In the ongoing debate over expansion of the federal children’s health insurance program — a debate over whether an extra $5 billion or $35 billion is enough to meet the health needs of America’s poor or near-poor kids — the Democrats have a decided advantage: They own the anecdote.
In their press conferences, they can trot out young children of struggling families who, by virtue of a rule set by politicians before they were born, do not qualify for publicly paid health insurance.
On stage, it’s a simple formula: If the Democrats get their bill, this kid gets insurance. If they don’t, the kid, usually with some chronic sickness, doesn’t get health care. And when the kid is standing right there, it’s a pretty devastating message.
You’re probably wondering: On the basis of this one kid, should we spend an extra $30 billion? But in American politics, the answer is almost always yes — even if the results are less than impressive. I know, because I’ve seen it up close.
In late 2003, I was a speechwriter for President Bush and was tasked with coming up with some kind of way to sell his proposal for a drug benefit add-on to Medicare. I would’ve liked to have had the president talk about the importance of overall reform in Medicare, using the introduction of the drug benefit to bring real money-saving changes to a system well on its way to bankruptcy.
But it wouldn’t have worked — nobody likes to hear such a downer.
So instead, we decided to tout the sugar, and virtually ignore the spinach. In town after town, we would find a handful of seniors who lacked drug coverage and who stood to benefit from the president’s proposal, and inserted them into the president’s speeches and public events.
So while the Democrats sputtered about the inadequacy of the coverage, we kept rolling out seniors who were paying punishing monthly bills for drugs. We owned the anecdote; the Democrats owned the “yes, but.” We didn’t get the money-saving reforms we hoped for, but we got a major legislative victory — or at last it seemed so at the time.
And so it will be with the debate over the State Children’s Health Insurance Program, the children’s health care plan known as S-CHIP. The Democrats have owned the issue because, quite simply, they promise to cover kids who would otherwise not get coverage at all.
The president would increase the program by 20%; the Democrats would raise it by $35 billion, or 140%, from current levels (and quite likely more, once you strip away budgetary gimmicks). The president’s proposal would cover all children living in households with incomes twice the poverty level, which stands at about $20,000; the Democrats would cover all children living in households with incomes three times the poverty level (and even higher in New York and New Jersey, where a family earning $83,000 a year could be eligible).
Do these differences matter, beyond creating a whole group of anecdotal children who are poster kids for a Democratic victory? Absolutely.
The extra money would have huge impacts on private health insurance markets, incentives for businesses to accelerate the trend of dropping private health coverage, future budget deficits, and so on. Those are all serious issues, and it would be good to heed them.
But for now, the only thing that matters is the anecdote. So the Democrats will very likely win this round.
But the Democrats should be forewarned: Their victory may be short-lived. When you win policy battles by anecdote, you can lose them by anecdote, too. Once the Medicare drug benefit went into effect, the anecdote of the cash-strapped senior desperate for help with drug costs turned into the anecdote of the confused senior upset with the premiums for that drug coverage.
Ultimately, policy does matter, and eventually, the voters do notice. In the case of children’s health insurance, if 3 million families choose federal-paid coverage over business-paid, voters will notice. If the deficit is even bigger and taxes even higher, they’ll notice.
If childless adults get coverage under this “children’s health” program, people will notice. And if the rate of uninsurance among children, especially the poorest kids, remains stubbornly high, people will wonder what all that money was spent on.
And in will roll the anecdotes — of the free-loaders, the bureaucratic snafus, the children still denied coverage, and the childless adults getting free coverage.
The anecdotes will be there, and there will be a Republican ready to exploit them. It may not happen next year, but it will happen — because when you live by the anecdote, you die by it as well.
Noam Neusner was President Bush’s principal economic and domestic policy speechwriter from 2002 to 2004.