Been awhile since we talked our way through a new health care plan, but the Ezekiel Emanuel/ Victor Fuchs voucher proposal is getting some press these days, so might as well give it a go. You can find the details of the plan in convenient pdf form here, but I'm going off of Ezekiel's new book, Healthcare, Guaranteed, which Newsweek's Mary Carmichael calls "the most exciting book yet to come out of the country's medical crisis." Here's how we're going to do this. Today, I'm going to go through the basic structure of the plan. Tomorrow, I'll give the argument for it. Wednesday, I'll give the argument against. So, the plan. You guys are going to love this. No individual mandates! Indeed, no mandates of any kind at all. Not on kids, adults, employers, no one. Vouchers are a whole different approach to universality. Basically, the government gives everyone a golden ticket that they trade in for a health care plan of their choice (provided it meets a fairly expansive minimum coverage level). Forget community rating and preexisting conditions and all the rest -- insurers can't price anyone out because no money changes hands between consumers and insurers. Rather, the government reimburses the insurers on a risk-adjusted basis. This is, essentially, single payer where the actual provision of health insurance is subcontracted out to competing private companies. As you might guess, this requires a substantial restructuring of the system. So no more Medicare, Medicaid, S-CHIP, etc. Folks who are in those programs now can remain, but there will be no new entrants. No more employers providing health insurance -- they've got nothing to do with it. No more paying for coverage through premiums. The voucher plan is funded by a 10 percent Value Added tax (essentially, a type of sales tax). If folks want more coverage, they can tell Congress to raise the tax. If they don't want to pay more in taxes, then they have to live within the plan's confines, or pay extra for supplementary insurance. Big decisions within the system are made not by Congress or by insurers, but buy a Federal Reserve-style National Health Board that has, in turn, twelve Regional Health Boards. These commissions, staffed by a variety of experts who're appointed by the president and confirmed by the Senate, will define benefits, carry out research on effectiveness, figure out risk adjustment, and so on (in this, the plan has shades of Tom Daschle's plan). And that, basically, is it. The government gives you a voucher. Various insurers compete to offer such good coverage that you'll give your voucher to them. The insurers then give your voucher to the government, and the government pays them some money, raised through a type of national sales tax. See? Health care is easy!
