The current debates in the Congress about both the supplemental bill to augment current State Children’s Health Insurance Program (SCHIP) shortfalls and the reauthorization of SCHIP for the next five years have produced many proposals swearing fealty to the prominence of children in our values and society. Even those opposing expansion of SCHIP do so on the grounds that we need to cover (poor) kids first before we expand the income or age limits for participation.
However, the release on March 15, 2007 of the report by the Urban Institute, Kids Share 2007, belies these homages to the importance of children. The report reveals that over the past half-century, children have been a “diminishing national priority” for federal lawmakers.
As the U.S. emerged from World War II and the Korean War, an increasing share of the budget was dedicated to domestic spending. Since 1960, spending on defense as a share of gross domestic product (GDP) has declined by over 50 percent. Non-child spending in Social Security, Medicare, and Medicaid has increased by a factor of 17 and nearly quadrupled as a share of GDP. Children’s programs, on the other hand — which include Medicaid, SCHIP, Food Stamps, Women, Infants, and Children (WIC), tax credits and exemptions, and education programs — have declined by about one-fifth as a share of domestic spending in GDP. Children’s programs have not kept pace with other domestic spending, and we have not kept faith with our children.
The Urban Institute’s report illuminates one the grand paradoxes of American politics. Surveys, particularly those in health care, reveal broad support for taking care of children, even valuing a child’s health care intervention more than an adult’s. In 2004 Marc Berk and colleagues published results of a survey that showed broad-based support transcending demographic and political lines for the government to play a role in ensuring adequate health care. The 2007 March/April issue of Health Affairs contains an article by Daniel Eisenberg and Gerry Freed that also discusses survey data and how we measure health preferences; it finds that respondents to surveys — even elderly respondents — assign a higher priority to health gains for younger people.
Yet when we count the dollars, children are receiving less and less of the federal pie. When we ask what accounts for this paradox, the cynics could answer that seniors vote and children don’t. Bill Hoagland, a former top adviser to Senate Republicans, was quoted in USA Today as saying that when programs for children in health care and other areas get pitted against Medicare, seniors win: “I know for a fact, first-hand, that ballots are distributed at nursing homes on Election Day, and they’re not distributed at the kindergarten level.”
Another possible answer, discussed by both Berk and Eisenberg/Freed, is that Americans are less selfish than uninformed. Simply put, many Americans might not realize how much we are spending on seniors and how little we are spending on children.
The debate over SCHIP supplementals and reauthorization is only a small battle in the attempt to refocus national priorities on meeting all children’s needs. A recent UNICEF report ranked the United States second to last among twenty-one industrialized nations in child well-being. This dismal showing should rally all of us to restore the U.S. to its role as leader in child health as we were in the beginning of the twentieth century.