November 27, 2007

Mr. John K. Iglehart is a national correspondent for the august New England Journal of Political Ideology, oops, Medicine, and why the NEJM needs a "national correspondent" is a question to which the answer is less than immediately obvious. Anyway, Mr. Iglehart has an editorial---sorry, article---in the November 22 issue entitled "The Fate of SCHIP---Surrogate Marker for Health Care Ideology," the central theme of which is captured wonderfully in this priceless passage:

President George W. Bush vetoed [a reauthorization of SCHIP despite the fact that] many legislators, a large majority of the public, major private stakeholders, and 43 governors strongly support expansion of the program. By contrast, in an effort to appeal to the conservative base of their party, the leading Republican presidential candidates agreed with Bush's veto---despite the fact that the program, though signed into law by a Democratic president, originated in a bipartisan compromise and was enacted by a Republican-controlled Congress.

It really, truly, absolutely does not get any better than that. Supporters are bipartisan, have a large majority of the public on their side, not to mention major private stakeholders, whatever that means, and 43---count 'em---governors who absolutely, positively are not influenced by the prospect of getting their snouts ever deeper into the federal trough. And the opponents? They are craven ideologues, pandering to their political base, and dismissive of the fact that SCHIP began as a great compromise passed by a Republican Congress.

Thus does Mr. Iglehart gloss over the problem of substitution of public coverage in place of private insurance with the assertion that "the compromise would have required states to prepare a plan to prevent families from enrolling children in SCHIP if private insurance was available to them." A requirement to prepare a plan! And if "available" private insurance is deemed by someone to be unaffordable? Can anyone possibly believe that this requirement would have reduced the crowd-out problem by even one family?

Iglehart simply repeats the budget numbers without any acknowlegement at all that the fiscal 2012 figures were fraudulent, as a means of reducing the official five-year budget projections. He ignores the longer-term problem of weak incentives on the part of public policymakers to feel constrained by the preferences of patients. Ad infinitum.

Anyway, you get the idea. Everyone wants their few minutes of fame, and so the NEJM simply cannot limit itself to medical science. Does this mean that the scientific articles also are politicized? It is hard to see how an editorial process fixated on politics can avoid that outcome.

Posted by Benjamin Zycher at November 27, 2007 10:32 AM

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