What if Medicare were a voucher program?

That’s what Matt Yglesias asks in a post published just moments ago, one that shares much of my own thinking about health reform:

The Affordable Care Act extends much-needed insurance coverage to the uninsured. It will be financially beneficially to most women and lower-income people regardless of their current insurance status. […] And it contains a large number of initiatives that hold at least some promise for making the American health care system a better value proposition. But […] the ACA doesn’t do nearly enough to get us where we need to be and won’t fulfill its promise unless legislators keep working at it.

Meanwhile, I think the real issues are obscured by continuing conservative obsession with repealing the Affordable Care Act. In a big-picture sense, what ACA is doing is transitioning American health care for the 64-and-under set into a means-tested voucher program. Meanwhile, the big conservative proposal is to transition American health care for the 65-and-over set into a means-tested voucher program. That doesn’t necessarily strike me as an unbridgeable chasm of principle. What if all Americans, regardless of age, got their health care through a means-tested voucher program that included a public option? [Bold mine.]

I just gave one answer in my Kaiser Health News column today: taxpayers would save $50 billion per year on a Medicare voucher program that includes a public option. Read my column (much more here too).

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