THE PLANK NOVEMBER 3, 2008
Harold Pollack is a public health policy researcher at The University of Chicago's School of Social Service Administration, where he is faculty chair of the Center for Health Administration Studies.
Today's New York Times contains a poignant article, "In Palin, Families of Disabled Children See a Potential White House Friend." With her infant son's diagnosis of Down Syndrome, Governor Palin has joined a community of caregivers that crosses every social boundary. My wife Veronica and I belong to that same community. We care for Veronica's brother Vincent, who thrives despite medical challenges and cognitive disability arising from fragile X syndrome. As fellow travelers on this caregiving journey, we wish Palin the best. We admire the compassionate way she relates to many families. Yet we have a very different picture of what disabled children and their families need.
Ten days ago, Palin delivered a long-awaited policy speech regarding children with cognitive disabilities. She raised some serious education issues--notably supporting full-funding of the Individuals with Disabilities Education Act (IDEA), a proposal that's been posted for months on Barack Obama's website. Yet her speech demonstrated she has much to learn about what matters to children--and adults--living with disabilities.
Revealingly, Palin never discussed a central issue: How will people with disabilities get health care? The thousands of words in her speech didn't include "insurance." Nor did she utter "Social Security" or "Medicaid."
Families need secure and comprehensive health coverage that pays for what needs to be done. They won't get that from the McCain-Palin health plan.
Last year President Bush vetoed (with John McCain's emphatic support) a bipartisan SCHIP expansion that would have covered more than three million children. This was a special blow to the disability community. A receptionist who earns $45,000 might not seem poor. Yet if her son requires tutoring or behavioral counseling she can't get through her school, if she has to work fewer hours to care for her son, if she faces a continuing stream of medical bills and copayments, she's in trouble.
As I have written elsewhere, children with cognitive disabilities are classic patients with "preexisting conditions" whom insurers prefer to avoid. Despite many flaws, employer-based coverage protects millions of people from medical underwriting and other discriminatory practices pervasive in the non-group market. Senator McCain's proposal to tax employer-based coverage would weaken this system without providing an adequate replacement.
Then there is Medicaid--the main vehicle through which cash-strapped states finance care for children and adults with disabilities. The McCain campaign's chief economist stated (without offering details) that his administration would reduce Medicare and Medicaid by $1.3 trillion by 2018. Differences between the parties go deeper. The Community Choice Act (CCA) would require Medicaid to provide recipients living at home with the same personal assistance services they could receive in an institutional setting. Senator Obama co-sponsored CCA. Senator McCain opposes it, on the grounds that it is too costly.
I am hardly an unbiased observer. I am a prosperous, tenured professor. Yet I am tethered by fate to someone who requires much help to live a decent life. We do a lot for Vincent. We could never provide for him without the Medicare, Medicaid, and Social Security benefits that carry much of the financial load.
That's what social insurance does. Acting as individuals, we are easily crushed by the tragedies life's lottery can bring. Acting together, we can confront these challenges. In her narrow governing vision and her crude attacks on Obama's mildly progressive policies as "socialism," Governor Palin fails to grasp this simple truth. As she travels down her own caregiving path--and as she gets to know her less-privileged peers--she will.