Yesterday, in an opinion piece in the Washington Post, Ezekiel Emanuel and Victor Fuchs called for dismantling rather than repairing the current patchwork U.S. health care system. They characterized the various reform plans being put out by presumptive and actual presidential candidates as Band-Aids for a perverse system characterized by “toxic interactions between public and private coverage.”

Their poster-child representative for toxic interactions was SCHIP (the State Children’s Health Insurance Program). The authors note that when SCHIP was authorized in 1997, there were 10 million uninsured children in the U.S. Now there are nearly 9 million, so SCHIP’s impact has been small. Of course, proponents could argue that without SCHIP the number of uninsured children would be closer to 15 million, and overall totals of uninsured Americans would top the 50 million mark. For those of us who watch and write about health care policy, however, the editorial by Emanuel and Fuchs raises some other interesting questions. What happens when those who view SCHIP as a particularly toxic example of our current system run headfirst into the growing coalition of forces and voices on the Hill to extend and reauthorize the SCHIP legislation?

Many seasoned Washington watchers assume that the fight over SCHIP will be the only game in town. What happens when reformers seeking to redo the whole health care system run into the vast and strange bedfellows of organizations supporting reauthorization of SCHIP? One strange bedfellows group includes the Business Roundtable, AARP, and Service Employees International Union (SEIU). Perhaps the largest coalition, getting ready for its mass lobbying day on February 13, is the Campaign for Children’s Healthcare, spearheaded by Families USA but including the American Academy of Pediatrics; American Public Health Association; American Federation of Teachers; Consumers Union; National Immigration Law Center; a host of Catholic, Jewish, and Protestant groups; and many children’s advocacy groups.

Perhaps we should hope that the debate on the reauthorization of SCHIP would also lay the groundwork for a serious discussion on how to reform and finance health care in the U.S. to provide adequate coverage and appropriate and timely services for all U.S. residents. Economists and physicians alike know that investing in early childhood provides the best outcomes. Including their testimony and proposals for how best to serve children, in what is admittedly a safety-net stopgap program, might help move the health care reform agenda past the political noise level.

Further reading. For more on health reform from economist Fuchs (professor emeritus, Stanford University) and Emanuel (Chair, Department of Bioethics, NIH) see their Health Affairs paper “Health Care Reform: What? Why? When?”