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Voucherizing Medicare

So there it is: the draft Republican platform says of Medicare and Medicaid,

The first step is to move the two programs away from their current unsustainable defined-benefit entitlement model to a fiscally sound defined-contribution model.

That means that instead of Medicare as we know it, which pays your medical bills, you’d get a lump sum which you can apply to private insurance — they’ll yell when we call it a voucher, but that’s what it is.

No doubt I and others will have much more to say about this, but let’s just ask the question: why is this “fiscally sound”?

Bear in mind that health expenses will still have to be mainly paid for by some kind of insurance; that’s in the nature of medical care, with its high but unpredictable cost. So what we’re doing here is replacing government insurance with a program that gives people money to buy private insurance — that is, adding an extra layer of middlemen. Why would this save money? I guess the answer is supposed to be the magic of the marketplace — but we have the experience of Medicare Advantage, plus studies of Medicaid versus private insurance, plus the raw fact that America relies more on private insurance than any other nation and also has by far the highest costs. Nothing, absolutely nothing, in the record suggests that this will do anything other than make health care less efficient.

And for those demanding documentation, it’s coming; too busy today.

So where are the savings? The answer is, it’s basically a way to deny health care to people while denying that you’re doing so. You don’t say, “we won’t pay for this care”, you just hand people a voucher and let them discover that it won’t buy adequate insurance. It’s health-care rationing — but by money instead of deliberate choice.

It would be far more cost-effective, not to say humane, to make actual choices — to decide that Medicare won’t pay for procedures of little or no medical value. (As always, individuals who can afford it can buy whatever care they want). And Obamacare makes a start on that. But hey, that’s death panels.

So instead of making choices, we’ll let people die because of inadequate assets. Fiscal responsibility!

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