POLICY: Fuchs and Emanuel on vouchers

In an article called  "Solved!" Vic Fuchs (and new-ish partner) Ezekiel Emanuel go into much more detail about their plan for creating a VAT-funded voucher system for health care. I’m moderately in favor of vouchers for health care and education so long as they are indiscriminate between public and private institutions (i..e don’t take money from public schools and give them to private ones). In fact the best of all worlds would have no "public" provision of either education or health care, but a voucher system that was closely controlled to make sure that inequality of geography and class was corrected. In other words you’d get a more valuable voucher if you lived in the ghetto than if you lived in the suburbs, which would encourage health plans and schools to set up there.

Having said that, I don’t think that Fuch’s plan has much chance of success in the medium term because I don’t think that Americans care enough about universal health care. More likely will be some kind of incremental legislation, such as that being discussed in secret by Heritage, Families USA et al. As I’ve railed many times on THCB, if it’s not universal and compulsory, no system will work in either reducing costs or reducing the number of uninsured, because the producers can keep on putting the prices (and services) up and the net result will be more people unable to afford insurance. So an incremental approach will not solve the problem for which a solution is being demanded (which is rising costs for the middle class rather than uninsurance for the lower class).

So in the long run this incrementalism will lead to a single-payer government funded (and possibly provided) system, which will have a defined and fixed budget–and may be administered via a voucher system  But it will take us a long time, or a national crisis to get there.  Who was it who first told me that health care reform only happened in times of national crisis?  Vic Fuchs.

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  1. Duncan,
    Thanks for your support of President Bush’s vouchers for the poor to purchase insurance. You are correct that the uninsured cost everybody and it would be cheaper to give the poor vouchers so they can purchase insurance in the free and open market.
    I don’t really see how Marie Antoinette saying, “Let them eat cake,” applies though.

  2. We may be nearer to a healthcare crisis than you think.
    The present employer-based system already includes an average $922 surcharge for each family policy it covers.
    Recently, a study of insurance in California found that fewer than half of all in-state employees earning between $9 and $11 per hour received employment-based coverage.
    As more and more become uninsured, their care actually grows more expensive – for they turn to ER’s for treatment.
    California, which appears to be about five years ahead of the nation as a whole, appears to be in a “downward spiral” as more and more become uninsured, which – by making benefits more expensive – causes more employers to drop benefits, and so on.
    “In the long run, we are all dead,” John Maynard Keynes once said; and Marie Antoionette once said, “Let them eat cake.” People are apt to weary of such arguments in the healthcare field.

  3. President Bush’s agenda includes vouchers for the poor to purchase individual insurance. The amount of the voucher is $3,000 and is enough to pay for a 30 year old couple and 2 children in most states. Large employee group plans know that employees are not going to pay $400 a month at their employer if the government is giving away coverage.
    Millions of American uninsured families will get insurance. So write your Congressman and tell them to support President Bush’s voucher system for the poor to purchase health insurance.
    The President’s voucher system can be found at hr1872.com

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