WASHINGTON – Better late than never, President Bush has provoked what could be a serious debate on the future of health care by threatening to veto an extension of one of the most popular and successful government programs in that field.
The fight he has started over the State Children’s Health Insurance Program, or SCHIP as it is known, is – in the words of Health and Human Services Secretary Mike Leavitt – “a surrogate for the larger philosophical debate on the role of government in health care.”
Had Bush joined that debate before his time in office had dwindled to 18 months and his approval scores slumped to Nixonian levels, the chances of something positive emerging would have been much greater.
Now, as Leavitt conceded in an interview, “it may take another election” to bring the country face to face with the larger issues Bush has raised – how big a role the federal government should take in providing medical services and how that role should be financed.
For the president and Leavitt, the answer is that the government should provide a safety net for the medical needs of the poor and the elderly – but everyone else should have private health insurance, with coverage monitored by the states and premiums subsidized by federal tax credits.
With that vision in mind, the administration repeatedly accuses the Democrats of favoring “government-run health care.” Unpersuaded by the success of Medicare and SCHIP, Bush and his associates denounce efforts by congressional Democrats to extend the program to millions more children.
As with Iraq, Bush is prepared to use stubbornness and a veto pen to combat public opinion. The Democrats have the easy side of the argument, promising to insure more kids from low-income families who are too well-off for Medicaid but not wealthy enough to afford private insurance policies.
The Senate bill would insure an additional 3.2 million children at a cost of an extra $35 billion. The House version, even more ambitious, would add 5.1 million kids and cost $50 billion extra over five years. Both would raise tobacco taxes to pay for the largesse.
By contrast, the president is recommending only $5 billion of new spending, though Leavitt hints that the administration could accept a higher figure as long as it did not involve expanding the program to new people.
What will probably happen is that Congress will pass a bill that will draw a veto – and then the serious bargaining will begin. The current authorization expires Sept. 30 and no one wants to see the program end.
But if and when a compromise is reached, the larger issues of health care will remain. And that is why it is important that the presidential candidates in both parties take advantage of the opportunity being offered by a series of health care forums this fall.
The Federation of American Hospitals and Families USA, a consumer-oriented group, have gotten together with several foundations to sponsor a series of sessions at the Kaiser Family Foundation’s Barbara Jordan Conference Center in Washington.
At each hour-long session, one candidate will present his or her ideas and then be quizzed by four serious health policy journalists – Susan Dentzer of PBS’ “NewsHour,” Laurie McGinley of The Wall Street Journal, Timothy Johnson of ABC News and Julie Rovner of National Public Radio. Each forum will be Webcast and tapes will be prepared by MacNeil-Lehrer Productions.
Hillary Rodham Clinton will lead off on Sept. 19 and John Edwards will follow on Sept. 24. The sponsors are still awaiting word from Barack Obama – whose big health care speech in Iowa drew mixed reactions – and other Democrats. Charles N. “Chip” Kahn III, the hospital association president, is still trying to sign up the first Republican contender.
Kahn, who is a veteran of past Republican campaigns, said that Bush’s current situation should demonstrate the costs of ignoring health care issues “until the Democrats confront you with something you don’t like.” The candidates “need to get out in front of this issue,” he said.
It will be revealing to see which, if any, of the major Republican candidates rise to this challenge.
David Broder is a Washington Post columnist. Contact him by writing to davidbroder@washpost.com.
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