

According to the Times:

The states’ willingness to spend, even under excruciating budget pressures, is a measure of the support for expanding health care coverage to the uninsured as Congress and the administration intensify their negotiations over a new federal health care bill.

And, while 48 states faced budget shortfalls this year, “in those that have managed to expand eligibility, governors and legislators said they viewed CHIP as a cost-effective investment.”

Several states have either decided not to enact previously authorized expansions or failed to pass legislation to expand eligibility or lower premiums.

Among these:

Sarah Palin’s Alaska

Bobby Jindal’s Louisiana.

Rick Perry’s Texas. (We remember well how Gov. Rick Perry rejected $555 million in federal stimulus money to help deal with Texas’ rising unemployment because the stimulus money had “strings attached.” Now, the great state of Texas is asking the federal government for a $170 million loan so that the state can continue paying unemployment benefits.)

Other states are : Jack Markell’s (D) Delaware; Sonny Perdue’s (R) Georgia; Jay Nixon’s (D) Missouri, Beverly Perdue’s (D) North Carolina; and Donald Carcieri’s (R) Rhode island.

And, according to the Times, “in California, the Legislature beat back Mr. Schwarzenegger’s proposal to eliminate CHIP altogether but seems to have accepted the enrollment freeze.”

Finally, the Times:

CHIP, which served about 7.4 million people in 2008, is credited with helping reduce the number of uninsured children by 2.5 million over its first decade. The Congressional Budget Office estimated that the revitalized program would eventually reduce the number of uninsured youths by an additional 4.1 million.

I hope that I have not gotten emotional about this issue, but in my honest opinion, blocking viable, affordable health insurance for America’s adults is one thing. In America, failing to provide vital health care for our children, is another thing—a shameful thing.

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  • Dr J

    “I hope that I have not gotten emotional about this issue”

    Your post was tantrum-free, and you didn’t go all Sally Struthers on us. Still, your entire analysis of the issue comes down to sick children being heart-rending. That’s an emotional argument.

    A rational argument would consider both CHIP’s benefits and costs, and in sober terms. It might go into what the actual exposure to children is with and without CHIP: do children actually die without it who wouldn’t have died with it? Do they end up getting treatment funded through other means? Or are they facing only the more indirect peril of being uninsured? How many? Why are the states who are declining to expand the program doing so?

  • Dave Francis

    It is a shame that some Americans are so gullible, to the outlandish propaganda and lies spat in the newspapers, television and radio about Obama’s health care agenda. They have demonized the British, Canadian and other worthy plans. Hidden under a sub-rosa undercover, these radical entities are determined to keep the special interest organizations in absolute power. Comprising of the money-draining profitable insurance companies and their rich stockholders. They don’t want any changes to the broken system of medical care, because it will hurt the status quo. I was born in England, in the county of Sussex and until the inception of the European Union and the European Parliament dictating to Britain. That they must accept millions of foreign workers, the nations medical system was exemplary. I never had to wonder if I would have to file bankruptcy, to pay my medical bills, or listen to the incessant ring of debt collectors on the phone.

    On several occasions I ended up in the cottage hospital and their was never a cost applied to it, never a ream of paperwork. No doctor, no hospital or specialist ask me for my Social Security number, drivers license or if I was covered by a predatory for-profit insurer. Today the British Isles is being submerged under a barrage of legal and illegal immigrants, who have never paid into the system, have caused some rationing. Prior to the importation of foreign labor my trips to doctor, to hospital, the eye or a dentist was paid from my taxation. Unless we pass a national health care agenda, Americans will never know what it’s like to breeze through their lives, without worrying about paying for health care? Tell your Senators and Congressman you want an alternative to the–GET RICH– insurance companies, before a Universal health care is killed. 202-224-312 REMEMBER THE INVESTORS AND STOCKHOLDERS DON’T WANT THEIR PIECE OF THE $$$TRILLION$$$ DOLLAR PIE DISTURBED. EVEN SOME POLITICIANS HAVE THEIR DIRTY FINGERS IN THE PIE?
    AS AN ALTERNATIVE TO THE PRIVATE HEALTH CARE, A GOVERNMENT SINGLE PAYER SYSTEM WILL ASSIST IN REVITALIZING THE WILTING US ECONOMY.

