The current controversy over the State Children's Health Insurance Program (SCHIP) provides us a good opportunity to clarify the nature of ideological conflict and the political gamesmanship that occurs prior to election season.
CHIP is designed to ensure that children whose families are too rich for welfare assistance, but too poor to afford private health insurance on their own can get it. It is a modest attempt to whittle down the large number of uninsured people in the United States, many of whom are children, by providing a subsidy for private insurance. The program is a block grant, which means that the states are given money by the federal government, which they can divide as they see fit.
But since it is funded by the federal government, and since it is set to expire at the end of September, it raises recently dormant questions about the proper relationship between the individual and the state, and does so within the context of a presidential election.
The typical conservative position begins with the idea that the individual should be free to enter into, or not enter into, any contract they choose. To impose a program on an individual is to minimize individual liberty. They would also hold that society should not be put in a position where they are forced to provide services for individuals, who they suspect may be able to provide them for themselves or their children, if they put their minds to it. This touches on the moral hazard argument that some used to argue against federal assistance for the hedge funds that invested too heavily in the sub-prime mortgage market. People should bear the responsibility for their choices. But even if assistance is justified, the conservative argues that the federal government is not the appropriate venue for providing it. Ideally the private sector should do so because they are more likely to do it efficiently. Governmental programs are famously leaky when it comes to transferring funds from one place to another. From a business perspective, this is attractive to conservatives also. Public spending can crowd out private opportunities.
The liberal would respond by stating that the lack of available health insurance is the fault of the free market, not the individual or government. There is no incentive for private insurers to protect the poor (no money in it), so government must provide it. It is part of the implicit social contract that binds citizens with the greater society and can allow individuals the space to develop their capabilities so they can then grow more self sufficient. To not do so would also invite social disruption which could undermine the stability necessary to maintain a healthy economy. They are less likely to buy into the idea that these programs can create dependency on the part of the beneficiaries, and also would point out that the program is in fact run by the states, though funded by the national government, so it is somewhat responsive to local interests. The true liberal however would have no problem with the federal government running the program because that would allow the program to not be affected by local prejudices which may seek to keep certain populations away from the health care that may allow them to rise in society.
The timing of the conflict is significant. It will expire at the end of the month unless reauthorized. Democrats see this as an opportunity to not only expand the program but do so in a way that commits presidential candidates for it or against it. The pundits predict that health care will be the dominant domestic political issue of 2008 and that CHIP is the first battle in the war over it's design.
President Bush sees this as a way to reestablish his conservative bonafides, and has threatened to veto any bill sent to him that does more than simply reauthorize the existing program as is. Democrats certainly hope that any Republican that votes with the president will position themselves in a difficult position, especially if the economy slips into recession.
Some find this cynical, but clarity on this issue gives voters the ability to impact policy since they can cast meaningful votes for or against candidates based on their positions.
Here are some useful links:
-Background from the Congressional Budget Office
-From the Texas Health and Human Services Commission
-Background from the Heritage Foundation
-Opposition from the Cato Institute
-LA Times predicts a Bush Veto
-Is there a religious obligation to provide health insurance?
