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Squaring the Circle on Children and Health Care

by MATT VIDAL

Talk about ideology. Earlier this month president Bush, who initiated an education program entitled No Child Left Behind, vetoed a bill that would expand the SCHIP program to provide health insurance to an additional 3.8 million uninsured kids. Where is a critic to begin?

Whatever rhetoric the Bush regime uses will not change the fact that millions of children will remain without health insurance. This is tragic in its own right, and in the richest country in the history of the world it should provoke widespread outrage. It is even more contemptible in the context of Bush’s apparent concern with the life chances of children, which follows from the “equality of opportunity” credo and is encapsulated in his No Child Left Behind education initiative.

In the conservative world view to which Bush appeals, where individual outcomes in the labor market are an exclusive result of human capital and motivation–rather than, say, class structure and unequal access to important resources–the only government intervention necessary to guarantee equal opportunity is to ensure relatively equal educational opportunities. The main thing is to invest in children’s education. And here, even conservatives agree, there is some role for public education (school voucher advocacy not withstanding).

But the highly oversimplified conservative world view ignores the possibility that unequal access in many areas, including health care, may undercut efforts focused solely on education. Indeed, as sociologist Gøsta Esping-Andersen, an expert on social policy and the welfare state, has noted, a large body of comparative research on socio-economic mobility indicates that reforming and improving education systems has a relatively minor effect on improving equality of opportunity (as measured by mobility).

For example, cross-national studies from the OECD Program for International Student Assessment indicate that social origins and family conditions have a much stronger effect on socio-economic mobility than education systems. As Esping-Andersen explains in the Summer 2007 issue of the popular sociology magazine Contexts, “the seeds of inequality are sown prior to school age on a host of crucial attributes such as health, cognitive and noncognitive abilities, motivation to learn, and, more generally, school preparedness.”

The issue of children’s health is intimately interconnected with the issues of education and equality of opportunity. Children who fall behind early in health have already begun on unequal footing. But scrutiny of the Bush veto hardly stops here. I would like to briefly shine two different lights on the proposed SCHIP expansion, one concrete and another more abstract.

First, then, what are the relative costs? Expanding SCHIP to cover the additional 3.8 million children was expected to cost $35 billion over five years. This is a large number, but it needs to be put into perspective. It is just 6% of the total amount spent on the so-called war on terror since 9/11 ($610 billion). Comparing the projected annual cost of the SCHIP expansion ($7 billion) with public spending in 2006, it is just 0.3% of the total Federal budget ($2,568 billion); 2% of the defense budget ($419.3 billion); 13% of the education budget ($56 billion); and 56% of the budget for the failed war on drugs ($12.5 billion). According to the Congressional Pig Book, 9,963 projects were identified in 2006 appropriations as earmarks, or pork-barrel spending of local or special interest. These projects cost $29 billion in 2006, over four times the yearly cost of expanding SCHIP.

Second, what about the bogeyman of socialized health care? Ideology is a powerful thing: conceptual frames have a powerful effect on how people think about the world. The Bush regime, like the conservative movement more generally, has masterfully used Orwellian language to frame policy debates. Think of the Healthy Forests program that expanded logging in protected wilderness areas, or the Clear Skies program allowing increased industrial air pollution.

Behind the Orwellian doublespeak remains a rigid ideology that is a tool of class warfare. Only by viewing the situation in these terms can we understand how the No Child Left Behind president vetoed SCHIP. If the program were extended to give an additional four million children health coverage, it would not be a railroad switch sending our economy off to socialism. Now, I would argue that getting on such a track would be the best thing for the health of the American society and the world. But in any case, modern economies are complex combinations of private enterprise, institutional regulation, and government intervention. Old tropes about “free market versus socialism” (read: Soviet Union or China) only retain currency for their ideological value.

All modern capitalist economies are highly regulated in a number of ways, but in ways that benefit powerful capitalist classes yet are ideologically coded as “private sector,” “free market,” and so on. Consider the American health care system. We spend twice as much, per capita, as the single-payer, government-run programs in other capitalist democracies. Yet the American system is hobbled with layer upon layer of bureaucracy and riddled with inefficiencies. It requires a very effective dominant ideology to instill in the population a preference for a highly inefficient American-style system over a government-run program, which we know from the experience of most other capitalist democracies is less expensive with better health outcomes.

Politicians in twenty-first century America should be working to make sure all of its residents have health coverage, not continually obstructing any progress by using the ideological scare tactic of the socialist bogeyman. We should begin with the nearly four million children who are currently without coverage, but we should not stop until we have a more efficient and effective health care system, whether this is administered by the public or private sector.

MATT VIDAL is a Postdoctoral Fellow at the UCLA Institute for Research on Labor and Employment. He can be reached at mvidal@irle.ucla.edu.

 

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Matt Vidal is Senior Lecturer in Work and Organizations at King’s College London, Department of Management. He is editor-in-chief of Work in Progress, a public sociology blog of American Sociological Association, where this article first ran. You can follow Matt on Twitter @ChukkerV.

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