  • DdW

    DrJ

    Thanks for your comment

    I said that I’d give it a try not to get too emotional. But of course it is heart-rending and frustating to know that, in America, millions of children do not receive the medical care they need—for whatever reason.

    And I admit that my post wasn’t a coldhearted analysis, it wasn’t even an “analysis.”

    It was just a post on an issue that comes down to “sick children [who do not get or can’t afford to get the necessary care,] being heart-rending.” And, if you wish, yes “that’s an emotional argument” to me.

    Now as far as lookign at CHIP in terms of cost-benefit analyses, in terms of what the actual exposure to children is with and without CHIP; as to whether children actually die without it who wouldn’t have died with it; as to whether these children end up getting treatment funded through other means whether they are facing only the more indirect peril of being uninsured; and, finally, as to the reasons why the states who are declining to expand the program are doing so, these are all excellent questions that are extensiveley covered in the real analyses on children’s health care, children’s insurance and SCHIP in numerous published sources.

    Please allow me more time and I should be able to quote (because I am not an expert, just an interested party) from the real experts to have answers for most of what you ask, which, by the way, you could also research, or probably already have the answers too.

    If you do have the answers–and you probably do—I and, I am sure, other readers would be interested in hearing (reading) them

    And, Dr J, please believe me that I am saying this in earnest, as this issue really is close to the heart.

    Thank you for commenting, and look forward to hearing some of the arguments and reasons for states declining to expand the CHIP program.

    Of course, the economy is a big factor, however, I am sure that every state could find lower priority pograms that can be cancelled or delayed to get some funding for CHIP.
    Dorian

    • Dr J

      D.E., I haven’t researched CHIP specifically and am not arguing against it. Maybe kids are indeed dying by the thousands, CHIP would save them, and it should be a super-high spending priority.

      But I think it’s important to notice that the 14,000 uninsured children the article mentioned are not the same thing as 14,000 dead children or even 14,000 children who are going without medical treatment, as you seem to have read it. $8 million would cover treatment for closer to 14 seriously ill children. When it comes to confiscating other people’s money, we owe them more due process than noting the issue is about children and therefore pre-empts debate.

      I’d love to see the left/right gulf on issues like this bridged, and your post shed an interesting light on it for me. I’ve seen plenty of healthcare-policy comments from the left voicing frustration that the right is being obstructionist. Your post made the point more explicitly: this issue shouldn’t be debated, because all the relevant data is in front of us: people need help. The right is “blocking” progress by refusing to end the debate and get on with it.

      Meanwhile, the right is frustrated because the left refuses to *start* the debate. Many, many people need help in a million different ways, and most laws we might pass will help some at the expense of making life worse for others. We collectively need to think clearly about the competing interests and find a balance among them, so an honest, rational assessment of costs and benefits is precisely the conversation that needs to occur. In that, anecdotes about sick children are as unhelpful and obstructionist as photos of aborted fetuses.

  • $199537

    Of course, the economy is a big factor, however, I am sure that every state could find lower priority pograms that can be cancelled or delayed to get some funding for CHIP.

    Overall I agree with you, there are probably many programs less important than children’s health. In the case of California though they have been unable to cut enough programs to avoid issuing IOUs. Seems like every program has supporters that think it’s vital.

    The debate really just isn’t over children’s health though, it’s about where the cut-off should be for the government to step in and help. At some point the parents should be expected to provide for their children, the question is where is that point.

  • SteveK

    Dr_J,
    Three questions:
    1) Are you a medical doctor?
    2) Are you a member of the AMA?
    3) Do you receive payment to lobby against the proposed health care legislation.
    Thank you in advance,
    SteveK

    • Dr J

      Steve, no, no, and no.

