Two days ago, I ran through the basic outline of the how the Emanuel/Fuchs voucher proposal works. (If you haven't read that yet, this post will be very confusing.) Today is the "pro" case for the plan. And here it is: this is a total transformation of the system. It does not build on the inefficiencies of the current structure, preserving them in amber for the next egenration. Rather, this is the closest we will ever get to single payer without entirely blowing up the private insurance industry. And since we're not going to blow up private insurance in the near-term, transforming them into something like publicly regulated utilities that might even compete to our benefit would be a pretty huge improvement. The voucher approach is, in many ways, far superior to an individual mandate, an employer mandate, or a tax credit approach. Essentially, the government guarantees you health insurance, just as they would in a single payer system. You choose from a set of competing private plans -- but that's different than being forced to buy one of a set of competing private plans. Health care becomes a right, not a purchase. Where a mandate plan gives you a mechanism to achieve universality, a voucher plan simply is universal. There's a big difference. But the big deal here is cost control. In health care, cost control is everything. At the current rate, health care will grow to 30 percent of GDP by 2030. That's money -- in the trillions -- that can't be spent on other things, either progressive priorities like universal pre-k or personal priorities like buying a home and taking a vacation. And what are we getting for the amount we spend? A health system where 47 million are uninsured, and experts estimate that 20 cents to 50 cents of every dollar spent on care is wasted on unnecessary or ineffective treatments. It's a tragically bad deal. Our current system is so pricey because of its basic structure, which hides costs encourages overuse of resources, and has basically evolved such that it's very good at creating profits and quite bad at ensuring the health of a nation. So when evaluating health plans, a good rule of thumb is this: The closer it is to our current system, the less it does to control costs. The farther it is, the more it does. The voucher system is very far indeed.
