You've heard the analogy. A national mandate requiring everyone to have health insurance is just like the requirement that drivers buy auto insurance. Mitt Romney, for one, cited the analogy in touting his health care plan as governor of Massachusetts several years ago.
An aide to Senator Hillary Clinton did as well in describing her new health insurance initiative. So did CNN commentator Bill Schneider. He said the mandate proposed by John Edwards is "just like automobile insurance. You have to buy auto insurance. You have to buy health insurance."
The analogy is bogus, and we'll deconstruct it in a moment. But first let's identify the reason the analogy is trotted out so often. It makes compulsory health insurance sound as if the need for it is inarguable and unproblematic and no more controversial than insuring your car. The strategy behind this is hardly a secret. Advocates of a mandate are soft-pedaling what, in truth, is another lurch toward government-run health care. And they are packaging it in a way that might sound appealing to otherwise hard-headed Republicans.
Likewise, with the program known as S-chip, which Congress voted to expand last week in the face of a certain veto by President Bush. S-chip was created in 1997 with a single, stated purpose in mind: to offer federally subsidized health insurance to children ineligible for Medicaid but unable to afford private insurance. Poor children, in other words. That was S-chip's sole rationale.
Now, with the new legislation, the S-chip subsidy would cover millions of middle-class kids. S-chip proponents scoot past this aspect of the program in a heartbeat and point to the uninsured children who will be insured. Only an ogre would raise an objection.
Of course, extending a poverty program into the middle class isn't new. Nearly 30 years ago, a young congressman from Michigan named David Stockman dubbed this phenomenon the "social pork barrel" in an article he wrote for The Public Interest. By including some of the middle class, a program ostensibly to aid the poor could attract Republican support on Capitol Hill. And S-chip has.
The new S-chip legislation is a particularly egregious example of this. Rather than keep S-chip's cap at 200 percent of poverty ($41,300 for a family of four), the bill would raise it to 300 percent ($61,950) nationally and even higher in New Jersey ($72,285) and New York ($82,300). Sure enough, 18 Republican senators and 45 GOP members of the House voted for it.
The worst part of S-chip isn't its cost but the massive crowding-out effect it produces. Millions of kids with private health insurance would drop that coverage and sign up for S-chip instead, because it's "free." S-chip is an offer few could refuse. The Congressional Budget Office says two million children would make the switch, and that is among the more conservative estimates.
Proponents justify the crowding-out as unavoidable in an otherwise good cause. They treat as mean-spirited Bush's insistence that 95 percent of legitimately poor children--below 200 percent of poverty--be brought into S‑chip before it's expanded. Senator Dick Durbin adopted the usual smarmy tone in urging Bush to sign the bill. He must do it "for the sake of the kids," Durbin said.