In the Christian Science Monitor David Rose proposes using vouchers to reform the healthcare system:
St. Louis – Democratic proposals to reform the American healthcare industry require too much faith in government while Republican proposals don’t solve the problem of the uninsured.
The best known hybrid proposal, the Wyden-Bennett plan, overhauls the current insurance industry and solves the uninsured problem by mandating coverage. But as we have learned from Massachusetts’ experience, enforcing mandated coverage is very difficult.
Americans deserve reform that deals with the three most important problems with American healthcare: (1) many people are uninsured, (2) those who have insurance worry that if they lose their job they might become locked out of the system because of a preexisting condition, and (3) many people are frustrated with increasingly intrusive insurance companies that treat patients more like criminals than customers. (Note that the skyrocketing cost of healthcare is not one of the Top 3 problems – more on that later.)
Any plan that doesn’t address these three problems is inadequate. Any plan that requires nationalizing healthcare is excessive and prone to failure.
To get everyone in the system without mandating coverage, we should enact a national sales tax – 6 percent would be sufficient – on all goods and services. This revenue would pay for a voucher that every American citizen could use to buy a catastrophic health insurance policy.
Vouchers for healthcare? Absolutely. Vouchers work. We solved the hunger problem in America with vouchers in the form of food stamps. This program is efficient because it is simple, transparent, and works with, rather than against, market competition.
By significantly increasing competition, a voucher program will give us better service and cost control while dealing directly with the problem of the uninsured once and for all.
I think he’s overestimating the possibilities for competition in healthcare but that’s a debate I’m having a lot these days. But he’s right in that the thinking on healthcare reform is far too constrained. I note, for example, that in his list of problems that demand solution he doesn’t include the problem of underserved communities which, interestingly, is a problem that might actually be mitigated with a voucher system.
The real tragedy of healthcare reform is that there are lots of prospective solutions to the genuine problems that confront us but not nearly enough time to test them all. In my view what should have been done when Bill Clinton attempted to reform the healthcare system was implement trial programs in different parts of the country rather than trying to overhaul the whole shebang at once. Instead, the well was poisoned for well over a decade.
I like the voucher idea. Always have. But it does nothing to solve criteria #2:
(2) those who have insurance worry that if they lose their job they might become locked out of the system because of a preexisting condition
No, those are not solutions.
If a 6% sales tax were imposed, I would stay at my home in Brazil and only return to the USSA for “free” health care.
If insurance is paid for through income taxes of fees on the uninsured, I am forced to stay in this country and sell my place in Brazil, since once in Brazil, I would have no access to routine health care and prescriptions, except on the private Brazilian market.
I appreciate health care, but do NOT care for insurance of any kind. Insurance is for religious, superstitious, old, infirm risk-averse folks. Any rational person who is young and risk-seeking should avoid it like the plague that it is. A sick young person should, of course, game the system by getting a job with “benefits” or simply move to Massachusetts.
Sure, such a voucher system is like food stamps. Any sick and starving Amerikan living overseas should always game the system by returning to the USSA for free food and health care!
Here’s how to solve the healthcare crisis:
1. Outlaw all insurance but “catastrophic.”
2. Tax all health “benefits.”
3. Require posting of all healthcare fees on the Web.
4. Outlaw price discrimination in favor of the insurance, medicare, or medicaid covered patient.
If this were done, good health care could be found cheaply, just as tools are found at Walmart, Sears, and everywhere on the Web.
How would the vouchers work in the case of people with employer-provided insurance? Would they simply request that the voucher be directed towards their company insurance? Could the company require them to apply the voucher as such if they provide insurance?
I like the “voucher” idea, as long as
A)the vouchers are given to everyone, and are enough to cover at least a decent modicum of treatments (meaning they have to adjust to inflation);
B)People are required to apply their voucher to some type of health insurance.
I have some other ideas in that area, but it’s a start.
You forgot to add any “rational rich person”. What happens to these people when (and yes, even the “young immortals” get sick and/or injured once in a while) they get caught without any real means to pay?
By the way, I suggested earlier in another post the idea of having the states choose one of the insurers available to act as a “default” insurer. That way, nobody will be caught without insurance, since even if you are too damn lazy to be bothered to touch your voucher, you’ll still be insured.
At the very least, it cuts down on some part of what you’ll need in terms of enforcement.
Speaking of enforcement, has there been any discussion at all about it of significance in the Greater Blogosphere and Media? Laws are only one part of the equation, and meaningless if the enforcement agency (or agencies) get shitcanned.
That’s one of the things that gripes me most about people who have the greatest faith in government. They seem to think that laws enforce themselves.