Last Thursday was 96 days before DD-Day, the day the Demographic Deluge begins. That is Jan. 1, when the first of 78 million baby boomers reach 62, the age at which a majority of Social Security recipients begin to receive that entitlement. Social Security is unsustainable as currently configured, but is a picture of health compared with another middle-class entitlement, Medicare.
On Thursday, the Senate, following the House, voted to create another open-ended middle-class entitlement. Congress is not inhibited by the Law of Holes, which is: When you are in a hole, quit digging.
Although it is the elderly who are devouring the federal budget—and through it, a huge share of the economy's future production—the State Children's Health Insurance Program is (mostly) about children, at least ostensibly. But it also is about a deep divide between the parties.
The struggle over SCHIP is an unusual Washington dust-up—one that actually is as portentous as Washingtonians, with their flair for (self)dramatization, say it is. It is a proxy fight over the future of the welfare state, meaning the trajectory of government and the burdens it will place on the economy, which, by its dynamism, must generate the revenues to pay the bills.
SCHIP was created in 1997 by a Republican-controlled Congress. Today's Democratic-controlled Congress wants to transform its mission. It began as a program whereby the federal government would subsidize state governments in providing health insurance for children from households not poor enough (generally 200 percent above the poverty line) to qualify for Medicaid but not affluent enough to afford to buy insurance. Were it to become law, the new SCHIP would be a long stride toward unlimited federal funds working as incentives for states to expand eligibility to more and more affluent families.
It would immediately include some with incomes 400 percent of the poverty line ($83,000 for a family of four). Over time, its "mission creep" would continue. Mike Leavitt, secretary of Health and Human Services, says that the new SCHIP would enroll 2.8 million more children, but 1.1 million of them would be from families for whom SCHIP had become an incentive to drop their private insurance. To that, some liberals say, sotto voce: Good.
Why? In the perennial tension between the competing values of freedom and equality, conservatives favor freedom, which inevitably increases unequal social outcomes. Liberals' mission is the promotion of equality, understood as equal dependence of more and more people for more and more things on government.
Liberals increasingly define the public good in terms of the multiplication of entitlements. Conservatives increasingly understand their mission as the promotion of attitudes and aptitudes they think are weakened by that multiplication.
The president proposed a $5 billion increase for SCHIP over five years. In a familiar Washington folk dance, the Senate voted a $35 billion increase, and the House endorsed a $50 billion increase but receded to the Senate sum, which was therefore declared moderate. The increase supposedly would be funded by a 61-cent increase in the cigarette tax.
So, this health legislation depends on a constantly large and renewable supply of smokers—22 million new ones. This "progressive" measure requires a regressive tax (smokers are predominantly and increasingly lower class) levied to expand subsidized health insurance ever upward into the middle class.
The president proposes a plan to give everyone personal ownership of fully portable (not tied to employment) health insurance policies—tax deductions of $7,500 for individuals and $15,000 for families purchasing policies. Liberals complain that this would be an incentive for employers to stop providing coverage. To which conservatives respond: Good.
They say: If we can disentangle health care from the wage system, General Motors can go back to being a car and truck company rather than a health-care provider unsuccessfully struggling to sell cars and trucks fast enough to pay employees' and retirees' medical expenses. Some liberals want to preserve the entanglement until business clamors for government to nationalize the one seventh of the economy that is health care.
For philosophic reasons, Democrats wish the bill would become law. For political reasons, they welcome the president's promised veto, which will preserve for them the issue of Republican beastliness toward "the children."
It has become a verbal tic for politicians to say that everything they do is "about the children." This rhetoric of pathos reflects the de-intellectualization of public life—the substitution of sentimentalism for reasoned persuasion. Bill Clinton carried this to comic lengths when, in his first State of the Union address, he noted that "not a single Russian missile is pointed at the children of America."
Those children-seeking missiles were diabolical. The new SCHIP, which would expand the dependency of middle-class children on government, is not diabolical, but neither is it just "about the children."