Maggie Mahar Looks at an Alternate Approach: Value Added Tax

'Tis the season. Election season, that is. With health care hot on the topic list for politicians, 47 million uninsured, and voters in general, it seems only appropos to look at some of the ideas floating up from the Blogosphere.

Maggie Mahar examines a plan proposed by Dr. Ezekiel Emanuel in her most recent post on Taking Note (which is, if you are unaware, a Century Foundation website). In the spirit of George C. Halvorson's exhortation to examine foreign systems in order to inspire the development of a uniquely American one, Dr. Emanuel proposes a Value Added Tax (VAT) to consolidate health care payment. While this may or may not be the correct path to take, the arguments as framed are rather compelling:

Here is how the plan works: Every American would receive a voucher for individual or family coverage. The vouchers would be of equal value and all insurers would be required to offer the same comprehensive benefits package to anyone who applied—young or old, sick or healthy.

Insures would report to 12 Regional Health Boards. Each Board would have a Center for Patient Safety and Dispute Resolution staffed by patients, physicians and lawyers that would receive and adjudicate patient complaints, compensate patients, discipline and disqualify physicians responsible for repeatedly injuring patients, and fund and develop patient safety programs. (Patients not satisfied with the Board’s resolution of their complaint still could sue for malpractice).

The Guaranteed HealthCare Access Plan pledges to cover the 257 million Americans who are not now on Medicare at a cost of nearly $1 trillion. This number includes what we now spend on employer-based insurance, Medicaid and SCHIP –plus what it would cost if the uninsured had employer-based coverage.

People who are now enrolled in Medicaid, SCHIP or Medicare would not be forced to switch to the new Guaranteed HealthCare Access Plan, but if they chose to, they could. For the time being, probably most seniors on Medicare would stay put. But over 15 years, these three plans would be phased out.

It is nice to run across a fresh perspective. Ms. Mahar's post goes in depth examining various permutations of this plan such as

• Why not just raise income taxes instead?
• How is the VAT an incentive to reduce waste?
• How will the Guaranteed Health Access Plan reduce administrative costs?
• How to protect the Health care system from lobbyists.
  
• The creation of an impartial Institute for Technology and Outcomes Assessment to provide impartial testing and review of new drugs and technologies
  

The article is rather long, but chock full of information and links back to relevant source material. Another course on the banquet of "food for thought" that is laid before the American voting public. Please feel encouraged to join the conversation in the comments both here and on Taking Note.

SOURCE: "A Fresh Look at Health Care Reform: Part II" 06/05/08
photo courtesy of Phillip, used under its Creative Commons license