# Can America afford conservative privatization in "voucher socialism" form? **URL:** \ **Category:** Great Debates\ **Created:** [June 24, 2012, 1:29am UTC](https://boards.straightdope.com/t/can-america-afford-conservative-privatization-in-voucher-socialism-form/626117 "2012-06-24T01:29:10Z")\ **Posts on this page:** 15\ **Page:** 2
**Author:** ![Really\_Not\_All\_That\_Bright](https://avatars.discourse-cdn.com/v4/letter/r/e8c25b/32.png) [@Really\_Not\_All\_That\_Bright](https://boards.straightdope.com/u/Really_Not_All_That_Bright)\ **Post date:** [June 25, 2012, 4:01pm UTC](https://boards.straightdope.com/t/can-america-afford-conservative-privatization-in-voucher-socialism-form/626117/21 "2012-06-25T16:01:03Z")
It’s worth bearing in mind that those economic migrants (presumably) left their home countries _after_ the fall of communism. Anyway, like Lemmy and Ozzy, the NHS is one of Britain’s greatest 20th-century products. ---
**Author:** ![BrainGlutton](https://avatars.discourse-cdn.com/v4/letter/b/82dd89/32.png) [@BrainGlutton](https://boards.straightdope.com/u/BrainGlutton)\ **Post date:** [June 25, 2012, 4:25pm UTC](https://boards.straightdope.com/t/can-america-afford-conservative-privatization-in-voucher-socialism-form/626117/22 "2012-06-25T16:25:48Z")
> [@puddleglum](#): > > Voucher socialism is a contradiction in terms. Socialism means that the state controls the means of production. Vouchers mean that the state provides citizens some money for a specific purpose. They are totally different and Lind just uses that to be perjorative and to mock people for their antipathy towards socialism. > If all conservatives wanted was cheaper healthcare, he would be right. Just nationalize healthcare and announce the government was cutting it 50% and le voila healthcare is 50% cheaper. But conservatives do not just want cheaper healthcare they want quality healthcare too. In order to get both you need innovation. In areas of healthcare where consumers shop with their own money you get innovation. In optometry you get LASIC and other eye surgerys where prices have fallen drastically over the last 10 years while quality keeps getting better. Cosmetic dentistry has brought us a seemingly never ending variety of ways to keep our teeth whiter, and the prices keep falling. > His arguments about how healthcare is different are "The same is true in the case of healthcare. Apart from minor, non-life-threatening services like dentistry and optometry, there can never be a competitive market in healthcare — there aren’t enough hospitals nearby, consumers can’t judge the quality of the care they are receiving, and deregulation could be catastrophic. " Most places do have more than one hospital nearby and in the few places that do not then the threat of competition would be enough to keep prices at market rates. Consumers can definetly judge the quality of care they receive. There is plenty of information available about how good different doctors are and if more patients were choosing hospitals and doctors there would be a market for even more information. > Deregulation could be catastrophic, but it also could be great. He does not even bother to argue this one. > None of his critiques are unique to healthcare. There are lots of small towns who can’t support more than one or two grocery stores. When you go to the car mechanic you have no way of knowing how good the service you are getting is. Deregulating trucking and airplane travel could have been a catastrophe, but they weren’t. > Competition is what creates innovation. Wanting to gain market share or being afraid of losing market share is why companies innovate. We have much more people on Earth than 100 years ago and fewer natural resources. Yet we are much richer than we were then because of innovation made people produce more with less. If we want lower prices and better quality innovation is our only hope. > The government’s incentives for innovation are much worse. If they do not innovate they may get voted out of office but they may not. What if a government does a great job on healthcare but the economy tanks. They will get voted out anyway, or if they do a poor job but win a war. They will get reelected anyway. > Government is very risk averse. every government worker knows the easiest way to get fired is to show up in the newspapers. Thus it is better to be cautious and ineffectual rather than risk embarassing your boss with a high profile failure. This creates a culture that is opposed to innovation. You meant all that ironically/satirically, like **foolsguinea’s** post #3, of course? ---
