What GOP Must Do to Avoid an American NHS
Alright, US Republicans, listen up.
You think your goal right now is to “Repeal Obamacare”.
But that has issues. Given your values, your goal should not just be to repeal Obamacare, but to prevent the emergence of a single-payer healthcare system in the United States, in which the US Federal government monopolizes 1/5th of the US economy in a botched attempt at recreating the NHS.
This does not mean trying to pass laws to sabotage the attempt. They’ll just get overturned, and that will be celebrated as a Democratic party victory.
You have to deflate the demand for single-payer healthcare. That is what is necessary for market-based healthcare to continue to exist in the United States. As long as the demand is there - and it is growing, as middle-class families come under increasing pressure - the desire for single-payer will re-emerge.
Yelling at people about how they don’t deserve healthcare because they haven’t worked hard enough will not help. You just picked up a bunch of rural voters that got laid off at the factories and can’t meet their deductibles. You have to focus on preserving the market-based allocation.
There is a simple way to do this.
- Each year, every American receives a healthcare voucher for $2,500. (Maybe more - this is way below our per-capita healthcare spending - but even you can do this much.) You can hide this as an earned income tax credit for the poor, a tax deduction for the middle class, etc, if you have to.
- The voucher can only be used to purchase valid medical services and medical insurance. We have licensing for doctors, so this shouldn’t be too hard to figure out.
- Any of the voucher not spent rolls over into a no-tax/low-tax Health Savings Account, where it builds up.
- Private money can also go into the account.
- Tax is only assessed above a certain amount / on death.
- By default, it goes to a zero-interest government account, but this can be changed by opening a suitable interest-earning HSA account at any American bank or credit union.
- Hospitals are still required provide emergency care for the uninsured/poor, however, up to ½ of future vouchers can be garnished, proportional to the size of outstanding claims.
- Vouchers and money from the HSA can be given to spouses or children for their HSAs, though not other relations (normally). It can also be disbursed in a will, but if so then it will be taxed as normal income.
Now, first objection is probably that this will bid up the price of medical care to the new floor. I believe that is unlikely - because the voucher accumulates and people don’t actually like randomly buying healthcare, it makes much more sense to save it up and spend it later as you normally would, or else just buy insurance.
Second objection is that people might launder the money to get it for themselves. In this case, the person they are screwing over is mostly their future self, so they have incentive not to do this.
Third objection, which I’m likely to get from my left-wing readers, is that this isn’t enough money. That’s probably true, but this is likely of more benefit than whatever the Republicans are currently cooking up. In the current situation we have some poor people buying the mandated insurance, but unable to actually get medical care because they cannot afford the deductible. Under this system, they can go get medical care tomorrow. Likewise, for pre-existing conditions, this ensures that at least the value of the voucher is available each year to pay for it.
Later administrations could raise the amount, but the benefit for the Republicans here is the preservation of the market mechanism. This is likely to be a popular program.
This could be coupled with a variety of other reforms to reduce overall healthcare costs, such as requiring hospitals to post information about their prices, success rates, etc. Don’t just cross your fingers and hope the market works. Education alleviates information asymmetry and lubricates markets. Create the right framework for suitable informed competition to take place in.
