Mr Emanuel proposes a universal healthcare voucher, entitling every citizen to privately-provided insurance, with standard benefits equal to those enjoyed by members of Congress. Insurers would be forbidden to deny coverage to any citizen, regardless of pre-existing conditions. They would be reimbursed by the government with a risk-adjusted premium for every enrolee ”“ taking account of age, sex, pre-existing conditions and other factors using a formula to be determined by a new National Health Board. The system would start by covering the uninsured and those covered by their employers; in due course it would absorb Medicaid and Medicare.
This is not a single-payer plan: competition among insurers and health plans would be crucial to its success. But competition would revolve not around denying coverage by excluding bad risks, but around providing good results. To that end, companies would have to report detailed information on their performance and quality of service.
This is not a new idea. France’s mostly excellent system has similarities. But the presentation of the case has never been so concise or clear. Why then will it get nowhere? Because Mr Emanuel wants his scheme to be financed through a value added tax of 10 per cent, dedicated exclusively to the purpose. This instantly consigns the idea to the realm of the politically impossible ”“ but bear with me a moment longer.
At least consider that Mr Emanuel might again be right. Total spending on health would come down under his proposal….
The essential problem in America’s health care system is the widely-held expectation of first-dollar coverage by some third party. What would auto insurance cost if people expected it to include oil changes and new tires?
At a secondary level, such first-dollar third-party coverage disconnects the consumer of health services (the patient) from the providers, thus rupturing the normal price feedback mechanism common in most other parts of the economy. Patients have little (if any) awareness of cost — because they’re not paying the bill directly — and their increased demands on the system drive up prices at the same time as it encourages providers [i]not[/i] to see patients as [i]customers[/i].
Cosmetic surgery and the fatty-fixers are two notable exceptions, and the contrast in their attitudes and services towards patients is remarkable.
The specific proposal can not possibly solve the underlying problem (expectation of first-dollar third-party coverage) because it will actually reinforce that same problem by removing even existing financial incentives to choose higher deductibles.
The proposal would also force people choosing to live in a healthy manner to cover (through taxes) the increased insurance and medical costs of those far-too-numerous people who repeatedly make un-healthy lifestyle choices.
My high-deductible medical insurance costs very little because I eat properly, exercise, and have never smoked. Similarly, my high deductible auto insurance costs very little because I haven’t had a moving violation or an at-fault wreck in many, many years.
If someone can give me a logical and rational reason as to why I should be mandated to assume additional expense in order to cover the consequences of other people’s poor choices … I’ll listen. Even so, the proposal has everything inside-out and will only make things worse.
OTOH, Mr. Hall, I also eat properly, excercise, and don’t drink or smoke. But (call it bad genes or bad luck) I have not one, not two, but three chronic illnesses (including Type I diabetes and rheumatoid arthritis). Should I be charged ten times more than you because of circumstances outside my control? Not everyone who practices healthy living automatically receives a clean bill of health. I’m not trying to get into an argument – I understand where you are coming from – but those of us who have large monthly expenses for prescriptions, especially [b]preventative [/b] care like test strips for blood glucose meters, I am often in a place where I have to choose what to spend my income on… even though I have health insurance through my place of employment.
Bart – you end up paying anyway. Until we start saying to smokers, the fat, and the irresponsible – you’re on your own – we pay through taxes. Further, the system you envision would not actually discourage people from smoking or eating. They simply encourage people from staying away from doctors. Which then makes matters worse.
Part of the problem is that health is not like buying new shoes. Second, why should cost be an issue? Second – most people would end up paying less. When it all washes out, there is more money in the economy to go for other things.
In a world where we had a tax on fat or high fructose corn syrup (like we do with cigarettes), your view might make a bit more sense. But health is, alas, a public issue for lots of reasons. It tends to affect entire economies, and the current system is a big drag for corporations (which is why some auto makers prefer Canada). Sharing the burdens would actually free up more money in the economy for other worthy investments.
“Second, why should cost be an issue? ”
You priced the cost of setting up, not to mention staffing (at a living wage) a hospital lately? Or of researching and developing a new medical technology or pharmacology (such as the MRI that would have saved my aunt’s life 3 decades ago, or the Salk vaccine that came 2 years too late to save my grandmother)?