**Author:** ![Voyager](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/voyager/32/133_2.png) [@Voyager](https://boards.straightdope.com/u/Voyager)\ **Post date:** [June 25, 2012, 5:22pm UTC](https://boards.straightdope.com/t/can-america-afford-conservative-privatization-in-voucher-socialism-form/626117/23 "2012-06-25T17:22:09Z")
> [@Iggy](#): > > The health care market does not have transparent pricing. Rates for substantially the same procedure can vary widely. When consumers have price information they change behaviour, even if it is the insurance company picking up the tab. > > Consultancy companies such as [this one](http://www.patientcare4u.com/Website/Consumerism.html) are even being paid by insurers because providing customers with pricing information works to save the insurer money. Transparent pricing is not practical, not for consumers. I go to a medical center with a very wide range of services. Even if there was transparent pricing (and remember, prices vary depending on the insurer) there is no way I could compare them to another provider without special tools. Even if I could, there is no way of determining which of these prices would be important to me. If I were doing pricing in this model, I’d lower the prices of checkups and dealing with colds and flu, and jack up the prices of a lot of other stuff. Insurers have an accurate model of the use of services, and the pricing is transparent to them during negotiations. They are always going to be able to do better than single customers. ---
**Author:** ![foolsguinea](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/foolsguinea/32/14751_2.png) [@foolsguinea](https://boards.straightdope.com/u/foolsguinea)\ **Post date:** [June 25, 2012, 9:24pm UTC](https://boards.straightdope.com/t/can-america-afford-conservative-privatization-in-voucher-socialism-form/626117/24 "2012-06-25T21:24:34Z")
> [@BrainGlutton](#): > > So, you’re suggesting a British-style system where all physicians are in effect salaried state employees like police officers, rather than a Canadian-style system where the state merely supplants the private health-insurers and regulates the fees and costs? Yes. It’s a slightly more efficient system in that it devotes administrative energy to supplies but not to patient billing. That said, up to the present day, we can say that pragmatically, any state-by-state reform in the USA (unless it started in Alaska or Hawai’i) was probably going to be Canadian-style. (Or French-style, with partial coverage by the state.) Each state could insure its own residents, and not have to build public hospitals with the fear that people would cross state lines to abuse them. But that’s a feature for building a state-by-state patchwork. The fact it hasn’t started yet, a half-century after Tommy Douglas, is probably due to the Federal government starting Medicare in the 1960’s. Even though it’s an ersatz French-style system which bizarrely robs working-age people to subsidize the aged, then tells us to pay for for-profit insurance after that, the existence of Medicare on a federal level makes forming a version on a state level inherently an awkward patch job. (Honestly, I’m not sure that the best way forward isn’t through a massive tax rebellion against Medicare. If enough businessmen simply refused to pay FICA, it might spur reform.) Today, we see that the states haven’t for the most part built single-payer, and in some regions, it will only come from federal involvement. If we’re going to do it all at once, we could expand (more) on the VA model to build a (more) British system instead (more) of the Medicare model to build a (more) French system. (Ideally, we’d have a system with a bit of both: public infrastructure for emergency care and infectious disease control, and portable citizen insurance for international travel.) And since our economy has pretty much killed the goose that laid the golden eggs, what with the concentration of economic power in the hands of the capitalist elite, the collapse of local bourgeoisie, and now high youth unemployment we’re told is “structural,” I think the relative attractiveness of a Medicare expansion over a VA-style system—that is, a FICA-funded insurance system over a public hospital system—is diminishing. Who can afford a payroll tax when there is no payroll? Granted, funding a Medicare overhaul not by a payroll tax, but from the general fund, funded by an income tax rise—even a _flat_ income tax—would be sufficient to overcome that issue. > [@puddleglum](#): > > Most places do have more than one hospital nearby and in the few places that do not then the