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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