She then went to the voucher wellspring—the Heritage Foundation—the conservative policy think tank, which has been pushing Medicare vouchers since the mid-1990s. A Heritage blueprint for reform claims vouchers could reduce Medicare spending by $702 billion over 10 years, but, says Sanger-Katz, Heritage estimates no savings from competition’s effect on the health sector. “It’s kind of like trying to find the Higgs particle in healthcare,” says Rea Hederman Jr., a Heritage research fellow. “We know it’s out there, but we don’t have the tools to find it.”
It’s reasonable to think that the evidence might have surfaced—one way or another—in the 17 years since Heritage begin promoting vouchers and competition to the media through a series of “Dear Journalist” letters and executive memoranda, which heavily influenced press coverage in the 1990s. In launching its quest for vouchers in the summer of 1995, Heritage noted, “A Medicare system based on consumer choice and market competition would mean choice and security for today’s elderly and a strong and solvent retirement health-care system for future generations.” But apparently, the evidence is hard to come by.
Sanger-Katz also consulted the Congressional Budget Office (CBO) for evidence backing up the voucher theory. None there either! She reported that the CBO has looked “repeatedly” at this question over the years and “has found no conclusive proof that insurance competition lowers health costs.” CBO director Douglas Elmendorf, in House testimony earlier this year, told members of Congress he could not “score,” or measure the dollar savings, resulting from competition because “we don’t have the tools.”
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.