Word: voucher
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Dates: during 1990-1999
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...whack, too bad. "If Congress can't get spending under control, why punish the rest of the nation?" he asks. Forbes' second area of concern is education, where he embraces the Republican idea of replacing what he calls the "inbred monopolistic structure" of the public schools with voucher plans. But on other social issues he is laissez-faire--moderately pro-choice, for instance, and against restricting immigration...
...purest form, managed competition would replace Medicare with a voucher good for the purchase of the health insurance of your choice. The government would lightly supervise the available choices. You could choose an HMO, a PPO, traditional fee-for-service medicine or whatever. If your choice cost more than the value of the voucher, you would pay the difference. If it cost less, you might get a rebate. Competition to sign you up is supposed to restrain prices and guarantee quality. The health-care system for federal employees works roughly like this, and it works well. Last year premiums actually...
Certainly it is hard to see how a voucher system can save Medicare much money unless it pushes people, subtly or otherwise, away from fee-for-service and into managed care (or gets them to pay for the difference out of their own pockets). Leaked reports about the Republican plan for Medicare say that it might impose caps on Medicare's annual cost, and that if costs exceed the caps, the difference would be taken out of the government's payments for fee-for-service insurance only. That is one way to drive people into managed care...
...seniors lobby is worried that if Medicare is turned into a cash payment or voucher, it will become indistinguishable from food stamps. It will be seen more like a welfare program, and people may start to wonder why we are financing gold-plated health-insurance welfare for the elderly, many of whom don't need it, when we do nothing for 41 million Americans--mostly workers and their families--who have no health insurance at all. The worry is reasonable. But so is the question...
...call for insurance reform, which means eliminating the onerous "pre-existing condition" clauses insurance companies use to deny coverage. It also targets Medicare and Medicaid as the last great preserves of fee-for-service medicine. Price controls are rejected because they spawn cost shifting. The alternative would use a voucher system to move future beneficiaries into HMOs. Those seeking greater care would have to pay for it out of their own pockets...