Schwitzer health news blog

The U.S. muddle over a child's right to health care

Princeton health care economist Uwe Reinhardt writes, in this week's BMJ:, about the "The US muddle over a child's right to health care." Excerpts:

"Up to eight million children of poor American families are without health insurance—so why is there a dispute over children's right to health care?

After the demise of President Bill Clinton's health reform plan in 1994, I posed for readers of JAMA (the Journal of the American Medical Association) this question: "As a matter of national policy, and to the extent that a nation's health system can make it possible, should the child of a poor American family have the same chance of avoiding preventable illness or of being cured from a given disease as does the child of a rich American family?"

That question has long been answered in the affirmative in most other industrialised nations. In the United States it evokes irritation. ...

These issues come to mind on the day President George W Bush has vetoed a bill that would extend health insurance coverage under the State Children's Health Insurance Program (SCHIP). ...

The battle over SCHIP is a classic US health policy debate in which seemingly technical jargon such as "crowding out" private insurance, arguments over the relative "efficiency" of private versus government medicine, and endless body counts on the number of children actually without health insurance camouflages much deeper and chronic ideological divisions.

When I wrote my commentary for JAMA a decade ago I was not at all seeking to use children as a tool of socialist propaganda. Rather, I sincerely—and naively, it turns out—believed that Americans could at least settle on the distributive ethic that should govern health care for the US children who are effectively disenfranchised. Alas, Americans cannot agree on the role of children in their society, from conception through to adulthood, let alone on their children's right to health care. Thus the kids must muddle through as usual—through the ideological muddle of the nation's adults.