Children are at risk in the current health care system

For generations, the elderly poor were consigned to misery, spent after a lifetime of backbreaking labor yet with little security to show for it. Their plight led Franklin Roosevelt to institute Social Security (over the objections of conservatives, who denounced it as "socialism") and Lyndon Johnson to press for Medicare (over the objections of conservatives, who denounced it as "socialism").

Those government programs worked so well that they virtually wiped out entrenched poverty among the elderly, who get guaranteed pensions and medical care. But our culture retains an outdated view of senior citizens as vulnerable and needy, so they command an outsized share of public compassion and political attention.

Contrast that with the well-being of children and young adults. According to the Department of Health and Human Services, health care spending (from all sources) for the 65 and older population was about $14,797 per person in 2004, while the spending per child was about $2,650. (Though health care spending has increased since then, the proportions have remained about the same.) The declining health of the elderly certainly accounts for most of the difference, but a culture that doesn't accept broad responsibility for its children accounts for some of it, as well.

How did we become an upside-down culture that spends lavishly on our seniors but is so stingy with our young? Is it simply a matter of voting power, which the older folks wield so effectively?

"The elderly are not only a powerful but also a growing segment of the population," said Isabel Sawhill, co-director of the Center on Children and Families at the Brookings Institution. "Families with children under 18 are not."

The status of children's health care has improved since the administration of George W. Bush, who twice vetoed an increase in spending for the State Children's Health Insurance Program, while pushing through a budget-busting prescription drug program for the elderly. President Obama and a Democratic Congress backed more money for SCHIP, a low-cost health insurance program for the children of the working class.

With the increased funds for SCHIP, the number of uninsured children has declined. But 7.3 million are still uninsured, according to the latest report from the Census Bureau. Young adults, too, are among those most likely to go without health insurance. Some simply bet on their invincibility, but others just can't afford the premiums.

What accounts for our odd generational schism, which treats the elderly as deserving but gives children short shrift? Indeed, many opponents of health care reform seem to believe that universal coverage would bestow lavish benefits on a group of lazy and undeserving folk who ought to just get a job. Never mind that many jobs don't offer health care, and most employers won't hire 3-year-olds.

"A lot of advocates for children are also advocates for the poor, and Americans, as we know, are less willing to support low-income families than people in other Western countries. Americans believe that everybody in this country has the opportunity to get ahead, and if they don't get ahead, it's probably something they've done," Sawhill said.

That view is naive, at best; callous and cruel, at worst. It disdains the hard work of many working-class parents, who, despite putting in grueling hours on the job, cannot afford health insurance for themselves or their kids. It also conveniently overlooks the underlying finances of Medicare, which is a form of welfare. The average Medicare recipient receives far more in benefits than he and his employers paid in.

Worst yet, a stingy and disdainful attitude toward children works against our collective long-term interests. I'm too close to geezerhood to begrudge senior citizens their Medicare, but I understand the economics well enough to know that the system depends on healthy younger workers for support. So we'd all be better off if the youngest Americans had access to the medical care they need.

Cynthia Tucker is the 2007 Pulitzer Prize-winning editor of the opinion page of the Atlanta Journal-Constitution. Reach her at

Share This Story