Tell Us Why, Mr. Bush

This commentary was written by CBSNews.com's Dick Meyer.

A very experienced colleague suggested to me the other day that President Bush is determined not to squander his historic unpopularity. He's going to use it to do whatever the hell he wants because he just doesn't seem to care much anymore.

That seems to be the case with the issue of providing health insurance for poor children.

You may have heard there is a scrap about this now in Congress, or rather, between Congress and the president.

Democrats and Republicans a decade ago managed to get their acts together long enough to enact a program called the State Children's Health Insurance Program (SCHIP). The idea was to get coverage for otherwise uninsured children in very low income families with earnings too high to qualify for Medicaid. Today, about 6.6 million children benefit from this program.

On September 30th, SCHIP will expire. So, once again, Democrats and Republicans need to do something that is really, really hard for them: take action. They need to renew the program.

President Bush is reluctantly willing to renew SCHIP with an increase of $5 billion over the next five years. That is probably not even enough to insure the children who already get benefits.

Democrats and Republicans on the Senate Finance Committee want to increase funding for SCHIP by $35 billion over five years. House Democrats want a $50 billion boost. The bipartisan National Governors Association also wants an increase much larger than $5 billion, but doesn't want to get into a catfight.

Why won't the president go along with a real increase? Excellent question.

What he says is that a big increase would be the "beginning of the salvo of the encroachment of the federal government on the health care system."

Huh?

This is the president whose proudest domestic achievement was extending Medicare to cover prescription drugs, one of the biggest "encroachments of the federal government on the health care system" in American history. Honestly, it is mind-boggling that the president could say this.

And I might add that this is the president who engineered the largest federal invasion of public education in history.

But it gets worse. It also gets a little complicated, so stick with me for a second.

House Democrats want to fund an increase for SCHIP by reducing the federal subsidy for a program called Medicare Advantage that pays tax dollars to HMOs to give health insurance to seniors. It's an alternative to Medicare. The idea behind Medicare Advantage was that since large private bureaucracies are so much smarter than large public bureaucracies, it would be cheaper to pay HMOs to cover some seniors than doing it through Medicare.

Wrong.

The government now pays HMOs between 112 and 119 percent of what it costs to cover a person on Medicare. So if it costs the government $100 to cover Sadie Sickly of Illness, Ohio, the government will pay Selfless HMO Inc. $119 to take Mrs. Sickly off their hands. Selfless HMO Inc. – and lots of real life HMOs – make a boatload of money off Medicare Advantage because of this government subsidy.

The Congressional Budget Office thinks that 119 percent subsidy could be cut, and HMOs would still make money and patients would still get good services. So House Democrats want to reduce the government subsidy for HMOs to help pay for an increase in SCHIP funding. Pretty straightforward.

HMOs – surprise, surprise – do not want that Medicare Advantage subsidy to be cut. Neither does President Bush. He thinks the free market is so cool that it should be subsidized by the government.

You see, he doesn't want the government encroaching on the health care system, so he's going take your tax dollars and give them to HMOs so they can encroach on the health care system.

The Senate Finance Committee thinks an increase in SCHIP could be paid for by increasing the tax on cigarettes. The president doesn't like that, either. He's an anti-encroachment guy. Except for HMOs. And prescription drugs.

Snarky and cynical people think the president is simply doing the bidding of tobacco and HMOs. I have no way to know what his motivations are, but I don't think he's just kowtowing to special interests. I think it's more likely he just doesn't want to do something that Democrats and poor people think is important.

Or maybe he has new evidence that the children who qualify for SCHIP are trying to obtain Weapons of Mass Destruction. A source close to the administration told me that.