Saturday, September 12, 2009

Obama Supports Vouchers

for healthcare.

At least, that's how I interpret the descriptions I have seen of his current plan, although I gather any interpretation is pretty uncertain at this point. He appears to be proposing:

1. That everyone be required to have health insurance.

2. That low income consumers get their health insurance subsidized.

3. That there be a "public option" that is not subsidized.

Combine those, and it looks as though low income consumers are getting a voucher that they can spend on either private or public health insurance. That's almost precisely the plan that Obama rejected for schooling when he decided to cancel the D.C. voucher experiment. The only differences are that, in the schooling case, there was still a net subsidy to the "public plan," since the amount of the voucher was less than the per pupil expenditure in the public schools, and that in the health plan, some consumers will be paying part of the cost of the public plan with their own money.


Karl said...

That's occurred to me, as well, but there are certain political factions that have done their level best to make "vouchers" a swear word – at best.

jimbino said...

I would still like to someone speak to the problem of American expatriates or tourists who will NOT have access to the Obamacare that they have been paying for through taxes or penalties.

There are some hundreds of thousands of us in that situation, including all the Medicare eligible, who can get NO Medicare outside the US.

whswhs said...

"Part of the cost" somewhat understates it. As an uninsured man, I have looked with concern at the reimbursement rules for both HR3200 and Baucus. HR3200 has a maximum percentage of gross income that people are required to contribute to their own health insurance, starting at 1.5% at 133% of the Federal Poverty Level and rising to 11-12% at 400%; people under 133% get Medicaid and people over 400% have no limit on what they are required to pay. Baucus, less generous, stops the subsidies at 300% of FPL and requires payment of 13% of gross income. I used to pay 12.5% of my gross income for catastrophic health insurance, back when I could still afford health insurance, and I can tell you it was no joke. And under Baucus, I would not be eligible for any subsidies . . . and the cheapest comprehensive insurance plan available to a single man in Massachusetts (which already had most of the requirements for insurance that Obama wants to impose nationally) is just under $10,000 a year, which would be substantially more than 13% of my gross income.

I expect that if the plan goes into effect . . . note that it's carefully scheduled to do so in 2013, after Obama's (hypothetical) second inauguration and two congressional elections away . . . a fair number of the currently uninsured will still be uninsured, but will also be paying out the 2.5% of gross income that HR3200 fines them for being uninsured, or the flat $950/person under Baucus, or whatever Obama gets Congress to agree on.

Maxim said...

But Obama is on the record saying that he supports single payer, and is probably only pushing a voucher-like system because single-payer wouldn't work politically. So his views on health and education are at least consistent...


Roger Koppl said...

Nice analysis, David. Thanks for that.

Anonymous said...

You're missing a key component of HR3200-- it bans the sale of private insurance. The grandfathering clauses also prevent any changes to terms or rates (both of which can be mandated by state insurance boards to change) or the plan loses its grandfathering.

Thus, HR3200 will remove private insurance from the marketplace over several years.

These "vouchers" along with everyone buying their own insurance will have to go thru the "Exchange" where governemnt sets all the terms of coverage and rates.

Thus there is no more market in insurance and the primary advantage of vouchers-- allowing the market to try to best fill the need-- is obliterated by HR3200.