threat of competition would be enough to keep prices at market rates. > … > None of his critiques are unique to healthcare. There are lots of small towns who can’t support more than one or two grocery stores. When you go to the car mechanic you have no way of knowing how good the service you are getting is. Really? And which is harder to start up, a hospital or a grocery? Granted, there is a fair bit of competition in the arena of primary care provider. That competition would be even better quality if we hadn’t somehow pushed med students out of general practice while creating a physician shortage. Thanks for reminding me. We really have multiple problems, some of which could have and should have been solved in the Bush years without socializing hospitals or insurers, and which won’t be solved by socialization as such. > [@](#): > > Deregulating trucking and airplane travel could have been a catastrophe, but they weren’t. Ask a trucker about that. > [@BrainGlutton](#): > > I would guess Jesus would say something along the lines of, “That’s your cross, physician, and you’ll bear it and like it.” Just as St. Paul enjoined slaves to meekly obey their masters (and masters to treat their slaves kindly), since slavery is but a fleeting thing of this world, and there is neither bond nor free but ye are all one in Christ – spiritually, not socially – and all the saved will be equal in Heaven anyway. No, that was Paul. Jesus would probably say we’re all Gentile and half-breed dogs, & completely irrelevant except to the ability of Jews to invest in, or something. (Seriously, read the Gospels with the idea of Jesus as a really nationalistic Jewish banker, tell me when it stops working that way.) If we were Jews, who knows? “Make me king and I’ll magically make everything better!”? Sad to say, Christianity is part of the problem. I think we are going to have to stop listening to crazy Jewish mystics of 2000 years ago and (even more so) to the goofballs who worship them, and figure out our own way. ☹ ---
**Author:** ![foolsguinea](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/foolsguinea/32/14751_2.png) [@foolsguinea](https://boards.straightdope.com/u/foolsguinea)\ **Post date:** [June 25, 2012, 9:36pm UTC](https://boards.straightdope.com/t/can-america-afford-conservative-privatization-in-voucher-socialism-form/626117/25 "2012-06-25T21:36:01Z")
To expand: > [@](#): > > “Make me king and I’ll magically make everything better!”? This is probably why so much of American Christianity—whether evangelical, fundamentalist, charismatic, pre-millennialist, “back to the book,” or whatever—is so useless to social reform. There’s a lot of hoping the Messiah will magically fix things, not a lot of trying to actually fix things. Much like the Democrats who expected Obama to be able to Franklin Roosevelt his way to massive reform without having to run progressive candidates for Congress and state legislatures. :shakes fist: Honestly, why is everyone waiting for Aragorn? ---
**Author:** ![Wesley\_Clark](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/wesley_clark/32/20581_2.png) [@Wesley\_Clark](https://boards.straightdope.com/u/Wesley_Clark)\ **Post date:** [June 25, 2012, 10:16pm UTC](https://boards.straightdope.com/t/can-america-afford-conservative-privatization-in-voucher-socialism-form/626117/26 "2012-06-25T22:16:14Z")
As far as transparent pricing, it does have a role. I have used the $4 lists as pharmacies and I have used sites like [pharmacychecker.com](http://pharmacychecker.com) to save a decent amount of money. I have been in situations where I needed two medications. medication A was 3x cheaper at pharmacy C than pharmacy D, but medication B was the exact opposite, about 3-4x cheaper at pharmacy D. So it paid to make two separate trips. Since pharmaceuticals make up about 1/10 of medical spending in the US, transparent pricing (and buying across national lines) would help people save money. But aside from that and a few other medical interventions like surgeries where you know for sure what you need such as joint replacement, obesity surgery, cataract removal, etc, how would pricing transparency really help? The average american has no medical training whatsoever, they can’t determine if the savings from an angioplasty and a stent are worth it compared to the higher cost of a CABG. If your doctor says ‘you need XYZ, but it doesn’t have to be right now’ then price matching can help. But that is only part of medical expenses. A lot of medicine is not knowing what is wrong, not knowing how to treat it, and not having a lot of time to price match. As far as I can tell, transparent pricing may help with 20-40% of medical costs (as a guess) but I don’t know how much else it would do. Seeing how 5% of people use up 50-60% of medical costs, you are going to need to address them. Truly keeping health care costs down are going to involve finding ways to manage chronic conditions cheaply. Right now we can’t do that very well. ---
