Prospect of Child Healthcare Program in Limbo

William Galston served as health policy advisor under the Clinton administration. Galston talks about efforts to promise health insurance for children and the push for universal healthcare.

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MICHEL MARTIN, host:

And we just talked with Julie Rovner, NPR's health policy correspondent, about the State Children's Health Insurance Program, Congress' efforts to renew it by September 30th.

And we're now going to be joined by Dr. William Galston, senior fellow of governance studies at the Brookings Institution, to talk more about the effort to get more kids health insurance, and more broadly about the push for health care for everybody.

Dr. Galston, thanks so much for speaking with us.

Dr. WILLIAM GALSTON (Senior Fellow, Governance Studies Program, Brookings Institution): Good to be here, Michel.

MARTIN: And you were among the key people working on health care reform during the Clinton administration, you know, a famous, you know, political brawl. Do you see similarities between the fights that you had then and the current fight over the S-CHIP bill, or are they different fights?

Dr. GALSTON: Well, the similarity is the incredible complexity of the issue. The difference is that there is even more public pressure to deal with health insurance and health care on a broad-base basis than there was 15 years ago.

MARTIN: Really?

Dr. GALSTON: Yeah.

MARTIN: Why so?

Dr. GALSTON: Well, for all sorts of reasons. Health care costs are soaring. A lot of employers are either increasing premiums and co-pays and deductibles for their employees or backing out of employer-based health insurance altogether. People are getting increasingly worried that even if they don't lose their jobs, they are gradually losing health insurance coverage. So it's turning into a very high-profile political and public issue for the 2008 presidential campaign. And certainly, in 2009, there's going to be intense pressure to act.

MARTIN: You heard on Julie's report about the sort of - the discussion just over this children's health insurance bill. And you see - you hear two strains emerging. You hear one strain that says let's just fix these discreet, individual problems. Many of the people who are supporting this S-CHIP program are saying let's just fix this particular problem and cover kids who fall between this sort of middle - in this sort of middle-class gap.

And then you have the president saying, and other people saying, no, we've got to go broader. We've got to sort of make a more comprehensive kind of approach to this whole problem. Do you think that - is that - do you think that that's just political posturing, or does that really represent kind of a philosophical split that we just haven't resolved as a country of how we want to handle this?

Dr. GALSTON: I think this is the wrong time and the wrong venue to have the broad-base debate. That issue really hasn't been teed up. Right now, you have - as Julie was discussing - three different controversies in a snarl. You have the narrow controversy about this Children's Health Insurance Program. You have a broader controversy about the future of Medicare. And on top of that, you have the broadest controversy about the future of health care and health insurance in this country. It will be hard enough to resolve the narrowest issue without bringing the others in at the same time. And I don't think that bringing more issues in is going to increase the chances of final passage of anything in the near future.

MARTIN: What about this - the idea of using the tobacco tax as a means of funding this particular program? Do you think that that's the way forward, to identify particular fundings versus for particular problems?

Dr. GALSTON: I don't know whether in every case identifying a particular funding source for a particular problem is the way to go. I think, in this particular case, it probably is, because nobody can think of anything else that will get as much support as an increased tobacco tax would.

MARTIN: What do you - what lessons did you - do you draw that you can share from your fights, you know, these many years ago to achieve health care reform in the Clinton administration that you would offer to policymakers tackling this buzz saw now?

Dr. GALSTON: I think it's very simple. The problem is so complicated that it cannot be done on the basis of one branch of government or one political party. There will have to be a conversation that brings the executive and the Congress together and many Republicans and many Democrats together. There's no approach that everybody will accept. But there are approaches that can get not only a narrow majority, but perhaps a super majority.

You've seen in states across the country, coast to coast - Massachusetts and California being the most conspicuous examples - political parties coming together, governors and legislatures coming together. That is a political marvel for how we're going to have to deal with this. And I hope it's a model that the new administration will embrace in 2009. I don't expect any serious action before that.

MARTIN: What do you make of that Massachusetts' plan? This is something that we've talked about on this program, where Massachusetts is requiring individuals to get health insurance. And they're going to try to create sort of pools for people who can't afford it under, sort of, current market rates to subsidize it, essentially making it individual mandate. What do you think of that approach?

Dr. GALSTON: I think it's a very promising approach. If you ask me whether I personally approve of it, I certainly do. And Massachusetts is a kind of controlled experiment to see whether that approach can be made to work. And if it can, then I think it's one of the most attractive models for the country as a whole.

MARTIN: Finally, sir, do you think you will see universal health care coverage in some form in the U.S. in your lifetime?

Dr. GALSTON: Yeah.

MARTIN: And what will it take? Really?

Dr. GALSTON: Absolutely.

MARTIN: What will it take?

Dr. GALSTON: I think it's inevitable, and I'll tell you why. This old model that relies on employers that we've inherited from World War II is now cracking under the strain of global competition. More and more businesses are coming to the conclusion that we need a new approach that involves the public sector. That's a huge shift from 15 years ago.

MARTIN: Businesses. Are there any models overseas that you find promising for the U.S.? Or you think this is going to be a custom-made, homegrown solution?

Dr. GALSTON: I think there's going to have to be an American solution to an American problem. We're not painting on a blank canvas here.

MARTIN: All right. Thank you so much.

Dr. GALSTON: My pleasure.

MARTIN: Dr. William Galston is a senior fellow of governance studies at the Brookings Institution. He joined us by phone from Brewster, Massachusetts. Dr. Galston, thanks again so much for speaking with us.

Dr. GALSTON: My pleasure.

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