Faulty Rx for children’s health care

OPINION:

Where can adults who make $70,000 a year pretend to be kids and get the taxpayers to pay their health care bills? If you live in New Jersey, you know the answer.

In fact, with the right mix of circumstances, a family making more than $100,000 is eligible for New Jersey’s State Children’s Health Insurance Program. Why? Because “it costs far more to be poor in New Jersey than in almost all other states,” one state official helpfully told my committee.

“Children’s health insurance” sounds like something for children, and it used to be. Now? Not so much. A third of those enrolled in New Jersey’s SCHIP are all grown up. Before anybody thinks I’m picking on New Jersey, let me add that it’s hardly alone. Minnesota, where 85 percent of the “children” on SCHIP are adults, is another. Nationwide, more than half a million adults are enrolled in these children’s health programs.

SCHIP is the state-federal partnership to help children of the working poor. It began when taxpayers saw children in need and wanted to help. The problems followed when activists saw taxpayers’ money and wanted to spend. Now there’s a campaign on to make SCHIP bigger than ever, but that means sanctioning the pretense that adults are kids, not to mention the notion that welfare is for people making dream salaries, and much of it in states that are accumulating billions of unspent dollars.

The excesses demonstrate what goes wrong when governments overreach. Now, interests as diverse as U.S. Sen. Hillary Clinton, New York Democrat, the U.S. Chamber of Commerce, the American Medical Association and the AFL-CIO want to use SCHIP to make America look more like New Jersey. We shouldn’t let this doubletalk get between us and common sense, however. Families who earn a little too much to qualify for Medicaid really do need help sometimes, and SCHIP exists to get them over the bumps.

Nobody doubts that American health care has its problems. Quality is hardly perfect or uniform and availability can be iffy. The Clintons tried to construct a world-class bureaucracy to solve the problem, and it collapsed under the weight of nonsensical complexity. Now some advise just folding everyone into Medicaid, the welfare program for the poor, or recasting the Veterans Administration as a national health system where everyone goes to government doctors in government hospitals. It has also been suggested that we throw open retirees’ Medicare coverage to all comers.

These things are not impossible, but their costs are staggering and each seems fatally flawed. That’s why the effort to socialize American medicine now begins small, with children, because that hardly seems so sinister.

I’m not convinced. When people in other countries say our health care is the best in the world, they’re not talking about government doctors and welfare medicine. They’re talking about America’s capacity to innovate and our determination to advance patient-centered care. In other countries, the gross weight of multiple government interventions has delivered more government and less health. When people need a doctor, plenty have to see a bureaucrat first, and some can die while they wait in line for common treatments.

The right way to fix health care isn’t to make everyone equally miserable. It’s to cut the cost and raise the quality. This happens when government focuses on delivering a robust economy in which insurers compete and working people can choose affordable coverage that fits their kids and their paychecks.

There are practical ways to do the job. Let’s start by allowing small employers to consolidate their purchasing power so they can offer health insurance without losing their shirts. Make health costs transparent and empower consumers to shop. And if we can reduce the threat of predatory lawyers with gotcha malpractice suits, health care inflation can cool.

But the Democratic leadership isn’t likely to be doing any of those things. Instead, they’re focused on making SCHIP grander and more pervasive. A Republican majority created SCHIP in 1998 and we want it reauthorized, but we want to make sure the “C” stands for children again. States need to provide coverage to kids and pregnant women between the federal poverty level and the 200 percent-of-poverty mark, and quit spending children’s money on adults.

Finally, when that New Jersey official came to Congress to plead for more federal money, nobody mentioned his state was amassing a $1.9 billion budget surplus. According to the published reports, 42 states now have surpluses. My state of Texas — where they’re not asking for federal help — is No. 1 and his is No. 3, and there are eight more with $1 billion surpluses.

Reauthorizing the SCHIP state-federal partnership this fall is a good idea. Inviting more and richer adults into a children’s welfare program is not.

Meanwhile, officials with sad stories about how they’ve overspent their budgets while piling up surpluses are not prohibited from dipping into the cash on hand. And if they don’t want to spend their own money on their own “children,” well, that should be instructive, too.

As for me, I plan to do the right thing in the SCHIP reauthorization for both the children — the real ones — and for the taxpayers, too.

Joe Barton, Texas Republican, is ranking member of the U.S. House of Representatives’ Energy and Commerce Committee.