Democrats & Liberals Archives

The Voucher Scheme for Healthcare

In the Feb 19/26 issue of The New Republic, Ezekiel J. Emanuel and Victor R. Fuchs present a healthcare scheme based on vouchers. Using my Healthcare Evaluation Guide, I find that this scheme is a pretty good healthcare system.

I discuss the system while comparing it against my criteria:

  1. A NATIONAL SYSTEM - This is truly a national system with a Federal Health Board that sets criteria to be followed by Regional Health Boards that will screen the health plans and monitor performance. The authors expect the system to operate like the Federal Reserve System. Benefits will be modeled - initially, they say - after the Federal Employee Health Benefit Plan

  2. EVERYBODY IS INCLUDED - Definitely. The system is open to all

  3. NOT EMPLOYER DEPENDENT - The employer is out of the system. The tax exemption for employer-sponsored health insurance would be repealed, yielding about $200 billion a year to be used for the new system

  4. GUARANTEED HELP WITH CATACLYSMIC EVENTS - Sicker people would be eligible for more expensive plans

  5. INSURERS MUST USE COMMUNITY RATING - Definitely. Insurers would have to accept everybody regardless of preexisting conditions or other risk factors

  6. INSURERS MAY NOT INTERFERE WITH DOCTOR DECISIONS - I'm not sure. I think perhaps insurers may not interfere, but Regional Health Boards may

  7. HOSPITALS MUST SUBMIT TO QUALITY CONTROL - The health boards will adopt standards that hospitals will be required to follow

  8. DOCTORS HAVE THE LAST WORD - I think they will, once they agree to follow the standards of the health boards

  9. PATIENTS MAY CHOOSE ANY DOCTOR - Their basic choice will be a specific health plan. Most likely, the plan would determine what doctor they may choose
The authors discuss how to pay for the system. In addition to the $200 billion they plan to get from repealing employer-sponsored health insurance taxes, they also propose a value-added tax (VAT) to raise an additional $750 billion per year. This is probably the most controversial part of the proposal.

Overall, this universal voucher-based healthcare system is pretty good and deserves consideration by our national legislators. It is one of the best that I have seen to date.

Posted by Paul Siegel at February 13, 2007 3:09 PM
Comment #207894

Does #2 mean it is totally voluntary?

Posted by: kctim at February 13, 2007 4:28 PM
Comment #207913

kctm: I don’t know from the writeup. It probably is because they say each person may apply to one of the plans. If you don’t apply, I guess you are not in it.

Posted by: Paul Siegel at February 13, 2007 6:20 PM
Comment #207914

Your system contains no incentives (yes I know it’s a dirty word) to stay well. Why should the $300 lb smoker pay the same as 160 lb runner?

Doctors have final say — Sooo doctors are never wrong and never perform unnecessary proceedures in order to pad the bill? Get real you must not know any doctors.

System is open to all —is this code for that we will be covering every illegal who is able to make it across the border?

Do you envision a system like that in Canada where people with serious conditions wait for mnonths to have a given proceedure done (unless they can come to the US and pay cash)?
Under your system can those who can afford it buy additonal insurance so that they are not subject to the limitations that your govt. plan might have? Will this create a system where there is a plan for the haves while the have nots have an inferior plan?

All of the proposals for national health care are better in theory than they will be in reality and every cost estimate in low balled; new Mass state medical plan and medicare part D for 2 recent examples.

Posted by: Carnak at February 13, 2007 6:30 PM
Comment #207917


I favor expanding Medicare coverage to anyone that’s not otherwise insured. Why? How will it work? Read on:

(1)The bureaucratic structure already exists.

(2)No more need for Medicaid. The states can get out of the insurance business and focus on building infrastructure.

(3)All government officials and employees will be covered by Medicare (that guarantees quality control).

(4)Premiums will be based on “ability to pay” so everyone can afford coverage.

(5)Insurance companies will still be allowed to compete, but they must guarantee certain minimum benefits.

(6)Put some “teeth” in the requirement for coverage. If you cheat to get out of the government plan make the penalty bankruptcy exempt just like taxes or child support.

(7)Once you “opt” in you’re stuck with Medicare for a minmum number of years. 3? 5? 10? That would take an economist to figure out.

(8)No tax exemption for company sponsored health insurance. Let’s put the “mom-n-pops” back in business!

(9)All Doctors should be held responsible for their actions. Abolish malpractice insurance! Hey, Doctor! If you mess up you’ll be held personally responsible just like a garbage collector that runs over a child. Pay attention! It’s my left leg, not my right!

(10)This can be amended every year by the congress! If the insurance industry and the health industry find a better way then WOW, cool! We all win.

Now, tear my plan apart. I know someone will.

