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Globe Editorial

Bush's unhealthy notions

THE Democratic and Republican leaders of the Senate Finance Committee have given President Bush the chance to leave a positive legacy on healthcare. He should accept their compromise to reauthorize and expand the Children's Health Insurance Program -- and abandon the deeply misguided arguments he has been making against the proposal.

S-Chip, as the federal-state program is known, was originally approved by a Republican-controlled Congress in 1997. Legislators from both parties realized that the private market, on its own, would never provide affordable insurance for families that earn too much to qualify for Medicaid but are on the edge of poverty. S-Chip has worked well, providing coverage for about 6.6 million people at the latest count, but it hasn't covered every child who needs insurance.

With the program up for renewal this year, it was reasonable to expect Congress to expand it. The compromise unveiled by Finance Committee leaders last week won't go as far as many Democrats want, but it would probably cover an additional 3.3 million children. It would be financed by a 61-cent-per-pack increase in the cigarette tax, which by itself would enhance health by making smoking too expensive for many teenagers.

But Bush is fixated on the idea that the expansion will hurt the private insurance market. "This will have the effect of encouraging many to drop private coverage, to go on the government-subsidized program," Tony Fratto, a White House spokesman, said Saturday.

The Congressional Budget Office analyzed the plan and concluded that, while it's impossible to prevent all families from switching their children from unsubsidized plans to S-Chip , two-thirds of the new enrollees would be previously uninsured. And S-Chip insurance is usually administered by private plans. The new S-Chip money would supplement, not compete with, the private market.

Bush has made another curious argument: "People have access to healthcare in America," he said last week in Cleveland. "After all, you just go to an emergency room." But these treatment centers of last resort are expensive and unnecessary for routine care. It's far healthier -- and more cost-effective -- when patients get preventive care or early treatment at a doctor's office. That's the kind of care encouraged by S-Chip.

Few politicians would want to rely entirely on private sources, without government help, to pay for healthcare for all Americans. Bush himself proposed a substantial tax break for all families, rich, middle-income or poor, to make health insurance more affordable.

The Senate Finance leadership, however, has given Bush an opportunity to target federal health dollars to those in particular need: poor and near-poor children. Support for this plan would provide a warm coda to Bush's last 18 months as president.