Spendthrift Bush Draws Line on Kids' Health: Margaret Carlson

Sept. 27 (Bloomberg) -- Responding to a question about the growing number of uninsured Americans, President George W. Bush observed: ``No one goes without health care in America. After all, you just go to an emergency room.''

This let-them-eat-cake attitude recalled Barbara Bush's observation when thousands of Hurricane Katrina victims lay sleeping with strangers on the floor of the Houston Astrodome. They're ``underprivileged anyway,'' she said, ``so this is working very well for them.''

The Bushes have had many more chances to inform themselves than did Marie Antoinette, so they must work harder to maintain their denial. For the president, denial seems to be a philosophy for governance. Why not have a mother whose child has a 102- degree fever wait, along with gunshot victims, in hard plastic chairs for hours to get a throat culture? They're underprivileged. That's what emergency rooms are for.

That attitude is at work in Bush's threatened veto of a $35 billion bill that would expand health insurance for low-income children. The president's proposal to spend an additional $5 billion over five years wouldn't be enough to continue coverage for all 6 million children now enrolled.

Republicans are balking. Cured momentarily of John Warner Syndrome -- named for the Republican senator from Virginia who frequently promises to vote his conscience but then caves to the president -- 45 House Republicans rejected White House appeals and voted with Democrats 265-159.

`Abandoning Children'

That's not enough to override a veto but it's many more than the five Republicans who voted for a similar bill in August.

The measure now goes to the Senate where it's likely to pass with a veto-proof majority. A backer of the bill, Republican Senator Charles Grassley, advised House Democrats to shame Republicans by ``calling a vote every three months'' and airing campaign ads ``accusing Republicans of abandoning children.''

Along with Senator Orrin Hatch of Utah, Grassley has repeatedly knocked down a major White House talking point that criticizes the program for pushing privately insured children into public programs and ``covering children in some households with incomes up to $83,000 a year.'' It doesn't.

Only New York asked to raise it that high because of its sky-high cost-of-living, and the administration turned down the request. The measure, in fact, generally limits coverage to families with incomes at 300 percent of the federal poverty level ($61,950 for a family of four.) In places with a high cost of living, about 70 percent of those enrolled would be from families earning less than $24,340.

Biggest Splurge

Along with a ``dangerous'' slide into government-run health care, Bush cites spending as a reason for being against the bill. He's right that spending is out of control, but that's largely his doing. According to the libertarian Cato Institute, Bush has presided over the largest overall increase in federal spending since Lyndon Johnson.

If suddenly Bush wants to be a cost-cutter, why draw the line at the pediatrician's door? He could get at some of the pork in the massive energy and highway bills. And how about the farm bill on the Hill now, with its massive subsidies for agribusiness? Bush's main problem with that bill is that it closes a loophole giving tax breaks to corporate chiefs holding board meetings offshore in the Caymans.

Bush didn't let spending worries keep him from pushing a prescription-drug bill, probably because it generates as many benefits for corporate America as for elderly America by preventing the government from negotiating discounts with drug companies, barring seniors from getting prescriptions filled in Canada, and mandating a role for private suppliers.

Hillary's Plan

The president is pulling out his unused veto pen for the state children's health insurance program, or Schip, just as Senator Hillary Clinton is rolling out her health-care plan, a vast improvement on her untenable 1,300-page opus of 1993. Her failed effort damped the appetite for taking on the problem for 14 years, during which 37 million uninsured grew to 47 million. She says she's learned ``some valuable lessons.''

Aside from any personal growth that might have occurred, Clinton has learned not to reinvent the wheel. Her plan is almost identical to ones proposed by former Senator John Edwards and Senator Barack Obama.

But who needs originality? All the Democrats have plans; all the Republicans have is talk about the evils of socialized medicine. The most transparent criticism comes from former Governor Mitt Romney, whose Massachusetts reforms mirror the Democratic proposals. To the New Romney, Massachusetts is as distant as Uzbekistan -- his history there is something to be expunged, like a juvenile record.

Scrap the Middleman

Bush's attitude toward children's insurance shows how conservatives and liberals look at the problem. Liberals want to cut administrative costs, relieve the burden on employers who became the middlemen for health care during World War II, and improve services.

Conservatives believe we overuse health care because a middleman pays the bills and any improvements will raise taxes. They want more medical savings accounts, which give the well-to- do a tax break for gold-plated coverage. They rarely address what happens if we do nothing.

The Democratic proposals don't get at the 20 percent of every health-care dollar that insurance companies spend trying NOT to cover anyone with a remote chance of getting sick and then trying NOT to pay claims if they do.

Nonetheless, insurers don't like Democratic reforms because giving consumers the same choice of plans that federal employees enjoy -- with Medicare-type administrative costs of around 2 percent -- isn't just letting the camel's nose under the tent. It's likely to knock out the poles holding it up until most people have fled the costly and inefficient private system.

Former Cabinet Secretary Donna Shalala told me that when seniors came up to her after speeches, they'd often implore her ``to keep government out of my Medicare.'' That's a tribute to the government-run program that in 1965 gave the elderly a health-care safety net. But it's more a commentary on Republicans who've managed to so malign government that people can't believe it produced a program so good.

To contact the writer of this column: Margaret Carlson in Washington at mcarlson3@bloomberg.net