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VOUCHERS! In making a case for a voucher-based health care system (not the best option, not the worst), Lawrence Kotlikoff writes:
It's also a progressive solution that Democrats should love. (Democratic presidential candidate Mike Gravel has endorsed it.)Well then! Sign me up!In any case, voucher plans float around every so often, so it's worth spending a moment on them. As Kotlikoff explains the idea, "The government would give everyone a voucher each year for a basic health plan. The size of the voucher would be based on one's health status. Those in worse health would get bigger vouchers, leaving insurers no incentive to cherry-pick. Furthermore, insurers would not be permitted to refuse a voucher or otherwise deny coverage." The obvious concern with a voucher-system is complexity. If the insurers can't reject your voucher, then the whole of the battle will be between insurers trying to make vouchers more generous, and government trying to keep costs down. If the insurers lose the battle to make vouchers more generous, they'll try and make their plans more stingy, or advertise only in rock-climbing magazines (where the young and healthy are likely to go). It's a very, very complicated way of creating a national pool -- one that simultaneously robs insurers of their ability to make profits, while still leaving them a host of manipulable variables with which to game the market. A good way of thinking about how this would work are the Medicare+ plans, which are almost exactly the same. There, the government opened Medicare to private HMOs, who would get the same amount of money Medicare expected to pay per person. The idea was the HMOs could hold down costs better than Medicare and, in turn, offer more expansive coverage. The opposite happened, and we're now paying the participating companies 120% of what Medicare pays per person -- but the Republicans refuse to roll back the program, and keep greenlighting the rip-off. I don't see how the vouchers idea differs, or protects against a precisely similar outcome, except that there's no "control" government program to serve as an alternative. It would be a bit better than the status quo, to be sure, but it's the sort of plan that may be acceptable as a final compromise, not the sort that you want to start with.--Ezra Klein
