Tuesday, November 12, 2013

Update on VoucherCare

So I was googling to see what came up in a search for VoucherCare (or, specifically Universal VoucherCare for all, as just VoucherCare brought up Democratic slams on the Ryan plan in the 2012 election).  Look what I found:  a paper on the Brookings website, titled "A Comprehensive Cure: Universal Health Care Vouchers" by Ezekiel J. Emanuel and Victor R. Fuchs, dated July 2007.  Here's the abstract:
The Universal Healthcare Voucher System (UHV) achieves universal health coverage by entitling all Americans to a standard package of benefits comparable to that received by federal employees. Enrollment and renewal are guaranteed regardless of health status, as is the individual's right to buy additional services beyond the standard benefits with aftertax dollars. Health plans would receive a risk-adjusted payment based on their enrollment. UHV is funded entirely by a dedicated value-added tax (VAT) with the rate set by Congress. A VAT of approximately 10 to 12 percent would insure all Americans under age 65 at a cost no greater than current public and private health care expenditures. 
UHV offers true universality, individual choice, effective cost control, and competition based on quality of care and service. To foster accountability and efficient administration, the voucher system creates a National Health Board and twelve regional boards with a governance structure and reporting requirements similar to the Federal Reserve system. The National Board establishes the overall rules and procedures and sponsors an independent Institute for Technology and Outcomes Assessment, which will slow the rate of growth of expenditures by encouraging cost-effective innovations. In each region a Center for Patient Safety and Dispute Resolution replaces the dysfunctional malpractice system. UHV is relatively simple compared with other reforms that have similar objectives. Most importantly, it is congruent with basic American values: equality of opportunity and freedom to pursue personal goals.
How times have changed!

Now, there are some pieces I'd argue with.  To begin with, I don't see why consumers should be able to buy the barebones plan until they get sick, then upgrade to the platinum "no deductible" version.   And the full paper doesn't provide any details on the plan design, except to say that the benefits would be "generous" -- in an era of high-deductible plans, this is too important an area for such a vague statement. 

But it surely would have been far simpler and more straightforward than the ultimate design - and it was Rahm Emmanuel's brother who authored this paper.  Did he himself disown this concept when it came down to actually campaigning and legislating, especially the honesty of a VAT rather than the hidden taxes and mandates of ObamaCare?

Anyway, this is tonight's Road Not Taken.

1 comment:

  1. "To begin with, I don't see why consumers should be able to buy the barebones plan until they get sick, then upgrade to the platinum "no deductible" version." hits the nail on the head. Maybe as an actuary you can articulate what is intuitively obvious to me, namely that in order to provide healthcare for all, all must participate. The ACA is, of course, much worse than the proposal you dissect in that it's not even necessary to buy the bare bones plan, and the lowest cost plan isn't (the young and healthy will be tempted to skip it and pay the price in the form of, e.g., a trip to the emergency room; the poor will go for the lowest-cost plan and get nailed with 40% of the cost of their care). The model for comprehensive (for all) coverage is Medicare, with subsidies for the needy in lieu of Medicaid. As with Medicare, the costs benefits are clearly defined and private insurance is available to supplement them. This is the model which every country which has made the decision to provide healthcare for all legal residents has adopted. Measures which permit free-loading until care is required simply increase the cost of the program. Measures which encourage people to risk what would be, for them, catastrophic expenses are immoral.


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