**Author:** ![supery00n](https://avatars.discourse-cdn.com/v4/letter/s/5f9b8f/32.png) [@supery00n](https://boards.straightdope.com/u/supery00n)\ **Post date:** [June 26, 2012, 4:39am UTC](https://boards.straightdope.com/t/can-america-afford-conservative-privatization-in-voucher-socialism-form/626117/27 "2012-06-26T04:39:51Z")
> [@BrainGlutton](#): > > [This article](http://www.salon.com/2012/06/12/will_conservatism_bankrupt_america/singleton/) by Michael Lind in Salon argues that we can’t. In a nutshell, his argument is this: > > 1. Nowadays, American conservatives (other than the really radical hard-RWs and Libertarians) mostly are arguing, not for total privatization of public services and programs and utilities, but for their provision through “voucher socialism” – i.e., government would continue to pay for such services with tax dollars, but would not provide the goods or services or run the utilities directly, but, rather, would issue vouchers (like food stamps) to people who need them, and let them use those vouchers to buy the goods and services from private enterprise. This, conservatives argue, would be more economically efficient, because, instead of a government monopoly that allows cost-inefficiencies to flourish, there would be price-competition between the private-sector providers. > > 2. That reasoning is wrong. A voucher system works perfectly well in **some** sectors (e.g., food stamps). But many of the services in question are natural oligopolies or monopolies. (E.g., if you need a hospital, you are necessarily limited in choice to the limited number of hospitals near you.) Providing them through vouchers would enable rent-seeking behavior among the private-sector providers and drive the prices **up.** > > Makes a lot of sense to me. Anyone see any flaws in this? Oligopoly in the private sector can be regulated as the government sees necessary to preserve some degree of competition, but the government will never regulate itself to increase its competition. If you let the Republicans fix the economy, they’ll do it. The Republican ideology is the closest to perfection there is, or will ever be, in the imperfect human world. Fight it, resist it, deny it, ridicule it, say it will never work, but in the end, we will all see that the Republican ideology was right. Don’t question the ideology - you’re only making it take longer for it to be realized and put into practice. The GOP is right 99% of the time. There’s a reason why it’s called the Grand Old Party. People say it’s no longer what it was, but they’re wrong. It doesn’t make sense, but it’s right. The Republican Party is still the Party of Lincoln, and I predict that in 30 years, 99% of the GOP’s current platform will be accepted by the world as correct, both morally and in terms of efficiency and prosperity. ---
**Author:** ![foolsguinea](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/foolsguinea/32/14751_2.png) [@foolsguinea](https://boards.straightdope.com/u/foolsguinea)\ **Post date:** [June 26, 2012, 4:19pm UTC](https://boards.straightdope.com/t/can-america-afford-conservative-privatization-in-voucher-socialism-form/626117/28 "2012-06-26T16:19:14Z")
Clearly my random sarcasm has set a precedent. Sorry? ---
**Author:** ![puddleglum](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/puddleglum/32/137_2.png) [@puddleglum](https://boards.straightdope.com/u/puddleglum)\ **Post date:** [June 26, 2012, 4:45pm UTC](https://boards.straightdope.com/t/can-america-afford-conservative-privatization-in-voucher-socialism-form/626117/29 "2012-06-26T16:45:56Z")
> [@BrainGlutton](#): > > You meant all that ironically/satirically, like **foolsguinea’s** post #3, of course? Yes, These are my real feelings. The only solution is to give the government control of healthcare. As any who follow the news knows, government is omnicompetent. There is literally nothing it can’t do, unless Republicans obstruct it. Running the healthcare system will be a snap. When government runs healthcare doctors will stop insisting on the “doc fix” to up reimbursement rates and voluntarily take a 30% pay cut. Pharmaceutical companies will stop lobbying the government and start producing new drugs out of the goodness of their hearts. Bureacrats will magically know how much each healthcare procedure should costs and how many of each kind of doctor there should be. Patients will stop demanding expensive tests and be satisfied with what Uncle Sam tells them is all they need. Old people will no longer want expensive life prolonging treatment. A new department of health will be created with the cost consciousness of the Pentagon, the efficiency of the Post Office, and the compassion of the TSA. Coins will have in “Government We Trust” on them and we will all live happily ever after. ---