      You’re illustrating my point, though. Calling for honest assessment and discussion of SCHIP’s costs and benefits is not the same as lobbying against it. What brings you to equate them?

      • SteveK

        Dr_J, Thank you for your response but contrary to your belief that I’ve illustrated your point, you’ve illustrated just the opposite. I was not attacking an “honest assessment and discussion of SCHIP’s… I was asking you a few questions to help me in forming future comments.

        It seemed that Dorian made some excellent points and, considering your VAST KNOWLEDGE of ‘Health Care in America’ I had assumed a yes, no, yes answer. I was surprised when you responded to Dorians question with, “I haven’t researched CHIP specifically and am not arguing against it. Maybe kids are indeed dying by the thousands, CHIP would save them, and it should be a super-high spending priority. BUT(emphasis mine)

        It seemed to me from your reply that you would rather ‘play ignorant’ than address a very serious (and valid) question.

        You always seem to have links to document anything that supports you position BUT when you’re asked a question that seriously questions your POV you ‘seem’ to jump into your “anecdotes about sick children are as unhelpful and obstructionist as photos of aborted fetuses” mode. Ergo, my questions.

        • Dr J

          Steve, I’m not playing ignorant, I’m genuinely ignorant about this program. Which puts me right even with Dorian…except that he took a strong position on it, based on an alarmist reading of the Times article.

          He’s right that I could go research it like I’ve researched many other healthcare topics I’ve posted on. But since I have’t expressed a POV on the program, I’m not feeling much burden of proof on my own shoulders.

          And truth be told, posting those links is a pretty thankless job. They tend to be received not as crucial cost/benefit data but as evidence of my heartlessness. Surely only an industry lobbyist would go bringing up cost/benefit data in such a crisis as this.

          As for being asked a question that seriously questions my POV, you’ve lost me on both counts.

  • adelinesdad

    DaGoat said it better than I could. I’m not necessarily against expanding SCHIP, but clearly there is a cost vs benefit analysis to be done here, and such an analysis need not be heartless. In fact, it us essential to do such an analysis in order to ensure we are helping the most people as we can. As far as I understand, under the newly expanded program, a family of 4 making up to 88,000 could qualify for SCHIP. In my opinion, that is enough for most families to but coverage for themselves. So, we have to consider that there are diminishing returns. Every dollar more that we put into SCHIP buys less, since it increasingly buys plans that would have been bought by the family anyway. That dollar maybe could be used for another program that would be more worthy, or (dare I say it?) left in the pockets of the taxpayers. So I ask the same question as DaGoat: at what point do we hold parents responsible for caring for the children they brought into this world?

  • $199537

    This debate always reminds me of the school lunch programs. Whenever anyone was against expanding the program, they were accused of WANTING CHILDREN TO STARVE TO DEATH. Who could ever vote to starve kids? Well no, actually the debate is at what income level do you start to subsidize for school lunches.

    CHIP has a similar emotional component, but the question is really where do you set the cut-off to get into the program. Actually a lot of Democrat/GOP arguments are essentially about deciding cut-off points.

  • DdW

    I was also hoping for DJ to come up with some sound cost analyses or other sound arguments for or against expanding CHIP.

    Since it looks that they are not forthcoming, I’ll try in coming days to provide so myself. In the meantime, I remain committed to the ideal of providing adequate healthcare to America’s children, regardless of how bleeding-heart liberal this may seem.

    And, sorry about the title “Children’s Health Care Is not Debatable,” I did not intend for it to be taken literally.

    In my mind, with the wealth, power, compassion, capability, idealism, etc., etc. our country has, it is a “slam dunk”–as was the Iraq war with its astronomic costs, resources, etc.,– that we could have better spent those resources on…hmmm…let me think…children’s health care.

  • DdW

    DJ:

    This weekend’s New York Times Magazine has an article that those with an eye on cold, cost/benefit analyses of health care might like.

