As "a conservative who wants to help restore the limited federal government envisioned in the Constitution," Rep. Roscoe Bartlett said, he could not in good conscience vote to override President Bush's veto of a bill boosting federal spending on children's health insurance. But the Maryland Republican also said he was "proud" to have supported the creation of the State Children's Health Insurance Program and promised he would "work to ensure a safety net of health insurance for the children of the working poor."
The Framers would have insisted on nothing less, as reflected in the Constitution's health-care clause. Oh, wait. The Constitution has no health-care clause. Nor does it include any other provision that authorizes Congress to spend taxpayers' money on health insurance for the children of the working poor, the grandparents of the middle class, the nephews of the super-rich or the kin of any other socioeconomic group.
Still, Bartlett and Bush deserve some credit for resisting the expansion of a highly popular program that never should have been created to begin with, especially since they knew they'd be accused of being stingy child haters. They would deserve more credit if they applied their avowed principles a little more consistently, in which case the charges of cruel penny-pinching would be less credible.
When Bush vetoed the SCHIP bill, which would have spent an additional $35 billion over five years, he expressed concern about "federalizing" health care. "I believe in private medicine," he said, "not the federal government running the health care system." He also worried that opening SCHIP to families earning up to three times the poverty level (about $62,000 for a family of four) would move it away from its original goal of serving people too poor to afford insurance but not quite poor enough to qualify for Medicaid.
It's hard to reconcile Bush's opposition to a bigger federal role in health care and his emphasis on strict means testing with the Medicare prescription-drug benefit he championed, which is expected to cost $675 billion during the next decade while compelling middle-class taxpayers to buy Lipitor for retired billionaires. More generally, Bush's "compassionate conservatism," if it means anything, means a willingness to spend other people's money on sympathetic causes.
No wonder Sen. Orrin Hatch (R-Utah) found Bush's SCHIP veto puzzling. "If we're truly compassionate, it seems to me, we'd want to endorse this program," Hatch said. "I don't think the president is somebody who doesn't want these kids to be covered."
If you're "truly compassionate," according to this prominent conservative Republican, you support more money for SCHIP. Otherwise, you want kids to die of untreated diseases.
The basic question of whether the government should force taxpayers to pay for children's health insurance has not come up much in the debate provoked by Bush's SCHIP veto. But there clearly is wide disagreement about the program's details, including eligibility criteria, coverage of adults, and minimum benefits.
The intractability of these disputes is illustrated by divergent responses to the Congressional Budget Office's estimate that between a quarter and a half of children covered by SCHIP would otherwise have private insurance. For supporters of "single payer" health care, this substitution of government for private coverage, which would become more common if eligibility criteria were loosened, is a feature, not a bug.
Instead of trying to resolve such issues at the national level, why not let each state go its own way, with results that vary depending on local values, the local cost of living and the local health-care situation? No federal money would mean that one state's legislators could no longer force another state's taxpayers to subsidize their generous impulses, but it would also mean no federal restrictions.
Permitting a wide range of policy experiments in areas where the federal government has no license to act is not just the law. It's a good idea.