I was pretty taken aback last week by the white hot blasts of vitriol unleashed at Ezekiel Emanuel over his Universal Healthcare Voucher proposal. The reason I was taken aback is that universal healthcare is a fundamentally liberal idea, and the only real point of contention in the comment threads was over which kind of universal healthcare is better: a single-payer plan or a plan that incorporates competition via insurance companies? Why then was UHV treated as if it was an idea on loan from the Heritage Foundation?
I'll take a stab at this.
Let's stipulate, right out of the gate, that healthcare is not a zero-sum proposition. Vaccination and routine screening, for example, are two areas where we can spend money to save money in other areas. So we can't just say that because private health insurance costs money, it's necessarily better to take it out of the system. Some expenses in health care constitute investment and therefore pay for themselves.
But. For-profit insurers are a big part of what is wrong with our current system. For-profit pharmaceutical companies are another big part, but this - vouchers - is about insurance. Insurance takes money out of the system as profit and represents an additional cost because of the layers of transaction and regulation it requires. And it gives us nothing
in return. Study after study has found that the only way to solve this is with a single-payer system. So whenever anyone - from Hillary Clinton to Ezekiel Emanuel - stakes out a position that includes private insurers, I for one can't take them seriously.
Real reform of America's healthcare system means taking the insurers out of it. Yes, it means doing serious battle with incredibly well-financed vested interests; yes, it's been tried before and failed - but it's the only real option we have. So when yet another well-intentioned soul puts forward a plan to reform healthcare without eliminating private insurance, the most responsible reaction is to slap it down.
Furthermore, vouchers - whatever their actual merits may be - have routinely been used by the Right and by Libertarians as a sneaky assault, particularly in the area of education. Suggesting vouchers for healthcare as a way of keeping insurers involved (or of deflecting their attacks) makes me very suspicious. I see this as an either-or tradeoff between private insurance and public healthcare; muddying that picture with vouchers serves no constructive purpose.