Wednesday, June 08, 2005

Universal Healthcare Vouchers

Washington Monthly has a suggestion for a form of universal health coverage which avoids many of the political obstacles to a single payer plan. While I'd suggest checking out the full article, here's a summary:

Ten Principles of Universal Healthcare Vouchers:

1. Universality: Every American under 65 years of age would receive a voucher that would guarantee and pay for basic health services from a qualified insurance company or health plan.
2. Free Choice of Health Plan: Individuals and families would choose which basic insurance program or health plan they wanted among several alternatives.
3. Freedom to Purchase Additional Services: Americans who wanted to purchase additional services or amenities, such as wider choices of hospitals and specialists, or more comprehensive mental health or dental services, could do so with their own money.
4. Funding by an Ear-Marked Value-Added Tax: Earmarking creates a direct connection between benefit levels and the tax level, serving as a political restraint on health care inflation. If the public wants more services to be covered in the basic plan, they must be willing to support a tax increase.
5. Reliance on Private Delivery System: This proposal does not call for government health care and would not legislate changes to the current private delivery system. Health insurance companies and health plans would continue to contract with physicians, hospitals, rehabilitation facilities, pharmacies and other providers for services to the individuals who enroll in their plans.
6. Ending Employment-based Insurance: Experience demonstrates that health insurance provided by employers lowers wages, raises prices or reduces employment. The end of employment-based health insurance would translate into higher wages, lower prices, and the recapture of lost tax revenue.
7. Eliminating Medicaid and Other Means Tested Programs: Since every individual and family would receive a voucher, there would be no need for Medicaid, the state Children's Health Insurance Program (S-CHIPs), or other means tested programs. Those covered by such programs would be incorporated into the mainstream health care system without means testing.
8. Replacing Medicare over time: While no existing beneficiary would be forced to change to the voucher system, Medicare would be phased out over time. Individuals turning 65 would continue to be enrolled in UHV; there would be no new enrollees in Medicare.
9. Administration: Modeled on the Federal Reserve Board, management and oversight would be the responsibility of a Federal Health Board with multiple regional boards to facilitate implementation of programs in different geographic regions. The board would be active contractor with health plans, defining and periodically modifying the basic benefits package, informing Americans about their health care options, reimbursing health plans, and undertaking data collection and research related to patient satisfaction, quality of care, and risk and geographic adjustments for payments. The board would regularly report to Congress on the health care system.
10. Technology and Outcomes Assessment: An independent Institute for Technology and Outcomes Assessment would be established. Its research and database would focus on assessing the effectiveness and value of different interventions and treatment strategies and disseminate information concerning outcomes of treatments delivered in regular practice.


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