Thursday, October 18, 2007

SCHIP Override Fails in The House

This was expected:

Supporters of a bill to provide health insurance for 10 million children failed this afternoon, as expected, to muster enough support in the House to override President Bush's veto.

The vote to override the veto was 273 to 156, or 13 votes short of the necessary two-thirds majority of those present and voting; the bill was originally approved by a 265 to 159 vote on Sept. 25.

The main suspense before today's vote was over how many Republicans would side against President Bush. Forty-four House Republicans voted for the bill today, compared with 45 on Sept. 25.

The White House said President Bush was pleased with today's result. "As it is clear that this legislation lacks sufficient support to become law, now is the time for Congress to stop playing politics and to join the president in finding common ground to reauthorize this vital program," said Dana Perino, Mr. Bush's spokeswoman.

Democrats had anticipated defeat, and Senator Harry Reid of Nevada, the Senate majority leader, and Representative Rahm Emanuel of Illinois, chairman of the House Democratic Caucus, immediately offered angry comments.

Certain aspects of the SCHIP debate have not received the attention they deserve. For example, the fight is not just over expanding SCHIP to cover more children, but also about keeping the coverage for the children who have SCHIP right now. The president's veto means that the overall expense on the program is capped at the old level, even though prices of health care have risen. What this means is that several states will have to cut the number of children they currently insure. In short: the debate is not between the existing program and a larger one but between a larger program and a much smaller one.

Another aspect worth emphasizing is that the majority of those polled on the question of SCHIP want to see it expanded. Even 70% of Republican respondents wanted to see that, and three quarters of all those who want an expansion said that they'd be willing to pay higher taxes for it. In short: Bush is rowing against the current here.

A third aspect I find pretty astonishing is the inability of so many conservative commentators to grasp the simple fact that private health care insurance really is unaffordable for many people who might otherwise look almost middle-class. You can forget about an affordable insurance policy if your employer doesn't offer group health insurance, and you can also forget about it if you suffer from a pre-existing condition. The individual policies offered to groups like these look affordable only if they cover very little, which means that they don't protect the buyer against the truly catastrophic effects of many illnesses. Even people who do have good private health insurance find themselves owing lots of money to hospitals after a stay in intensive care or a complicated surgery.

George Will recently wrote:

SCHIP is described as serving "poor children" or children of "the working poor." Everyone agrees that it is for "low-income" people. Under the bill that Democrats hope to pass over the president's veto tomorrow, states could extend eligibility to households earning $61,950. But America's median household income is $48,201. How can people above the median income be eligible for a program serving lower-income people?

Imagine yourself living in New York City, earning $61,950, with, say, four children. Imagine that your employer doesn't offer group health insurance (most small firms do not). How much would you have to pay for an individual policy covering the whole family? How much is your rent? The point Will ignores here is that standard of living doesn't depend only on the income one earns but also on how much everything costs. It also depends on the number of people one supports out of that income. It's quite simple to imagine a particular income meaning an affluent lifestyle in some place such as India, whereas the same income in, say, London, would make you and your family destitute.

But even ignoring that definitional problem in Will's article, I find that many conservative commentators suffer from an odd kind of blindness when talking about health insurance. It's not a product that you can buy in little snippets if you can't afford the big chunk you actually need, and that chunk can cost more than a middle-class person can afford. Add to that the ever-decreasing number of jobs which still offer health insurance, and the problem becomes something which not only the poor suffer from.