“Philosophical Differences”

Last week the House Energy and Commerce Committee voted to kill a program that offered states bonuses for doing a better job of enrolling eligible low-income children in the Medicaid and S-CHiP programs. This was part of the House Republican effort to pretend to implement the Ryan Budget Resolution, which was not, of course, actually enacted by Congress. So it pretty clearly represents their priorities.

In Matt Dobias’ report on the action for Politico, there’s lots of talk from Republicans about how the bonuses undermine tough policing of the programs for possible fraud, and boost costs that states might have trouble covering when the bonuses run out. On the other side of the argument is Ron Pollack of the advocacy group Families USA:

The whole purpose of the funds is to make sure that children who are eligible based on state-determined standards have an easier time — rather than a harder time — getting enrolled.

Matt Salo, executive director of the National Association of Medicaid Directors, however, said he sees a broader divide at play.

“In Congress and across the country, there are philosophical differences about whether public programs should be available to everyone with as little effort as possible,” he said. “And there are others who believe they should be made available, but don’t beat down their doors to force it on them.”

I’d say the “philosophical differences” run a little deeper than that. Why do we offer health insurance to low-income children? Is it because we just want to do them or their parents a favor? Or is it because giving kids basic health services tends to save an incredible amount of money in the long run, in chronic illnesses that might otherwise be prevented or managed, in expensive emergency room visits they won’t have to make, in costs that the rest of us will eventually bear? Could it even be that we value health as an end in itself, and would like to reduce the number of unnecessary deaths from untreated health conditions? Is it possible we think healthier children produce a healthier, happier, more prosperous country?

Oh, sorry, I forgot. Anyone sharing that sort of “philosophy” might also see the value of universal health coverage, instead of treating the very idea as a socialist abomination sure to lead to health care rationing and euthanasia. That doesn’t describe our current breed of congressional Republican.

Ed Kilgore

Ed Kilgore, a Monthly contributing editor, is a columnist for the Daily Intelligencer, New York magazine’s politics blog, and the managing editor for the Democratic Strategist.