Friday, December 13, 2013

Republican Solution for Everything? Vouchers, the Convoluted Plan falsely portrayed as "Free Market."

Salon's MICHAEL LIND wrote the definitive piece on conservative Voucher-Mania. We kind of knew something was deeply wrong with this snake oil scheme:
Voucher-mania: Why the right is diseased (and out of ideas): Conservatives have exactly one answer for all spending questions -- and it has little to do with serious economics.

“Vouchermania” may be the term used by future historians to describe the puzzling rage for vouchers that has swept the right wing in the last few decades. You got a problem? I got a voucher.

Education? The right wants to give people vouchers to buy K-12 schooling from private schools, or, failing complete privatization, from charter schools.

Healthcare? The right wants to replace Medicare and Medicaid with vouchers to let people shop for health insurance or healthcare in a deregulated healthcare marketplace.

Retirement?  The right wants to privatize Social Security, replacing it with tax-favored individual contributions to private retirement savings accounts — a de facto voucher system.

There's a trick, a gimmick, to vouchers; an excuse to use unlimited taxpayer funding for special interest groups:
In order to be electable, conservatives have to abandon pure libertarian principle and accept the idea of vouchers funded by taxation — even though this is really just “voucher socialism,” as hardcore libertarians sometimes point out. How are voucher systems, funded by taxation, supposed to save the taxpayers money, compared to public programs?  

Conservatives and libertarians put forth ... Competition among multiple providers of education, health or retirement security will drive down prices. This rests on the assumption that the government is an inefficient monopoly. 
This is where voucher logic goes off the rails:
Vouchers will reduce costs by discouraging over consumption of particular subsidized goods and services by citizen-consumers. This rests on the assumption that rising costs in healthcare and higher education tuition are caused by Americans buying too much of both.
In the medical realm, if citizens have to pay more — for example, in the form of higher deductibles — they will either force medical providers to cut costs and offer them bargains or, failing that, will go without drugs and treatment and die sooner. Either way, the public cost of healthcare to taxpayers — particularly to the rich people who pay most taxes — is reduced. 

The cost-shifting argument ... implies that most Americans, including most Republican voters, are “overconsuming” healthcare and higher education ... plans to use “premium support” to voucherize Medicare ... the savings would probably come from forcing Americans to consume less healthcare by making them pay more out of pocket, not from competition among providers. If major insurance companies lack the leverage to bargain down drug prices, hospital prices and physician fees, can any rational conservative honestly believe that Grandma can do so, by comparison shopping? 

But vouchers should not be used, as many on the right want to use them, as a camouflaged way to cut benefits to working-class and middle-class Americans, by increasing out-of-pocket costs. If the right wants to cut benefits for most Americans, it should say so honestly, and not try to disguise what it is doing by inflation adjustments like “chained CPI” or vouchers accompanied by high out-of-pocket payments. 

And comparison shopping is impractical in medicine, because even if prices were transparent and publicly available — and they are not in the U.S. — patients would lack the ability to evaluate particular physicians, hospitals and kinds of treatment. That’s why, in the field of medicine, the consumer can never substitute for a combination of public oversight and professional self-regulation.

All of this should be common sense. But the political-intellectual game on the right of devising new vouchers as panaceas for America’s problems continues. While conservatives have proposed housing vouchers as the solution to poverty, there appears to be no voucher that can reduce the poverty of conservative public policy thought.

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