    While it does not address CHIP specifically, just imagine the patient ( the “you”, or the “stranger”) to be your child, instead of someone who has already lived a relatively good, long life:

    “You have advanced kidney cancer. It will kill you, probably in the next year or two. A drug called Sutent slows the spread of the cancer and may give you an extra six months, but at a cost of $54,000. Is a few more months worth that much?

    The costs of the current health care system are becoming increasingly clear, and public sentiment for a more systematic approach may be growing. We’d like to know what you think about the prospect of rationing.

    If you can afford it, you probably would pay that much, or more, to live longer, even if your quality of life wasn’t going to be good. But suppose it’s not you with the cancer but a stranger covered by your health-insurance fund. If the insurer provides this man — and everyone else like him — with Sutent, your premiums will increase. Do you still think the drug is a good value? Suppose the treatment cost a million dollars. Would it be worth it then? Ten million? Is there any limit to how much you would want your insurer to pay for a drug that adds six months to someone’s life? If there is any point at which you say, “No, an extra six months isn’t worth that much,” then you think that health care should be rationed.”

    To read the entire article go here:

    http://www.nytimes.com/2009/07/19/magazine/19healthcare-t.html

    Dorian

    • Dr J

      Dorian, a good article filled with good sense. It illustrates the economic barbs lurking under such simple-sounding ideas as “I don’t want rationing” and “Everyone should be covered.”

      I particularly liked this bit:

      Will Americans allow their government, either directly or through an independent agency like NICE, to decide which treatments are sufficiently cost-effective to be provided at public expense and which are not? They might, under two conditions: first, that the option of private health insurance remains available, and second, that they are able to see, in their own pocket, the full cost of not rationing health care.

      That speaks to some of my big concerns about public health care. I don’t hear much acknowledgment that the tradeoffs implemented by people’s insurance companies or wallets must still be made in a government system. I have concerns about meeting that first condition, if a bottomless-entitlement program demolishes the private market. And costs are far from transparent today, so it’s not clear how to meet the second condition either.

      Thanks for posting the link, it was a good read.

  • adelinesdad

    D.E., do you believe that there should be an income cap for CHIP, and if so what do you believe that should be? Or do you believe that the federal government should subsidize insurance for all children, regardless of their parent’s income?

  • DdW

    I believe that in our country every child—poor or wealthy—should have adequate health care.

    If the parents can’t afford either the care or the insurance, then, yes, the government should help.

    • adelinesdad

      I agree, but that doesn’t answer my question. So in response I’d ask how we are to determine if a family can afford the care or the insurance. Do we just let the familes tell us and take their word for it? Are we to naively assume that if a family doesn’t buy health insurance for their kids, they can’t afford it? If we’re not careful, we will not be subsidizing health care for children, but instead be subsidizing big screen TVs and recreational boats.

      But I suspect you don’t want to get into the specifics, and I respect that. If you are making your point that you want us to go all in to help children who don’t have insurance, and leaving “all in” vague, then that’s fine. I agree. But that doesn’t mean that I need to support every bill that comes out of the sausage factory that *intends* to help kids get healthcare, regardless of the cost or whether there are better, more efficient ways to accomplish those goals. Like I said before I wasn’t necessarily opposed to expanding CHIP, but I object to the tone of your post that implies that anyone who does opposed it, or who might oppose any similar expansion, is heartless.

      (BTW,I don’t think it should matter but maybe it does to some–I do have children, including one with a chronic illness)

  • DLS

    Dorian is incorrect.

    But it’s worth revisiting the S-CHIP incrementalist scenario, and considering the current idiocy by the Dems in Washington, and another example of what they could do instead that is incrementalist and which would probably receive better public reaction.

    It’s a “pincer” strategy that I’ve described for _years_. (Admittedly, it will take others still more years…)

    We have Medicare for the elderly.

    The age-related “pincer” strategy for incrementalists is to provide Medicare to all children, next.

    (That’s even before other moves such as incorporating Medicare into Medicaid.)

