Little media attention has been paid to the fact that the same Clinton health plan that Americans resoundingly rejected in 1994 is being implemented for children. Efforts to establish government health care programs are stronger than ever; they are just not as obvious and are occuring with little or no public debate. Reporters should start paying attention to this important trend.

The Clinton Health Care Task Force documents — made public through court order — reveal that a "Kids First" approach would be used as the first step to phase in the full Clinton-style health care plan if the original plan failed. Today, the "Kids First" strategy is working:

Medicaid. The government Medicaid program, which provides medical assistance to low-income families, is rapidly evolving into a middle-class entitlement program that could soon replace private insurance for our nation’s children. Forty states have already expanded Medicaid beyond the federally established mandate. In fact, some states have offered Medicaid to families with incomes three to four times the poverty level and some do not require an asset test to determine Medicaid eligibility. Today, one-quarter of America’s children already participate in Medicaid.

School-Based Health Care. School clinics have long delivered first-aid and emergency care, but lately they have expanded their missions, adding a broad array of services such as psychological and reproductive counseling.

In 1985, there were only about 40 school-based health centers operating in the United States. By 1993, 40 states used federal block grant funds or state general funds to support school-based health clinics, according to a Robert Wood Johnson Foundation survey. Today, there are over 900 hundred school-based health centers operating in all but seven states. In fact, over half of all states have established mechanisms that permit them to deliver health care services in public schools financed by Medicaid.

SCHIP. Under the new State Children’s Health Insurance Program (SCHIP), states have several options for spending the new federal health care dollars. Thirty-nine states will likely include Medicaid expansions to cover uninsured children. Some states are using tax dollars to lure families into government-sponsored health care in an effort to promote an agenda of universal health care for children, with little or no public debate.

It is not difficult to envision how a children’s health care system, delivered through the public school system and/or through Medicaid, could serve as a precursor to nationalized health care.

While efforts to expand health care access and affordability for children may be well intentioned, this current trend could have serious unintended consequences. Such expanded government health care programs could encourage families to drop their private health insurance, reduce health care choices, infringe upon parental rights, and threaten medical privacy. School-based health centers give public schools broad responsibility and latitude regarding medical treatment and psychological and reproductive counseling of children — trumping this parental responsibility.

Another concern with school-based health care is the lack of health privacy. In many cases, children are subjected to intrusive physical exams and psychological testing without parental consent. Psychological testing information and records can then be shared between state government agencies, again without parental consent.

While Americans agree that children should have access to quality health care, few believe the federal government should be most responsible for providing that care. In fact, more than half believe the responsibility for health care rests with the children's parents. Yet the first major steps toward Clinton-style universal health care for children have already been taken and they could rapidly evolve into a government-mandated program for all children in the U.S.

The framework for socialized medicine for children is becoming entrenched across the nation. Although efforts to pass a large-scale version of socialized medicine failed in 1994, the "Kids First" back-up plan is successfully being implemented at the federal and state levels. Medicaid expansions, school-based health care, and SCHIP have enormous potential to force all American children into government health care. Reporters should make sure Americans know about and can debate government’s role in providing health care to children before all are forced under a single, government health care roof.

Naomi Lopez is director of health and welfare studies at the Pacific Research Institute in San Francisco, California and author of the Institute for Health Freedom's recent study, Are American Children Being Lured Into Socialized Medicine?

— Rich Noyes