**Author:** ![Wesley\_Clark](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/wesley_clark/32/20581_2.png) [@Wesley\_Clark](https://boards.straightdope.com/u/Wesley_Clark)\ **Post date:** [June 26, 2012, 10:50pm UTC](https://boards.straightdope.com/t/can-america-afford-conservative-privatization-in-voucher-socialism-form/626117/30 "2012-06-26T22:50:45Z")
> [@puddleglum](#): > > Yes, > These are my real feelings. > The only solution is to give the government control of healthcare. As any who follow the news knows, government is omnicompetent. There is literally nothing it can’t do, unless Republicans obstruct it. Running the healthcare system will be a snap. > When government runs healthcare doctors will stop insisting on the “doc fix” to up reimbursement rates and voluntarily take a 30% pay cut. Pharmaceutical companies will stop lobbying the government and start producing new drugs out of the goodness of their hearts. Bureacrats will magically know how much each healthcare procedure should costs and how many of each kind of doctor there should be. Patients will stop demanding expensive tests and be satisfied with what Uncle Sam tells them is all they need. Old people will no longer want expensive life prolonging treatment. > A new department of health will be created with the cost consciousness of the Pentagon, the efficiency of the Post Office, and the compassion of the TSA. Coins will have in “Government We Trust” on them and we will all live happily ever after. It works in every other wealthy country. And an ever growing number of middle income countries. ---
**Author:** ![puddleglum](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/puddleglum/32/137_2.png) [@puddleglum](https://boards.straightdope.com/u/puddleglum)\ **Post date:** [June 28, 2012, 3:04pm UTC](https://boards.straightdope.com/t/can-america-afford-conservative-privatization-in-voucher-socialism-form/626117/31 "2012-06-28T15:04:01Z")
> [@Wesley\_Clark](#): > > It works in every other wealthy country. And an ever growing number of middle income countries. “Voucher socialism” also works in Singapore which has the best healthcare system in the world. It uses a combination of medical savings accounts and individual subsidies or vouchers. It has a free market and there is a marginal cost paid for by the patient for pretty much every procedure. As a percentage of GDP it costs one quarter of what America’s healthcare system costs. One would think that with the huge hash that Europe’s governments have made of their budgets we should look elsewhere for inspiration. ---
**Author:** ![PrettyVacant](https://avatars.discourse-cdn.com/v4/letter/p/49beb7/32.png) [@PrettyVacant](https://boards.straightdope.com/u/PrettyVacant)\ **Post date:** [June 28, 2012, 6:32pm UTC](https://boards.straightdope.com/t/can-america-afford-conservative-privatization-in-voucher-socialism-form/626117/32 "2012-06-28T18:32:40Z")
> [@puddleglum](#): > > One would think that with the huge hash that Europe’s governments have made of their budgets we should look elsewhere for inspiration. LOL. Don’t forget they all play soccer as well. And talk kinda funny. ---
**Author:** ![BrainGlutton](https://avatars.discourse-cdn.com/v4/letter/b/82dd89/32.png) [@BrainGlutton](https://boards.straightdope.com/u/BrainGlutton)\ **Post date:** [June 28, 2012, 6:35pm UTC](https://boards.straightdope.com/t/can-america-afford-conservative-privatization-in-voucher-socialism-form/626117/33 "2012-06-28T18:35:32Z")
> [@puddleglum](#): > > “Voucher socialism” also works in Singapore which has the best healthcare system in the world. It uses a combination of medical savings accounts and individual subsidies or vouchers. It has a free market and there is a marginal cost paid for by the patient for pretty much every procedure. As a percentage of GDP it costs one quarter of what America’s healthcare system costs. > One would think that with the huge hash that Europe’s governments have made of their budgets we should look elsewhere for inspiration. Wait, now, **is** it a free market? That is, is the pricing completely unregulated? ---
