Commentary Magazine


A Crafty Health Care Move

Earlier this summer, when Senate Democrats (with significant support from some Republicans) offered a bill that would expand federal subsidies for children’s health insurance , conservatives accused them of trying to bring government-funded health care in through the back door. Now, as if to prove the point, House Democrats this week are preparing to introduce a much more ambitious plan to fortify and expand the government’s role in health care.

The New York Times reported that the plan, slated to be made public in the coming days, would not only vastly expand the scope of the State Children’s Health Insurance Program (SCHIP), it would also reduce the incentive for private health plans to participate in the Medicare program, and eliminate the requirement in current law to limit Medicare’s reliance on general revenue for its funding.

Two points about why this bill is a smart play by the Democrats. First of all, it’s intended to make the Senate plan (which would increase SCHIP funding by more than $35 billion) appear to be the most moderate of three alternatives, mediating between the White House’s proposal of a $5 billion increase and the House’s $50 billion.

Secondly, and more importantly in the long term, by tying together politically appealing cases for coverage—for the very old and very young—the Democrats are making a concerted effort to move toward government-funded health insurance. Historically, Medicare has been seen as a crucial foot in the door for advocates of government health insurance, and the SCHIP program, created in 1997, was very consciously conceived of as a step in this direction as well. By explicitly tying the two together in one bill, House Democrats can both gather a powerful coalition behind them (the AARP will mount a national campaign for the bill, for instance), and begin to press in on America’s private health care market from both sides.

Advocates of nationalized health care may, oddly enough, have learned a lesson from the pro-life movement: the way to achieve revolutionary goals in American politics is by taking one small step after another, each carefully designed to be emotionally appealing and hard to oppose.

Although President Bush has promised to veto both the House and Senate versions of the bill, the Democrats’ new strategy makes it more likely that the Senate bill might, in time, gain the votes to override such a veto. Fiscally, socially, politically, and practically, this would be a bad idea. But you have to admire the Democrats’ craftiness.