Our Questionable Commitment On Kids' Health Insurance

The House has passed a bill expanding S-CHIP, the combined state-federal program for children's health insurance. It passed Congress in 2007 but was vetoed by President Bush. With expanded Democratic majorities and a Democratic president, it seems likely to become law this time around. And who can be against making sure that kids have adequate health care, right?

Me. Or at least this version of ensuring it.

The problem is the payment mechanism. The bill pays for the expansion by raising the federal cigarette tax by 61 cents per pack. I have two objections to this funding method.

First, it's either unsustainable or it taxes addicts. The idea of a "sin tax" is to reduce the consumption or the activity being taxed. If the goal of raising the cigarette tax is to reduce smoking while at the same time expanding children's health insurance coverage, then its implementation will indeed reduce cigarette sales and eventually deprive the program of the money it relies on. A sin tax is simply not a sustainable source of revenue for any program if the sin tax accomplishes its objective. Or, if raising the price of smoking doesn't decrease the incidence of smoking, then perhaps all we are doing is shifting the cost of the program expansion to those who are addicted to nicotine and who have no choice but to pay whatever taxes are required to satisfy their habit. That hardly seems like a just way to fund a kids program.

But my more fundamental objection is that taxing smokers absolves the rest of us from taking responsibility for this program that most people say they want. Most people say they support health insurance for kids; but how strong is that support if the best we can say is "yes, insure kids--but only if smokers pay for it." I think if I support a program, then I should be willing to help pay for it myself, not sluff off the responsibility on others.

This legislation is one example of what's wrong with our relationship to our government today--or, conversely, our government's relation to us. It's easy to be for something that requires nothing of us. It was easy to be for the Iraq war if we were asked neither to server nor to pay for it. It was easy to be for tax cuts if we didn't have to give up any programs that would help make those cuts fiscally responsible. And it's easy to favor expanding health care as long as someone else picks up the tab.


But that approach is not sustainable, and it's not realistic. Government isn't an abstract entity that just takes our money, or just doles out programs. It's the way we work together to achieve certain goals that we think are of national importance. It's the way we pay together for programs we say we want. And we do pay together, for the most part; I don't want to minimize the taxes that many people pay or the burden they impose on some households.

But by placing the burden of paying for popular programs on a particularly small part of the population, we avoid having a real discussion about what we are and are not willing to pay for ourselves. I think we should have that discussion because I think it's the only way to achieve long term fiscal responsibility. I think that if we really care about health insurance for kids, we should be asked to help contribute to the cause. And if a majority of us say that we're not willing to pay, then maybe some of us don't really care about insuring kids as much as we say we do. Real support is manifested by a willingness to act; talking about some wonderful goal won't make it happen.

If most people say they don't want to pay for kids' health insurance, it may not be the outcome I prefer. But at least that's responsible democracy. To impose programs or reduce taxes as if they're all free may be democracy too, but it's not a responsible one, and it's not an approach we can keep up for long without suffering the fiscal consequences. Let's have an honest discussion with ourselves on this and other issues, and let the chips fall where they may.