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CHILDREN: The U.S. Doesn’t Put Its Money Where Its Mouth Is

March 20th, 2007

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.

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2 Trackbacks for “CHILDREN: The U.S. Doesn’t Put Its Money Where Its Mouth Is”

  1. Health Care BS » Blog Archive
    March 20th, 2007 at 10:55 pm
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    March 20th, 2007 at 8:27 pm

4 Responses to “CHILDREN: The U.S. Doesn’t Put Its Money Where Its Mouth Is”

  1. David Catron Says:

    I’m not convinced that congressional ambivalence on the issue of SCHIP funding can be attributed to insufficient national emphasis on the well-being of children. Grace-Marie Turner points out in the WSJ (March 17) that much of the money allocated for SCHIP has been diverted to adult patients. She provides a variety of examples, including the following:

    “In 2005, 87 percent of Minnesota’s SCHIP enrollees were adults, as were 66 percent of those enrolled in Wisconsin’s program … In Arizona—which has one of the highest rates of uninsured children in the nation—56 percent of those enrolled in SCHIP were adults.”

    In other words, these and other states are deliberately misallocating SCHIP funds. So, the problem here is not some sort of national callousness toward children, but rather a legitimate concern about bureaucratic mismanagement of a program specifically designed to provide for the health care of those children.

  2. Neil Gardner Says:

    Jane Hiebert-White Jane Hiebert-White wrote about:

    Children’s Dental Health Improvement Act of 2007 (S. 739) “to improve the access to and delivery of dental care to uninsured.
    For future lesson planning, I think it is very informative to note that Medicaid kids are insured and have been since 1965. Still year after year, they have no or minimal access despite the insurance. We can introduce ten more years of Children’s Dental Health Improvement Acts and still get no where until we deal with a system that has no social mission and providers that have to make a living on people with real money!

  3. Jane Hiebert-White Says:

    After the recent death of a 12-year-old boy in the Maryland suburbs of DC, Maryland’s new senator Ben Cardin, along with Sen. Jeff Bingaman (D-NM) introduced early this month
    the Children’s Dental Health Improvement Act of 2007 (S. 739) “to improve the access to and delivery of dental care to uninsured children through a number of steps, including allowing states flexibility to cover dental services through the State Children’s Health Insurance Program (S-CHIP).”

    This tragedy appears to be leading to new attention to dental care on Capitol Hill.

  4. Neil Gardner Says:

    I have a related story to tell about children and access to care, specifically, dental care!. Sometimes you can have a program that will pay for care, but still not have access, and what does that mean for the future???

    Let’s look at dental care for the poor. The federal and state governments taken together have done several hypocritical things related to access to care here for poor children. First through the licensure procedure, these government entities have created a monopoly for dentists in that only dentists can legally treat dental disease. Second, these same governments have decided that dental care for poor children is important enough that the government will pay for such care. However, the monopoly dental profession that these governments have created almost unanimously refuses to see these kids, as shown by the 20-25% access rate that Medicaid children have. These children also have by far the most dental disease.

    How do folks think this conundrum of payment with no access should be handled in the future? Should licensed health professionals by forced to see these state paid children somehow?? If we went to a single payer system, would that solve the problem, and/but would there be enough providers to do the job??

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