    Just don’t play games with the word “children” to go beyond age 18 (particularly if lefties insist on all adult rights for 18-year-olds at the same time, an irony or hypocrisy they fail routinely to grasp).

  • DLS

    “clearly there is a cost vs benefit analysis to be done here, and such an analysis need not be heartless”

    Any cost-benefit analysis or any failure at all to join the stampede is, by “definition,” “Heartless!” [tm]

    After all, what is at issue here are lib & Dem emotions (as usual, not facts and logic) and incrementalism, which in S-CHIP’s case means vaulting the cutoff level at multiples of the poverty level. (Don’t forget the 400% games they tried last time.)

  • DdW

    DJ.

    Thanks for some good comments.

    DLS:

    I said,

    “I believe that in our country every child—poor or wealthy—should have adequate health care.

    If the parents can’t afford either the care or the insurance, then, yes, the government should help”

    You said, “Dorian is incorrect”

    DLS, what I wrote is what I believe in. Not facts. Now, call it naive, disagree with it, but don’t call it incorrect. Just as I won’t call what you believe in (including your faith) “incorrect.”

    By the way, do you have children, grandchildren, etc? I do…

    And by the way, I disagree with you, but I would not call what you believe in incorrect or wrong.

    Finally, even if I am incorrect, I am proud to be incorrect when it comes to the health care and well-being of our children

    Thanks for your comments

  • DdW

    adelinesdad:

    First, I am sorry to hear that you have a child with a chronic illness, and I hope that his or her medical treatment and medicines are not too much of a financial hardship on you.

    With respect to how families qualify for CHIP for their children, each state sets the income limits according to size of family. For example for a family of four, I believe the lowest qualifying figure is $35,280 (North Dakota) and the highest $88,200 (New York).

    How these amounts were come up with, you and I can probably do our research for each state.

    Whether these amounts are reasonable, fair or whatever, that’s probably a very subjective judgment.

    As to, ” how we are to determine if a family can afford the care or the insurance. Do we just let the familes tell us and take their word for it? Are we to naively assume that if a family doesn’t buy health insurance for their kids, they can’t afford it? If we’re not careful, we will not be subsidizing health care for children, but instead be subsidizing big screen TVs and recreational boats.”, I can only say that we have to assume that most American families would have the health and welfare of their children at heart. Now, I know that there are always exceptions.

    But, my honest opinion is that, I would rather take the chance that one family would buy a bigscreen TV and/or a recreational boat (instead of buying health insurance for their children), than jeopardizing the health of a hundred, or thousand, or more children by denying those who really need it some financial support—solely because some may abuse such benefits. (Hopefully the states have ways and means to verify a family’s needs and whether the benefist are being used for the intended purposes)

    I hope I have answered your questions, and given my position, on which you are very free to disagree.

    Dorian

    • Dr J

      Dorian, no question, we can agree approximately all families do have their children’s welfare at heart. But rather fewer have the taxpayer’s interest at heart, and many people–perhaps most–don’t plan very well.

      So your family is in perfect health, you just got a $1200 tax refund. Do you buy a bigscreen TV, or do you save the money in case little Nefertiti breaks her arm or you lose your job six months from now and need to start paying for COBRA?

      Having trouble with the question? I’ll make it easier on you: Uncle Sam promises to pick up the bills for either of those calamities, but *only* if you can’t pay them yourself.

      Mmm, quite a moral dilemma, huh? I bet you’ll resolve it in time for the Red Sox game.

      • Dr J

        “I think better of the American people.”

        Do you? Do you honestly think people are terrific planners? Then why do we need Social Security, since planning for retirement is such an obvious need?

        Really, the premise of virtually every social program and much social policy is that people cannot look after themselves. If they could hold a job, we wouldn’t need welfare. If they could read contracts, we wouldn’t need so many consumer-protection laws. If they could avoid becoming addicts, we wouldn’t need to outlaw drugs.

        I sure wish this premise were wrong, because I can’t stand these programs that deny people freedom, but I’m not at all sure it is.

