10/26/2012 02:28 pm ET Updated Dec 26, 2012

The Bottom Line

The final debate once again drew the nation's attention to the extraordinary difficulties our leaders face. Whoever is elected president will confront international conflicts as well as the problems caused by the financial crash of 2008. The newly elected congress must join the administration to clean up a $16 trillion national debt and lower a nearly 8 percent unemployment rate. With the heavy toll on the middle class, a full 15 percent of Americans are in poverty. In the aftermath of the crash, children have fared even worse -- 22 percent of them are poor.

No matter who wins in November, the road forward will be rocky. A looming set of automatic budget cuts is set to take effect in January. To avoid the across-the-board budget slashing, the current congress and administration will have to make difficult spending decisions shortly after the election. The cuts will be drastic by necessity. Few if any industries or programs will be spared. But along the path to financial stability and economic recovery, some things must be sacrosanct.

We must have a bottom line.

As physicians caring for children, we admit that we have a strong bias. Our bias is that children matter -- to our future and to our present. Children make up 24 percent of the U.S. population. Yet they received little attention in the debates. This just doesn't make sense, since investments in children's health and education offer solutions to some of our most serious economic challenges -- including high health care costs and the pressing need for American workers with skills to stand up to global competition.

There is strong evidence that investments in quality health care and education for children pay for themselves and bring significant returns. These investments lead to better health, lower health care costs, and greater economic productivity in adulthood. Every political candidate who cares about this country's future ought to commit to continuing and substantially expanding the current administration's investments in today's children as the bottom line.

How our nation treats its children reflects our societal values. Children can't vote. They depend on us -- parents, grandparents, pediatricians, teachers, and other child health advocates and professionals, to do right by them, stand up for them, and advocate for what they need to grow and prosper. It is critical that political leaders do the same.

Despite the economic challenges we've all faced since 2008, there has been significant progress for children: the passage of the Children's Health Insurance Reauthorization Act (CHIPRA), the Healthy Hunger Free Kid's Act and the expansion of Head Start. This is no time to turn back that progress. Yet programs like the Prevention and Public Health Fund, pediatric research at the National Institutes of Health, and many maternal and child health programs are on the chopping block (see here). Depending on which way congress decides to act, so is Medicaid, the single largest health insurance program for low-income children. Budget cuts now being proposed at the federal, state and local levels will push more children into poverty, and provide poorer education and health care. The American Academy of Pediatrics has resources to help explain these cuts and what they mean to programs in your state and to children across the country (

We truly believe that Americans want what's best for our children. In order to provide the best we can -- in health care, education and opportunity -- we must continue to invest in children from the ground up, not cut crucial programs that do just that. We must make children our bottom line.

My colleagues Joshua Sparrow and Judy Palfrey join me in this statement.