SCHIP and the Presidential Veto

According to the New York Times, President Bush today vetoed the bipartisan bill to continue and expand the State Children's Health Insurance Programs, or SCHIP. This bill had overwhelming support in the House, and a "veto-proof" majority in the Senate (though I will note that 67 votes in the Senate is only veto-proof if all 67 are committed to overriding the presidential veto). It is overwhelmingly popular among American citizens, because who wants kids to suffer?

Now, President Bush claims many things about the bill, most of which are, I think, at least somewhat true. The expansion of New York State's SCHIP coverage did lead to some employers deciding to drop the families of employees from the insurance coverage they sponsored (this actually occurred in the non-profit agency I was working for in 2002, and it happened because the choice was to eliminate coverage for families or make the employee contributions so high that none of us could afford it). We were pissed, but since most of us didn't make that much money anyway, we had the option of signing our kids up for SCHIP. Or having the childrens' fathers cover them (which is what most married women in the agency did).

There's also President Bush's claim that those calling for the expansion of SCHIP actually want to establish something along the lines of Medicare-for-all, a single-payer system in which the government would be the one to pay for our medical expenses.

There's a lot of information and rhetoric to back up this claim. Largely, the grassroots folks most committed to the expansion of SCHIP (including myself), do support Medicare-for-all. Hell, Diane Archer (founder of The Medicare Rights Center) is particularly vocal about it. (An article quoting Archer and describing the problem particularly well is here.)

So, Bush's concerns are valid in that they are based in fact. But that begs the question: are they morally valid?

Now, many would castigate me for posing the question of universal health care provision as a moral issue, but I don't see any other way to pose it. Sure, you can break down the economics of how lack of access to care leads to lost wages and costlier treatments due to lack of access to preventative care, screenings and timely interventions, but at the bottom it's a question of valuing human life and livelihood.

In the United States, there are currently 47 million uninsured. That's a lot (more than the population of all west coast states, of all northeastern states, etc.).

Uninsured persons in the United States are much less likely to seek health services when they need to. A 2005 report based on 2003 CDC data found that a huge proportion of uninsured Americans with chronic health problems did not seek adequate health services, and sought services far less than their insured counterparts. This has serious long-term consequences, folks. It leads to serious complications, resulting in greater need of inpatient hospital services, greater stress on families, and greater risk of such negative sequelae as, oh, bankruptcy and death.

This is even more dangerous for children who miss out on important immunizations, health screenings, and care for chronic conditions. Furthermore, if you don't have a regular health care provider (more likely if you are uninsured, as it is hard to prioritize paying for routine check-ups over routine food and shelter), you are more likely to seek your care at local emergency rooms. Now, the president may not see this as problematic, but I do. Emergency rooms are not places to seek basic care. They are centers for acute, emergency care. But when your child has a high fever and no pediatrician, that does seem to qualify as an emergency. I do believe, though, that a child is more likely to get worse before they get better if she has to go through the trauma of many hours in the emergency room; this is after she's already become sicker than she would have been had she had access to a regular doctor.

Seeking basic care through the ER also does a disservice to patients in that it is nearly impossible to have meaningful continuity of care. I work at a hospital. We keep excellent records. But a consistent human-to-human interaction is essential to creating trust between patient and physician, and also essential in allowing the physician to make visual, aural, and affective assessments. This is why good hospitals try to have some continuity of care for all inpatient visits. There's a head doctor assigned to your care, even if that doctor isn't the only one you see. In the pastoral services department at my hospital, we try to provide continuity of care for those who are frequent patients. In some instances, the chaplains, nurses, physical therapists, or personal care assistants are the ones with enough contact with patients to know when there has been an unusual change. But it also goes for any continuing medical relationship; sometimes, only a doctor that has seen you over a period of time knows what sort of questions to ask to get to the bottom of your current problem.

Getting into confessional mode, I have been having a helluva time with health insurance lately. I am working part-time to the degree that my basic needs (rent, food, phone and electric) are met, and applied for individual coverage. My application was denied because of pre-existing conditions, the treatment of each of which actually reduces the cost that I might add to health systems down the road if they were untreated. That is, it's cheaper to pay for insulin now than amputation later. And so on. So I applied for continuing coverage from the university through which I got care as a student, and that application has been held up.

The thing is, I am able to do amazing work part-time and still have the opportunities to engage in community building, caring for family members (which has, as always, uncounted economic value), volunteer, etc. I live more simply than most folks do, and I am happy with the way the economics of my life work.

Except for the fact that I have several chronic illnesses, which necessitate my having health insurance, which is contingent on having employment that will provide it.

So, in theory, I need to work more hours, hours that another worker might need the earnings from, in order to get what I do need: access to doctors and medicines.

It seems ridiculous.

And this doesn't even start to count the ridiculousness of refusing to provide government-sponsored insurance for those who cannot afford (or find enough flexibility in) full-time work on account of family obligations but earn too much to qualify for Medicaid. It seems that, rather than living out the value of supporting real families, the Bush Administration is committed to valuing only families that are high earners.

This veto of the SCHIP bill today is another sign that President Bush does not support families. He doesn't support the families of soldiers and veterans, he does not support the children of working people, he does not support non-traditional families, and he does not support the families of individuals with chronic health problems.