WHY UNIVERSAL HEALTHCARE VOUCHERS?….I guess I am a bit perplexed by people’s reaction to the Universal Healthcare Voucher proposal. We offered this new idea for 3 reasons:

1) We don’t have universal coverage now. It is not as if the choice is between vouchers and universal coverage with single payer. The alternative is between a broken healthcare system robbing all other programs and vouchers.

2) Over the last 80 years we have not been able to enact a universal single payer system. Not Roosevelt, not Truman, not Kennedy, not Johnson, not Nixon, not Clinton could get a universal single payer plan passed. What hope is there for that proposal? Maybe some unique combination of circumstances would make it possible ? depression with war and civil unrest ? but unlikely. But the onus is on single payer advocates to show why it is likely given this history ? and that seems an unlikely proposition, a pipe dream.

3) A single government program would be massive ? 7 times larger than Medicare and 5 times larger than any European program and 10 times larger than the Canadian system. Further, government programs are slow to adapt. We need to harness other institutions and also the flexibility and innovativeness of the market while protecting people.

These three considerations lead to vouchers.

Finally, we should not react to healthcare vouchers like we react to education vouchers. There are good arguments against education vouchers ? taking money away from schools, siphoning off the best students, fragmenting a universally guaranteed benefit. None of those arguments hold for health care in 2005. Healthcare is not universal public education. We don’t have a universal health care system. Good risk patients are already siphoned off ? it is called employment based insurance. Vouchers guarantee universality with cost control in a format that can be enacted in America.