In his recent State of the Union message President Bush promoted the hoary old idea of expanding health care access through tax credits. These proposals cannot make coverage universal, nor would they control costs in the U.S.‘s wildy inefficient and unjustifiably expensive health care system.
Fotunately serious health care reformers in the US are rallying to a new (and old) idea: universal health care vouchers that could be used to buy a variety of different kinds of private health insurance plans. I advocate this idea of universal health care vouchers in Citizen Cyborg, inspired by the Clinton health care reform proposal and Ezekiel Emanuel’s book The Ends of Life.. Universal vouchers (a) make coverage universal, (b) ensure that all the plans that people can buy include certain benefits, (c) contol costs through administrative simplification, and (d) allow for radically diverse technological options, depending on the trade-offs that different consumers are willing to make.
For instance, the pro-enhancement plan could gene-tweak you instead of sending you to dieticians and smoking cessation, freeze you instead of torture you with protracted end-of-life treatment, and pay for your limb augmentation or gender reassignment instead of psych counseling. The religious conservatives’ plan would deny you abortion and birth control, and pay for extended care of the brain dead. Everybody’s happy.
My question about vouchers has to do with my mother. She has not been able to /buy/ health ins. for more reasons than just not having the money. Nearly all health ins companies will refuse you if you have /any/ pre-existing conditions. Or, if they take you, your premiums rates are so high as to be prohibitive.
Vouchers wouldn't mean that everyone could get healthcare unless that issue is addresses. It doesn't matter if you have a voucher for a standard amount of money if your premium will be astonomical by comparison.
Would there be a law passes stating that the price of health insurance would be standardized? If that were passed now, alot more people could be on healthcare even without a voucher.
Also, there have been problems with ins companies refusing to pay for something that is necessary for someone to stay alive. Will there be a law enacted to fix that as well? It seems to me that if perhaps health-insurance companies were required by law to offer life-insurance to their clients, then it would be in their best interests to pay for requested therapies that would keep their client alive. Just a thought.
Also, after reading from the above voucher link....
Why can't we have a single-payer system as a 'user interface' but that would still list all of the various healthcare options of different ins companies? It could also be a place were people could rate them, and easily switch between one an another without too much hassle. The SPS would also be able to deal directly with the insurance companies on disputes of payment, etc, so that the enduser did not even need to be aware of it. If the SPS has it listed as an option under your policy, then it should be handled. If you submit a request to find out if something will be covered, the SPS should be the one to do the work for you, and then to publish the findings on the informational part of the insurance companies listing.
Basically the SPS could be a regulating factor to make sure that everyone gets equal coverage, and to limit paperwork for everyone as the SPS would create the standardization across companies. Also, if you wanted a higher ins coverage or to add dental or something, you could also be able to do that through the SPS so that it is all taken care of in one place, and you would know of all your options and how people have rated them.
This would nulify the need for a voucher system because it would basically be a voucher system on the SPS side but without the enduser needing to actually get a voucher. It would look like the healthcare of other nations, but you would still be able to choose what you want (religiously slanted, or tech slanted healthcare, etc).
By creating one interface, you could have all of the benefits of both worlds, and get regulation, and lower medical costs while you were at it.
Wouldn't that bring together all the different factions into one arena?
In fact, your line of thought describes the Clinton health care reform proposal of 1994, which is my preferred reform model for US health care. It is a universal voucher system with a strong "Health Purchasing Cooperative" regulating who can sell insurance and for how much. Critically it proposed that you had to charge a flat community rate, not a risk-rate; that the rate had to be within a certain range; that you had to provide a certain minimum package of services; and that you had to accept all comers.
Those reforms would have meant only about a dozen of the largest insurers would have been able to stay in the market, but they would have been able to develop different packages of services and compete for the annual vouchers.
Without all of those pieces, there are many potential unintended consequences. So yes, I support a more radical reform than simply universal vouchers. But even that is a bit of a stretch right now I'm afraid.
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