How Did We Let This Happen to Our Children?

The late comedian Jack Benny made himself the butt of a running gag about how cheap he was.  A crook would come up to him and demand “your money or your life!”  After a long pause, Benny would deadpan to the increasingly impatient crook, “I’m thinking about it.”

It’s funny to think about someone who would hold onto his own money so tightly that he would put his own life at risk.  It’s not funny to think about people who would do the same and put their children’s lives at risk.

At the beginning of the 21^st century, we could feel good about the progress we were making to improve the health of our children.  While child poverty rates were doggedly high, other key indicators, including infant mortality rates, low birthweight rates, immunization rates, and violence rates, were all improving.  We had reason to believe that even the “compassionate, conservative” approach to policymaking would continue to get results.

It didn’t happen.  Some data from the Annie E. Casey Foundation’s KidsCount program tracking children from birth to adulthood show just how poorly we've been doing these last few years:

• After dropping from 38,351 in 1990 to 28,035 in 2000, the number of infant deaths increased to 29,138 in 2007;
• The number of low birthweight babies increased from 289,418 in 1990 to 354,333 in 2007, and the percentage increased from 7% to 8.2% of all births during the same time period;
• 75.7% of children age 2 are properly immunized, up from 72.5% in 2003 but down from 77.4% in 2005; 
• 52% of children age 6-17 do not engage in exercise at least five days a week, and 32% of 10-17 year olds are overweight;
• 14,140,000 children in 2007 had special health care needs, up from 9,360,356 in 2001;
• There were 10,198 teen deaths from accident, homicide, and suicide in 2007, age 15-19, a number that has remained steady over the decade.

When some political leaders hold up a mirror to these facts, they see them backwards.  They see decline and call it exceptionalism; they see investment in our children and call it waste.

In the early part of the past decade, we cut our taxes and got involved in two wars.  We paid less attention to the health of our children than we should have.  We put too little money into their well-being, and the trend line is still going in the wrong direction.  

Where children are concerned, American exceptionalism has become American “except-ionalism.”  We’re taking care of everyone “except” our children.

Governors have asked the federal government to let them cut children’s health programs this year, when they should be expanding them.  Twenty-six of them even went to court over the Medicaid expansion mandate, arguing that they were being “coerced” into providing needed services for families and children (see below).

There was a time when we invested in programs for our children because we understood that letting any children go hungry, be homeless, or become sick and not be able to get care was unacceptable in the greatest nation in the world.

We created mandatory immunization programs to protect them from deadly diseases.  I've still got the polio immunization card my mother was given by the public health department when I received my vaccine.  No one argued that we didn't have the resources to pay for this.

We didn't always need a crisis to take care of our children.  We built playgrounds and sports fields to give them plenty of opportunities to exercise.  We protected them from weapons and violence to keep them safe.  We invented Medicaid and Children’s Health Insurance Programs in part to make sure they had health care when they needed it. 

Today, we have elected officials saying we can’t afford all these things.  It’s not really because the money’s not there.  It is.  It’s because they think we’re too cheap to part with it.  They have us playing Jack Benny's old role, except no one's laughing.    

The decline in the health status of our children is where the political fantasy that we can cut and do no harm is introduced to reality.  Children get sick, and some even die, when we stop investing in their health.

Some brave political leader needs to step up and ask: What's more important, your money or your children's lives?  Will we really need to think about it for long?

A note about the Florida court ruling on health reform:  A short version of what the judge decided on Monday was that the individual mandate is unconstitutional, but that the Medicaid expansions are not.

The Supreme Court will have the final word on the individual mandate, probably in 2012 or 2013, but before it takes effect in 2014.  The judge's ruling in that area will have no effect for now.  States that don't want to implement the provisions that are already part of the law probably will not be let off the hook.

Though it wasn’t part of the headline, the judge also found that states are not being “coerced” into participating in the Medicaid program and providing the expanded coverage mandated under the law.  This finding means that the 26 states battling against the law have been defeated on one of the two main fronts on which they joined the battle. 

The Medicaid expansions will cover over 15 million Americans by 2016, and will be paid for almost entirely by the federal government.  How the states respond will be a test of their support for children, elders, and low income families.