Posted by: KansasDem at February 13, 2007 6:37 PM
Comment #207942

Abolish mal-practice insurance? Won’t work. The potential liabilities are too high. Doctors will just stop practicing or refuse to perform risky procedures.
Regulating the insurance industry like has been done by some states for the auto insurance industry would help curtail cost. In CA auto insurers have to justify their rates and must base their individual rates on the individuals record,not as they prefer, the zip code of the driver. The results have been a continued lessening of rates for good drivers.
Most mal-practice suits are not frivolous. They involve grave errors although there are some. Doctors are not miricle workers and sometimes are blamed ubjustifably. These suits get weeded out quickly by the courts. The hubub about them is a red herring.

This sounds like yet another give away to the insurance industry, I repeat. Medical insurance is NOT healthcare. Keeping a large part of the problem as part of the solution makes no sense.A political compromise? Edwards plan still gives them a role if,and only if, they can compete with an alternative single payer government plan that consumers will have the option of joining.
As far as taxing the benefits I recieve from my employer through collective bargaining? In the grand tradition of the American trade union movement,”Up yours,buddy!”

Posted by: BillS at February 13, 2007 8:35 PM
Comment #208011

We The People have the health care system we deserve. I say raise the cost to 3 trillion. The federal government pays out more per capita just on medicare and medicaid that either Germany or France do for their health care that covers all citizens. Both of those countries provide better service, have more doctors per patient and get better results than our miserable system which we love to call the best in the world. Some day soon, we are going to awaken from our beautiful red, white and blue dream and realize that we are on a hell bound train that is pulling into its destination. Then we can blame the rest of the world and take it down with us.

Posted by: jlw at February 14, 2007 2:46 AM
Comment #208026

Thanks Paul.

Posted by: kctim at February 14, 2007 9:10 AM
Comment #208056

Her’s an interesting essay on the subject.

Posted by: traveller at February 14, 2007 12:15 PM
Comment #208075

Why do you consider community rating a good thing? I can understand if you had a semi-community rating scheme which prohibited setting premiums based on the genetic diseases and other factors beyond the individual’s control. But to exclude behavioral factors such as smoking and obesity from the calculation is forcing the responsible people to subsidize the irresponsible. Which is to say, it’s just plain wrong.

Posted by: Nick Kasoff at February 14, 2007 1:47 PM
Comment #208088

“is forcing the responsible people to subsidize the irresponsible. Which is to say, it’s just plain wrong”

Yes it is Nick. But it also the way of life here in America now.
Get used to it, its going to get a whole lot worse.

Posted by: kctim at February 14, 2007 3:03 PM
Comment #208137

kctm,nick kasoff
Smoking,obesity,alcoholism,drug addiction ARE health problems and need to be addressed as any other. The societal benefits for doing so are great. Real universal access to treatment would among other things lower the crime rate. Mental illness is another area of concern. The biggest mental instituion in the country are our prisons.Not only are the mentally ill illserved but the cost to taxpayers is considerable. Many mental problems can be prevented or controlled with early access to treatment.
Like it or not,we are all in this together. What effects one has an effect on all. If you slip on the stairs under any national plan you would recieve treatment. Why? It was your fault for being clumsy,wasn’t it?

Posted by: BillS at February 14, 2007 6:11 PM
Comment #208216

IF the societal benefits are so great, then why do people smoke, eat like pigs, drink alcohol or do drugs? Do they do so because they do not care about society or do they do so because they should be allowed to live their life as they, not others, want to?
In a free country, this would not even be an issue. Govt has no business or right, dictating how people should feel, care or help others.
Freedom of choice should apply to everything, not just killing babies or who one wishes to marry.

“Real universal access to treatment would among other things lower the crime rate”

So would making a law saying everybody must practice their 2nd Amendment rights. How do you think most Americans would feel about a law requiring every citizen to be trained and armed? It would be wrong wouldn’t it be.
It is not the govts right to force one persons beliefs onto others.

“Many mental problems can be prevented or controlled with early access to treatment”

Of course they can. But “free” treatment does not mean people will use it.

And the prison cost to taxpayers is so great because one thing and one thing only: they are not treated as prisoners who have been found guilty of a crime. They are treated and portrayed as misguided innocents who should be pitied.

“Like it or not,we are all in this together. What effects one has an effect on all.”

Respecting individual freedoms and rights does not mean one disregards the lives of others. And, like it or not, our individual rights and freedoms are the most important things in which our country was founded on.

“If you slip on the stairs under any national plan you would recieve treatment.”

If I slip on the stairs today, I will reaceive treatment. Why? Because I know it is a possibility and I have planned for it. So tell me, do I help society by planning and taking care of myself or would it help society more if I let them do it for me?

“Why? It was your fault for being clumsy,wasn’t it?”

You are absolutely correct. It happened to me and it is my responsibility. I should not expect govt to force you and others to degrade your own lifestyles in order to pay for my misfortune either.

Respect individual rights and freedoms or keep taking them away until there are none left?
I know where myself and the founders stand on the issue.

Posted by: kctim at February 15, 2007 10:25 AM
Comment #208395

I wonder if a voucher program would work with school choice?

Posted by: JoeRWC at February 16, 2007 8:16 AM
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