Earlier this week, I described the Ezekiel Emanuel/Victor Fuchs health care voucher proposal. On Wednesday, I gave the case for it. Today is the case against. And the case against comes down to basically one word: Politics. The other day, I said, "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 plan is pretty far from our current system, and does a lot to control costs. The flip side of that rule is that the farther a health care plan is from our system, the more it does to control costs, the harder it is to pass through the United States Senate. It may be a policy virtue that the voucher plan begins to shut down Medicaid, Medicare, and S-CHIP. It may be a policy virtue that it completely severs the link between health care and employment, and creates an entirely new system in which people receive coverage. In fact, those things are policy virtues. But they are massive, undeniable political liabilities.
