Health Care. Again… Insure the kids first!

What does it take to see the obvious?

First, in today’s weirdly reshaped political process we should not be wringing our hands over details in the Senate’s version of Health Care legislation.  The current bill is warped by the need for perfect unanimity among members of the Democratic Party coalition.  The Republicans’ strangely awe-worthy trait of utter party discipline, threatening filibusters instead of negotiating and deliberating as individuals, has put the independent senator from Hartford (capital of the insurance industry) in a powerful position to make certain that his industry gets what it wants.

In the current Senate version, that is.

But remember, all the Democrats need is to get some kind of bill out of the Senate.  It will then go into a reconciliation process with the version passed by the House.  The final bill that results from that blending will then be offered up for a straight vote in both chambers with no filibuster allowed. This means that:

1- liberals who are crying now about President Obama’s “cave-in” concessions to Joe Lieberman ought to learn something about the process. And about patience.

2- Since the final bill will only need 50 Senate votes to pass, Senators Lieberman, Lincoln, Landrieu, Nelson, Baucus and several other Democrats from more conservative states, will be able to posture and vote against it, for the sake of those at home, and still see it pass.

3- If the final version looks a lot more like the House Bill, and thus more liberal than anything the Senate might have passed, that will only be the Republicans’ fault.  They could have negotiated and participated in a real process of deliberation, and hence had a real voice on the reconciliation committee.  (Democratic majorities have traditionally given the GOP Congressional leadership substantial voice in the reconciliation process — that is, until the Republicans chose all-or-nothing political war. Total political war has its consequences)

But I want to focus, briefly, on another matter— one that I’ve raised many times before… that the Democrats have waged this struggle with the wrong emphasis, all along, in ways that are tone-deaf to both justice and the inclinations of the voters.

On several occasions I’ve pointed out the obvious, that Americans are inherently more “socialistic” toward children than toward adults.

When it comes to grownups, we retain, from Wild West Frontierland days, an attitude that people ought to stand on their own two feet.  Hence, our public still expresses relative puritanism over issues like welfare and insurance etc, compared to other industrial nations. (For all the FoxNews screeching about “Socialist Obama,” the most radical version of health care reform that he ever proposed — including the “public option”– was positively right-wing by European standards.)

But that puritan-cowboy-individualist reflex tends only to apply when the topic is adults.  The point I have been pushing is that we feel differently toward kids.

Just Go Ahead and Take Care of All Kids First!

It goes all the way back to Adam Smith, the so-called “father of capitalism” who nevertheless pushed for free public education.  The logic is simple.  Free enterprise works best from a level playing field, so that a maximum number of  individuals can participate inthe competitive  process, delivering ever-iproving goods and services  (Um, duh?  This is why any trend toward monopoly or oligarchy is the enemy of enterprise, whether that oligarchy is governmental or “private.”)

Now, one can level the field by bringing the aristocracy down a notch. (Smith actually favored this, to a cautious and limited degree, at least by eliminating the secretive, collusive power of oligarchs to warp markets.) But a better way is to lift the bottom up. Again, carefully.  In the right ways.

If helping the poor has real capitalist-pragmatist justifications, certain types of help benefit long-range competition better than others. Conservatives are right to be suspicious toward lefty endeavors to “equalize outcomes.”

On the other hand, certainly, the most justifiable kind of aid to the poor is also the most moral — lifting up children. Even rough-n-ready Americans know that.  And even George W. Bush felt compelled to push the State Children’s Health Insurance Program (SCHIP), which – inefficiently and haphazardly – helped states with matching funds, to reduce the number of uninsured children.

My point is that Obama and the Democrats have been foolish to ignore this inherent double standard — a willingness on the part of Americans to apply socialist methods to help kids.  Instead of trying to expand Medicare downward to include people between the ages of 55 and 65, they should have gone to the other end and presented a provision to simply cover all American children.

I’ve been proposing this for a long time. First, it would – in a shot – take care of the most vulnerable citizens and those whose long range futures merit the greatest investment… offering the most profound return, on a simple cash-actuarial basis!

Second, a lot of the health care needs of kids offer great bang for the buck.  These include effective preventive care, or the rapid attending to brief-acute problems… exactly the areas where even Republicans admit that Canadian-style single payer systems work best.

Third, even if that left a lot of parents uncovered, at least those parents would get their worst fears lifted off their shoulders.  They could then negotiate their own policies with private insurers from a position of strength.  In fact, the insurance industry would know it had to play nice, or else “children” could be re-defined upward, from ages 21 to, say, 25… and so on.

Finally, this approach is politically powerful.  Because many who rage at “socialism” for lazy adults would not dare object to making sure that children get seen by a doctor and have their basic needs met. Putting opponents ina position of refusing care for babies… now that’s political hardball.

Frankly, it worries me that this blatantly obvious option seems not to have occurred to Obama or the Democrats.  It reveals a tone-deaf lack of political savvy, as well as any clear-eyed notion of how to get the most accomplished, in a long and grinding process of incrementalism.


David Brin’s best-selling novels are in 20+ languages. The Postman was filmed in 1997. Brin’s non-fiction book — The Transparent Society —  won the 2000 Freedom of Speech Award of the American Library Association.  Discussion can follow him to   or