Copyright c 1994 by Nicholas Johnson
The Cedar Rapids (Iowa) Gazette, August 22, 1994, p. 4A

Serve kids first, then get back to greed
by Nicholas Johnson

"Women and children first!"

When I was a boy, we considered that the appropriate cry on a sinking ship or
burning building.  When it comes to health care, it may still be good policy --
and politics.

It is not true that the health care debate is driven only by greed and politics. 
There are doctors who advocate the Canadian "single-payer" approach. 
President and Mrs. Clinton's proposals seem genuine efforts to serve the national
interest.  Many business executives support them.  The Kaiser Foundation paid
for TV commercials and literature explaining the issues.  Many others make
unselfish efforts to put forward the best possible proposals.

But the health care debate, so far, demonstrates far more self interest than public
interest.  Insurance and hospital executives fear loss of substantial salaries and
expense accounts.  Many doctors view anything less than $200,000 a year as
poverty wages.  Some government employees think any change threatens their
jobs.  Many a lobbyist, lawyer, public relations and advertising executive profits
handsomely from maintaining the status quo.  Corporations want to reduce
health insurance costs.  Employees fight reductions in benefits.  And those my
age and older -- who cause a disproportionate share of the $1 trillion cost -- are
reluctant to compromise.

In the midst of this mean-spirited grasping, who's watching the children?  To the
extent we are witnessing a political process, the answer is _nobody_.  Children
are notoriously miserly when it comes to making campaign contributions, and
none of them vote.  They have no trade associations.  Few hire lobbyists.  They
don't even write letters to the editor.  So what do they expect?

A few years ago I saw a teacher with the bumper sticker, "If you think
education is expensive, just wait until you start paying for ignorance."  It is also
true that children's health care is a lot cheaper than adults' disease treatment.

We're not saving money by neglecting our children's health.  Every dollar
invested in early childhood programs returns six dollars in savings (health,
education, welfare, crime, and other costs).  There are about 20 nations with
better infant mortality rates and 65 with better immunization programs than we
have.  Prenatal care costs about $400.  A very-low-birthweight baby's intensive
care can cost $150,000 -- or more.  That's expensive neglect.

Forget about humanistic, do-gooder liberalism.  Think greed and long-term
costs.  Satirist Jonathan Swift offered the "modest proposal" that poor children
simply be eaten.  While that would radically reduce our welfare bill (most of
which goes for kids), even Rush Limbaugh wants to separate himself from Swift
and Jeffrey Dahmer on that solution.

If we fail to provide health care for the elderly they soon die.  If we fail to
provide health care for our children, and are unwilling to eat them, we not only
have to pay those children's health care costs for their 70-year lifetime, we also
lose their productive contribution.  And a very high proportion of those
enormous lifetime costs could be saved if we would pay the relatively small cost
of giving them health care as children.

Can't we postpone the health care debate long enough to enact the legislation
necessary to see to it that all pregnant mothers and all children (until, say, age
6) get all the health care they need --  regardless of their ability to pay?  At 6,
kids can be sent back to the streets to fend for themselves.  But at least until
then we can give them a healthy head start.  First let's pass that law.  Then we
can get back to our delaying tactics, rhetoric of greed, bash-Clinton political
games and gridlock.

Surely this is an approach that politicians and ideologues of all stripes can
support.  Those who advocate the "right to life" of a fetus before birth surely
would support that child's right to a healthy life thereafter.  Even steely-eyed
bottomline bean counters should see the advantage.  What could make more
sense than mammoth long term cost savings?  I can see the conservatives'
slogans now:  "A healthy child becomes a taxpaying adult."  "Healthy kids
today, better soldiers tomorrow."

"Women and children first."  C'mon guys, it's enlightened greed.  Just do it.

_______________
Nicholas Johnson, a former co-director of the University of Iowa Institute for
Health, Behavior and Environmental Policy teaches at the UI College of Law.


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