“This is only the first battle in this Congress over who will control health care in America,” Mr. Hensarling said. “Will it be parents, families and doctors? Or will it be Washington bureaucrats? That’s what this debate is all about.” Hensarling has it wrong on both accounts: Parents, families, and doctors certainly don’t control health care now. And under all the Democratic contenders’ plans, insurance companies would still hold the cards.
But who would hold the cards under Single Payer? Government bureaucrats? Business desperate to decrease health costs, even if it’s paid through taxes? Working class families who will need more care as the population ages? We need to think about this. 1935’s Social Security was proceeded by general strikes in San Francisco, Toledo, and Minneapolis the year before. And Mediciare and Medicaid were brought in to respond to social unrest in the cities.
By ROBERT PEAR, New York Times, October 6, 2007
WASHINGTON, Oct. 5 — The debate now raging here over the children’s health insurance program offers a cautionary lesson to Democrats running for president. It shows how hard it will be to persuade many Republicans to sign on to their vision of universal coverage.
If Democrats and Republicans had so much difficulty agreeing on a plan to cover 10 million children, most of them from low-income families, how can they ever agree on legislation to guarantee insurance for 250 million or 300 million people?
Many of the questions that provoked fierce argument in the battle over the child health bill would be even more divisive in a debate over universal coverage: Should the government subsidize insurance for middle-income people? How much government involvement is too much? How much should the government spend, and who should foot the bill?
In vetoing a $35 billion expansion of the State Children’s Health Insurance Program on Wednesday, President Bush said the bill would improperly allow higher-income families to benefit from assistance meant to help poor children.
Democrats said the president was out of step with the nation. They see a consensus forming around the goal of universal coverage, meaning access to health insurance for all, with payment coming from public and private sources. Given presidential leadership, they said, the goal can be achieved.
But it will not be easy. This year’s debate over the child health bill prefigures a battle over health policy that is likely to run through the presidential campaign and occupy center stage in Congress in 2009, regardless of who wins the election.
Representative Jeb Hensarling, Republican of Texas, said the debate over coverage of children was “a proxy fight” between advocates for two competing visions.
“This is only the first battle in this Congress over who will control health care in America,” Mr. Hensarling said. “Will it be parents, families and doctors? Or will it be Washington bureaucrats? That’s what this debate is all about.”
The child health bill was overwhelmingly approved in the Senate, 67 to 29, with support from 18 Republicans. In the House, 45 Republicans, more than one-fifth of the party caucus, supported the bill, which passed there by 265 to 159. (Currently lacking a veto-proof majority for the legislation, House Democratic leaders have decided to delay an override attempt until Oct. 18.)
The substantial margin of passage in both houses obscured visceral disagreements over philosophy and ideology. Those differences could create formidable obstacles for a president of either party, in the absence of a landslide like those that preceded creation of Social Security in 1935 and Medicare in 1965.
Democrats insisted that the proposed expansion of the child health program would not mean a new entitlement or lead to government-run health care. They repeatedly pointed out that while the federal government and the states pay for the program, most children on the rolls receive care from private doctors and hospitals, and most states have contracts with private insurers to manage the care.
One co-author of the bill, Senator Charles E. Grassley, Republican of Iowa, said critics in his own party who referred to the expansion as “socialized medicine” were making “outlandish accusations.”
But that is exactly the accusation many Republicans are making.
Representative Pete Sessions of Texas said the child health bill was an “attempt to make millions of Americans completely reliant upon the government for their health care needs.”
Senator Mel Martinez of Florida, a Cuban refugee who is general chairman of the Republican Party, said the bill would move the nation toward “socialized health care, a Cuban-style health care system, with rationing of care, long waiting lines and, worse yet, no choice.”
The criticism reflects the concerns of many Republicans. Mr. Grassley himself said, “Many in the Democratic Party, including several of the Democratic presidential candidates, want a government-run single-payer health care system.”
While the Democratic candidates for president deny wanting a single-payer system, they do say the government should play a larger role. Defining that role is perhaps the biggest domestic policy challenge facing the next president.
Under Senator Hillary Rodham Clinton’s proposal, people could keep their existing coverage, choose a private plan offered by the Federal Employees Health Benefits Program or sign up for a new “public plan option similar to Medicare.”
Former Senator John Edwards would give everyone “a choice between private insurers and a public insurance plan modeled after Medicare.”
Senator Barack Obama says he would “establish a new public insurance program” for people who do not have access to group coverage.
Amid the partisan uproar, some lawmakers see the nucleus of a possible bipartisan coalition.
Senator Ron Wyden, an Oregon Democrat who has worked on health care for three decades, said: “What’s emerging is a sense, in both parties, that each side has been right on a key point. Democrats have been right about coverage; if you don’t cover everybody, the cost of caring for the uninsured is shifted to people with insurance. Republicans are right about the need for choices and private alternatives.”
Mr. Wyden said he saw a potential for bipartisan agreement “if we link the idea of universal coverage to the idea of a private health care delivery system.”
Stuart M. Butler, a vice president of the conservative Heritage Foundation, said the debate over the child health program carried an important lesson for Republicans.
“Many Republicans have yet to recognize that it’s important to cover children, and that you have to offer a different vision as an alternative to simply expanding government programs,” Mr. Butler said.
Mr. Butler would offer financial help, through the tax system, to families with incomes two to three times the poverty level ($41,300 to $61,950 for a family of four) to help them pay for private insurance covering their children.
Many Republicans like that approach, of course, but Mr. Butler suggests that they failed to push it sufficiently in the tug of war on child health care.
“It’s hard to fight something with nothing,” he said.