**Author:** ![Wesley\_Clark](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/wesley_clark/32/20581_2.png) [@Wesley\_Clark](https://boards.straightdope.com/u/Wesley_Clark)\ **Post date:** [June 28, 2012, 9:35pm UTC](https://boards.straightdope.com/t/can-america-afford-conservative-privatization-in-voucher-socialism-form/626117/34 "2012-06-28T21:35:07Z")
> [@puddleglum](#): > > “Voucher socialism” also works in Singapore which has the best healthcare system in the world. It uses a combination of medical savings accounts and individual subsidies or vouchers. It has a free market and there is a marginal cost paid for by the patient for pretty much every procedure. As a percentage of GDP it costs one quarter of what America’s healthcare system costs. > One would think that with the huge hash that Europe’s governments have made of their budgets we should look elsewhere for inspiration. if voucher socialism could give us universal healthcare for 5% of GDP then I’d be all for it. However what will likely happen in the US is health care costs will continue to grow at 5-10% a year, health insurance premiums will grow at 20-40% a year and the vouchers will grow at the rate of inflation (1-4% a year). The gap between health insurance and health care vs the vouchers will be left to the public to come up with on their own. I do not know how much of that is due to Singapore’s system though (of which I don’t know a lot about), east asian nations tend to have extremely low health spending for some reason. Taiwan, Japan, Hong Kong, etc. Hong Kong has a heavily statist health system and it is also about 6% of GDP. I’m not saying it can’t be done via a voucher system, but the voucher system in the US would not be like Singapores. The US voucher system would be the gov. giving people a subsidy that adjusts to inflation to buy health insurance where the premiums go up 25% a year. ---
**Author:** ![puddleglum](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/puddleglum/32/137_2.png) [@puddleglum](https://boards.straightdope.com/u/puddleglum)\ **Post date:** [June 29, 2012, 2:30pm UTC](https://boards.straightdope.com/t/can-america-afford-conservative-privatization-in-voucher-socialism-form/626117/35 "2012-06-29T14:30:19Z")
> [@Wesley\_Clark](#): > > if voucher socialism could give us universal healthcare for 5% of GDP then I’d be all for it. However what will likely happen in the US is health care costs will continue to grow at 5-10% a year, health insurance premiums will grow at 20-40% a year and the vouchers will grow at the rate of inflation (1-4% a year). The gap between health insurance and health care vs the vouchers will be left to the public to come up with on their own. The alternative is for costs to grow 5-10% a year, and taxes to grow 5-10% a year until healthcare consumes the entire government’s budget. The difference is that there is the possibility that the voucher scenario will reign in the growth of healthcare spending. The US government spends the third highest amount on healthcare per capita in the world but only manages to cover half of the country’s healthcare expenses. Advocates of government run healtch care seem to think that the government can double the amount of healthcare provided by the government without spending more money. Any objection to this type of magical thinking are waived away by the fact that other countries did it. What this ignores is that the reason other countries spend so much less now is that they have been spending much less for decades. The rate of growth in healthcare expenditures in the US is around the average for industrialized countries. So the only way for government led healthcare to magically make healthcare cheaper is to invent a time machine to go back to the 1960s and reduce the amount of healthcare spent then. As to your point about Singapore, asian countries definetly spend less than most other countries, but healthcare in Singapore is cheap even for an Asian country. Also look at Switzerland where the government does not provide any healthcare but subsidizes its citizens to buy health insurance. Their government spends only about a third of what ours does on healthcare, they cover the whole country, the growth in healthcare spending is lower than the median industrial country and their life expectancy at age 65 is the second best in the world. Just another example of how we should be copying success and not failure. [Previous page](https://boards.straightdope.com/t/can-america-afford-conservative-privatization-in-voucher-socialism-form/626117.md?page=1)