‘Medicare for All” has become a distinguishing phrase among Democratic candidates for president. If we are going to reform our health care system to improve health and not just respond to disease and chronic illness, however, we must change how we provide care for children. Medicare was designed for seniors and not children.
A 1-year-old with a beginning developmental delay, or a 15-year-old experiencing depression, requires different health services than a senior with limited mobility trying to remain at home. Whether under Medicare for All, Medicaid and CHIP, or any other financing system that is developed, we need to define health care for kids differently from adults.
Preventive services for adults largely help to maintain the health they have. Children are growing and developing health behaviors which will determine whether or not they develop chronic diseases and conditions. If we can improve their health trajectories, the benefits to them and society accrue over decades. Therefore, a focus upon preventive and developmental health services is key to child health care. This also is where our public responsibility is greatest.
The employer-based health care system covering most working adults does not cover those who have retired, and we established Medicare to provide that coverage. While employer-based health care may not work well for many working adults, there is a plausible argument that employers be responsible for addressing the health care needs of their employees. To extend that responsibility to the employee’s children, however, makes much less sense and creates additional burdens for employers who do. As health care costs have risen, it is no surprise that employer-based health coverage has seen its greatest declines in coverage of and services provided for children.
Fortunately, Congress and presidents of both parties have stepped into provide health coverage — under Medicaid and the Child Health Insurance Program (CHIP) — to fill this gap. This has been a success in ensuring most children have some basic health coverage.
Yet health coverage children receive largely is based upon an adult health model and around treating disease and injury — not advancing healthy development. While the field of pediatrics has recognized it is essential to respond to biomedical determinants of health and also social determinants, this is not being financed by current child health financing systems. It represents the exception rather than the standard for practice.
If we start from the premise that we need a health system that works for all children — and improves their healthy development — we could do much to prevent the chronic health conditions that drive health costs today. We would have healthier children, who also would do better in school, be less likely to be involved in risky youth behaviors and be more equipped to compete and lead in a world economy as they enter adulthood.
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Any health care plan that candidates offer should distinguish between the health care children need from that adults need — and ensure the system provides that care for kids. The 2020 elections offer the opportunity to increase public dialogue and build public will to improve children’s health.
Charles Bruner was founding director of the Child and Family Policy Center and was an Iowa state senator.