RALEIGH – First diagnose, then treat.
This is not exactly an earth-shattering insight into the basics of proper medical care, but it’s worth keeping in mind when analyzing political debates about, say, health care. Unless policymakers have a clear understanding of the scope and causes of the problem they mean to address, their responses can be not just ineffective but counterproductive.
All too often, such understanding is lacking. Simplistic analysis and shoddy reporting by the news media don’t help. Consider the now-infamous case of Graeme Frost. He is the 12-year-old boy who gave the Democratic response to George W. Bush’s Sept. 29 radio address explaining the president’s rationale for vetoing a costly expansion of the State Children Health Insurance Program (S-CHIP).
Injured in a car accident, the young Frost said in his radio segment that if it hadn’t been for S-CHIP coverage, he wouldn’t be here today. Most media organizations repeated the story without question. Only later, when fewer people were still following the story, bloggers and other media teased out the facts about the Frost family’s “modest” lifestyle, which includes a large and expensive home, kids in pricey private schools, and other inconvenient details. If the Frosts chose not to purchase the relatively inexpensive private insurance coverage already available for their children, it was certainly not for lack of discretionary income.
More generally, a major defect of the S-CHIP debate has been the often-repeated assumption that the program was designed for “low-income” children whose families “earned too much for Medicaid but not enough to afford private coverage.” For most affected families, this statement just isn’t true. Most families in the S-CHIP income range had health insurance before S-CHIP was enacted a decade ago. Estimates vary, but it’s reasonable to conclude that at least half of current S-CHIP enrollees would have health coverage anyway, but are enrolled in S-CHIP because it paid for by taxpayers. That means that the program is an extremely expensive means of covering the truly, chronically insured, and is helping to unravel the private market for health plans (an effect which, as I have previously observed, is often welcomed by its advocates, who really favor total government control of health care plans).
Expansive definitions of who is “poor” or “low-income” aren’t just present in the debate over health care. Many politicians and activists have a picture in their heads about poverty in America that is wildly out of sync with reality.
On this point, Robert Rector, longtime welfare-policy expert at the Heritage Foundation, has for years sought to correct the record. His latest enumeration of the available data on households considered to be below the poverty line is worth a close look:
• 43 percent of poor households own their own homes. The vast majority of poor households own automobiles, do not live in crowded residences, have air conditioning, and enjoy such amenities as cable TV and VCR or DVD players.
• The average poor American has more living space than the average individual living in Paris, London, Vienna, Athens, and other large European cities.
• The extent of chronic hunger is grossly exaggerated. Only two percent of poor households say they “often” do not have enough to eat, while 89 percent say they have enough to eat.
This is not, of course, to suggest that there aren’t destitute people in America who are homeless, hungry, uninsured and overlooked. But a panicky or political motivated exaggeration of the problem is hardly the right way to begin crafting sound public policy. As Rector notes, the major causes for chronic poverty today are family breakup, inadequate education, and the absence of a truly full-time worker in the home. These are conditions that can be alleviated over time by a combination of public-sector and private-sector action.
As for S-CHIP, we aren’t even talking about the poor. There are several crucial reforms that would help to moderate the cost of health coverage and the risk of its interruption due to job change or layoff. There’s no need to expand government control further – and certainly no need to try to bamboozle the public with misleading sob stories.
Hood is president of the John Locke Foundation.