So this is not my first attempt at blogging – before I posted the “official” first post, I removed a set of posts from my prior blogging attempt two years ago. Ha! I don’t recall deciding to focus on healthcare, but that’s what all the prior blog posts were nearly all about. And we’re still talking about it! But we’re no closer to a solution.
Here’s the deal: the Republicans really just want to go back to the status quo ante. No Obamacare, and periodically we’ll hear “repeal and replace” – but the “replace” doesn’t really seem to be much, just malpractice reform or the usual “buy insurance across state lines” (that is, to circumvent state-by-state coverage requirements). And, to be sure, there’s no shortage of problems with Obamacare – everything from the peverse incentives of the employer mandate to the free rider issue of guaranteed issue to the mess of the subsidies and everything else that’s been discussed to death.
But the status quo ante just isn’t viable. Medical costs are escalating unsustainably. Employers are cutting their subsidies for employee health insurance, and moving to high-deductible plans. I’ve read – don’t ask me to find a link now – that the stagnating salaries we’re now experiencing are to a significant degree explained by the every-increasing amounts that employers are shelling out for their employees’ healthcare. And, Obamacare or not, employers will be passing on an every-increasing share of the cost to their employees, or ceasing to provide it at all.
Periodically Republicans propose a tax credit approach — $2500 for an individual or $5000 per family, for instance – which is a step in the right direction, at least, but it doesn’t go far enough, since all individuals, and all families, don’t have the same health insurance costs.
If I were czar, as my dad would say (does everyone’s dad say that?): we’d move to a full-blown VoucherCare. Yea, the Dems used that term pejoratively, but it’s really the best way forward: vouchers for all citizens, permanent residents, and individuals on temporary work visas of whatever kind. Vouchers vary by age and sex, and, initially, health status, and can be taken to any insurer, and are sufficient to buy a catastrophic-deductible insurance policy, with the whole thing funded by, inevitably, a bump in income tax (as part of a broader tax reform, ideally).
Insurers would compete on how low a deductible they can offer for the given voucher amount, or promote their level of customer service, or have differences in the size of the provider network. In a perfect world, the disconnection from the employer would enable hospital/doctor networks to develop a “staff-model HMO”-type product aimed at the local community in a way that isn’t possible in the employer-based system, when the employer has to provide insurance suitable for all their employees in a given metropolitan area. I’m not a healthcare actuary, but I tend to think that a significant part of the solution to high healthcare costs has to be doctors, hospitals, and insurers working together as the standard model.
The policy would also cover only those treatments which have been proven to be effective, not those which are experimental or based on a doctor’s hunch or unproven conventional wisdom, and certainly not treatments or pharmaceuticals based on politics. Individuals could buy riders to cover additional treatments, or to lower the deductible. And sliding-scale clinics could provide care for those who can’t afford the out of pocket costs up to the deductible.
Is VoucherCare politically possible? I’d like to think it’s got something for everyone: for Republicans, the free-market approach with relatively few regulations; for Democrats, the assurance that all Americans would have provision for their basic healthcare needs – not the routine treatments, but the sort of bills that land people in bankruptcy.
But I don’t think Republicans really recognize that the current system isn’t sustainable. And Democrats, if they’ve relinquished the “Medicare for All” single-payer vision (let’s call it Medicaid for All and see how many people favor it), still want to keep the system tightly regulated, with the government spelling out coverage details. And no one wants to talk seriously about funding, instead playing the game that a few small hidden taxes will do the trick!
And that’s as far as I get – since I am, in fact, not czar, and don’t have the ear of any politician, I’m stuck with blogging.
But, really, say it with me now: VoucherCare!