Should the public, especially those who will be coming in to Medicare in the next decade and after, take a chance that the Higgs particle of healthcare will emerge, or is it too much of a gamble, as Sanger-Katz seems to suggest? She notes that, in theory, the market would reward insurers that find innovative ways to delivery care by limiting coverage for costly, unproven treatments or by paying doctors for quality, rather than for the number of services they perform. But, “There are basically no examples of this in the US healthcare system,” she reports, and suggests that the opposite might happen when a few powerful insurers and a few powerful hospital systems run the show, as she has noted in her earlier reporting.
Voucher advocates say they’re worth a try, arguing that any valid cost-saving theory should be tested. The public seems less inclined to gamble, however. In our highly unscientific CJR Town Halls in the swing states of Missouri and Pennsylvania, we found that retirees and those nearing retirement did not like the idea of vouchers at all. Jackie Calmes of The New York Times reported over the weekend that a Times/CBS poll found that three-quarters of voters want to keep Medicare the way it is. “I don’t trust anybody who says ‘voucher,’” said Gary Fieldsend, a 62-year-old New Hampshire voter.
Sanger-Katz has advanced the voucher discussion by exposing that the foundation and driving force for Medicare vouchers rests more on ideology than on hard evidence. The National Journal piece is a refreshing must-read, and we hope it comes up in the October 3 presidential debate on domestic policy.