Pediatric Politics

Clinton creates a KiddieCare Crisis

I'm making a prediction, and you can hold me to it. Sometime in the next year or two, you will see a television ad that looks and sounds something like this:

(Spot begins with scattered sounds of coughing and a picture of a hand cupping a mouth.) "Rachel has a nagging cough that just won't go away. It could be serious, but she hasn't been to the doctor about it because she has no health insurance."

(Camera pulls back to show face.)

"Rachel is only 6 years old." (A low, ominous musical tone, followed by pictures of poor children.) "Right now, there are 10 million children in America without health insurance. Ninety percent of these children live in working families but neither qualify for government programs nor have enough money to buy coverage."

(An image of the American flag flashes past.)

"It is simply wrong that children in America are denied health coverage that is provided to children in every other industrialized nation."

(Pictures of ambulances rushing to the hospital and children in hospital beds.)

"And if we don't give these children the health coverage they deserve today, they'll be coming to our hospital emergency rooms in the future with costly illnesses that we may not be able to cure."

(Camera returns to Rachel's face.)

"Call your member of Congress and tell him that Rachel deserves better."

The campaign for KiddieCare has begun. Last fall, candidates talked a lot about senior citizens and Medicare. Television ads played in many congressional districts showing exploitative pictures of frail elders fretting about the possibility of losing their benefits or becoming burdens on their families. You ain't seen nothing yet. AFL-CIO President John Sweeney stated it clearly last December: Congress had better protect and expand government public assistance programs. "If they don't come around," he says, "we'll use children's health the way we used Medicare, and that's a promise and a commitment." Believe him. After all, children make for better TV than seniors. Most people are predisposed to feel sympathy for innocent children but may associate pictures of the elderly with annoying parents or in-laws. That's why international aid organizations run infomercials about poor children in foreign lands rather than their presumably equally poor parents and grandparents.

In fact, those cloying ads with TV's Sally Struthers and Pernell Roberts pitching "a dollar a day" for poor Salvadorans, Somalis, and Bangladeshis are a telling sign of things to come. Already, politicians are starting to use the hook of uninsured children to pitch new health insurance programs at the federal and state levels. In January, Senate Minority Leader Tom Daschle (D-S.D.) proposed a new $4 billion federal program to use refundable tax credits to subsidize 90 percent of private health insurance premiums for families with annual incomes up to twice the federal poverty level. The bill would provide smaller subsidies for wealthier families earning up to $75,000 per year. Since 83 percent of American families make below $75,000, this is a classic middle-class entitlement. Similarly, Bay State Senators Teddy Kennedy and John Kerry have proposed a joint federal-state program to purchase private "child-only" health insurance for modest-to-middle-income families at a projected cost of $9 billion.

In January, President Clinton introduced his budget plan, including a proposal to subsidize health insurance for temporarily unemployed workers and their children. The Clinton administration also wants to require states to use savings from Medicaid reforms to loosen the program's eligibility requirements and expand enrollment. In March, the Children's Defense Fund held one of its media-savvy press conferences to demand health insurance for all American children and announced plans for a June 1 "Stand for Children" featuring CDF President Marian Wright Edelman, Rosa Parks, and noted child welfare expert (and talk show host) Rosie O'Donnell. To make the event a truly nationwide effort, local organizers have formed 170 Children's Action Teams in 38 states to set up a variety of headline-grabbing rallies and protests for the same day. "If you care about the 10 million children who don't have health insurance," Edelman intoned solemnly at the press conference, "sign the virtual petition for healthy children on the Internet and hold a rally or candidate forum to urge leaders to ensure healthy children now."

There are several reasons why congressional Democrats, the Clinton administration, and other advocates of expanded government control over health care have picked KiddieCare as their newest vehicle. One is that they got burned in 1993 and 1994 promoting ClintonCare for everyone, and they want to move slowly and cautiously. Another is that children, unlike the elderly, cost relatively little to insure. They rarely get seriously ill. Obviously, however, the most important reason for trying to sneak the KiddieCare nose under the tent is the Sally Struthers angle. When confronted with manipulative pictures of needy children, otherwise rational people lose their capacity for thought. Emotion takes over. And the people for whom this hook isn't enough often buy the typical CDF pitch that a little money spent now (on health insurance) will actually save money in the long run (by heading off serious medical conditions and ensuring healthy child development).

For those who get a little nervous about the prospect of a massive new government entitlement, largely targeted toward the middle class, the KiddieCare hook-and-pitch represents all that is wrong with the public policy debate today. It is based on gut reactions rather than careful analysis. It assumes that every problem has a government solution. And it stigmatizes those who don't go along as uncaring and cruel.

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