Health care vouchers to cure our health care woes

Earlier today GWU's Department of Philosophy held its annual Elton Lecture featuring Dr. Ezekiel Emanuel, an oncologist and Chair of the Department of Bioethics at the National Institutes of Health.

In his lecture, Dr. Emanuel presented his analysis of what goals should we want an
ideal health care system to achieve? Which health care reform best realizes those goals?

Dr. Emanuel identified seven goals of reform: cover everyone, control costs, provide integrated high quality care, choice for consumers, fair financing mechanisms, medical malpractice reform, and a stronger economy. He then showed quite convincingly that our current health care system falls quite short of these goals. Some of the highlights of our system failings include the 47 million uninsured, fragmented care system (e.g., the typical Medicare patient sees on average seven different physicians including five specialists), and subpar medical care (e.g., a RAND study in NEJM showed that people receive 55 percent of recommended care).

The Guaranteed Healthcare Access plan is Dr. Emanuel's prescription for our ailing health care non-system. He argues that his plan both reforms the financing and delivery side of health care creating a more equitable and sustainable system. Under the Guaranteed Healthcare Access plan all Americans would receive a health care voucher, fully funded with a 10 percent Value Added Tax (yes, VAT would be a new sales tax), to sign up for a private health insurance plan. The health insurance plans would offer a standard set of benefits equivalent to the Blue Cross Blue Shield PPO plan in the Federal Employee Health Benefits Program. Those who wish additional insurance protections could purchase supplemental policies with their own after-tax dollars.

The overseerers of this sytem would be a Health Care Board (modeled on the Federal Reserve Board) that would determine the benefit package, oversee regional insurance exchanges, and regulate health care plans.

The final two major pieces of this plan are an Institute for Health Technology Assessment and Center for Dispute Resolution. These entities protect beneficiaries; eliminate the need for medical malpractice insurance; and compare the effectiveness of health care services.

For those interested in learning more about this plan, Dr. Emanuel recommends http://www.fresh-thinking.org/ and http://www.healthcarevouchers.org/.