  • DdW

    Moral dilemma, only for a cynic.

    I think better of the American people,

    That’s where you and I apparently differ.

  • adelinesdad

    It’s not a matter of a moral dilemma. I didn’t say that people would choose flat-screens over their kids health care. What I’m saying is that as we increase the income threshold higher, we are making it possible for people not to have to choose. If the government says that I qualify for free health care for my kids, and I take it even though I also own flat screen tvs and all sorts of other non-necessities, am I immoral?

    And you said, “Hopefully the states have ways and means to verify a family’s needs and whether the benefist are being used for the intended purposes.”

    We’re not talking about fraud here. Even if states have the best verification system possible, if I legally qualify then I legally qualify. The question is whether I *should* legally qualify. And I’m not talking about using the money the government gives you to buy flatscreens. I assume the recipient never sees the money. The question is whether the recipient uses the money they would have used for health care on non-necessities. It is impossible to verify this after-the-fact, as it is impossible to only fill the left side of a bucket with water.

    It comes down to this basic question: What is a “poverty line”. According to one source, wikipedia, it is “the minimum level of income deemed necessary to achieve an adequate standard of living in a given country” That seems like a reasonable definition to me. So why is it that we have to give government hand-outs to people who make 4 times that amount? Now, we can debate whether the poverty line is too low, and it probably is, but 4 times too low? Is someone making $88,000 poor? If not, then be definition they have enough money to purchase an adequate standard of living, which includes health coverage for their kids. There may be exceptions, such as families with kids with special health care needs. But those are the exceptions and we can handle those situations in different ways rather than giving away health care to all families because a few might need it.

  • DdW

    What would you define to be “the poverty line”?

    Is $35,000 way too much?

  • DdW

    Hey guys, this has been a great discussion.

    I appreciate your comments and your viewpoints, but I guess we have come to the point where we’ll have to agree to disagree. I don’t think you are going to be able to change my views on this issue, just as I won’t be able to change yours.

    My views remain that a nation that can send a man to the moon (and is considering even more sensational and expensive space efforts), a country that has spent and continues to spend almost a trillion dollars on an unnecessarhy war (enough to pay for the healthcare of every child in our nation for the next one hundred years, at least); the most powerfiul, affluent, compassionate, caring nation in the world, should be able to look after the health of its most vulnerable, of its future—even if there may be the risk of some abuse and inefficiencies, even though some may be as irresponsible as to opt for that big screen Tv instead of (or in addition to) the government paying for their chilren’s health care (insurance).

    But that’s just my personal view.

    Thank you

    Dorian

  • adelinesdad

    No, as I said the current poverty line (which I believe is 22,000 for a family of 4) is too low, and 35,000 maybe is too. But 88,000 clearly is too high. I understand that states get the set the income threshold for their own state programs, but it’s still true that the federal government is offering to subsidize the program up to 4 times the poverty line. I can’t count the number of times I’ve heard an argument that we need such-and-such state program because if we don’t implement it, we’ll lose out on federal funding. So justifying the high federal threshold by putting the responsibility on the states to come up with a more reasonable threshold doesn’t hold water, in my opinion.

    But fair enough. We’ll agree to disagree. I’ll just part with this thought:

    I agree with the title of this post. Health care for children is not debatable. What is debatable is S-CHIP, and every other bill Washington concocts. And it will always be so, so long as there are unintended consequences to even the noblest of intentions; so long as many politicians care about saving face rather than doing what’s right; so long as money doesn’t grow on trees; so long as there are bad ways, good ways, and even better ways of accomplishing a worthwhile objective; and so long as we strive to balance the sometimes competing ideals of fairness, freedom, compassion, and personal responsibility. So long as any of those things remain true, there’s room for debate even when we all agree on the ideal outcome.

    • Dr J

      Well said, AD. I don’t sense much disagreement on the goals: we should keep children healthy.

      There is quite a bit of disagreement on the means.

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