What's wrong with Medicare vouchers? There has to be a "better way."

By Jim Buchanan

Here in North Carolina, through painful experience, we know a thing or two about floods. With a flood, most of the focus – necessarily – is on not being swept away in the turbulent waters. But there’s more than the rushing waters. There’s what’s beneath – who knows what kind of contaminants picked up in the deluge, who knows what kinds of creepy-crawlies lurking beneath.

That’s the way it is with Washington these days. The normal trickle of news out of the White House and Congress has turned into a flood of information. Beneath the roiling surface of that flood there are things of which we’d best be wary.

While the nation is distracted by a torrent of news, political leaders inside the beltway have been busily working toward painting a bullseye on the back of Medicare – “bullseye’’ in this case being spelled v-o-u-c-h-e-r.

Vouchers are an idea that has been floated repeatedly, a favorite of House Speaker Paul Ryan, R-Wisconsin. Ryan’s vision goes by the benign moniker “A Better Way.’’ The end vision of A Better Way would offer privately-managed health plans, with the government providing a stipend, or voucher, enabling people to buy their own health insurance.

That sounds nice in theory, but has a lousy track record in reality. If voucher attempts had worked in the past, we’d have such a system already in place. Instead, reduced coverage, annual and lifetime caps, higher deductibles and skyrocketing cost growth promise to be the legacy of vouchers.

Currently, Medicare provides a guaranteed level of coverage for doctor visits and hospital care. With vouchers, the guarantees disappear. Medicare as we have known it will cease to exist.

Back when Ryan was taking the first bite at this apple in 2011, the Kaiser Family Foundation estimated that by 2022 health care spending under vouchers would consume about half of a typical 65-year-old’s Social Security check, compared to 22 percent under current Medicare.

Spending aside, there’s also the prospect that if you couldn’t afford available plans with what a voucher is worth you’d simply be out of luck. That’s a hard sell, so don’t except to hear much about it. Instead, expect to hear a lot of talk in coming days about Medicare being doomed. You’ll also hear the phrase “entitlement reform’’ bandied about quite a bit.

That’s a nasty little rhetorical shift that should be surprising, and insulting, to anyone who has paid taxes into the system during a working career. Now that you’re expecting some of that money back, it’s suddenly become an entitlement. The voucher selling point is that it would spur competition and offer more choices thanks to the wonders of the free market.

But as the value of vouchers are not designed to keep pace with the rate of healthcare inflation, and given the fact private insurance costs generally rise faster than the costs of Medicare, it’s easy to see that the voucher concept simply transferring costs government to seniors – and increasing them along the way.

Wendell Potter, a former health insurance industry executive turned consumer advocate, pointed out the pitfalls of the private market salvation theory in a 2015 commentary.

“Consider this: one of the reasons Medicare was created in the first place was because insurance companies really didn’t want old people as customers. To discourage older folks from even applying, the insurers adopted the practice of charging people five to ten times as much as younger people for the exact same policy. Worse, they refused to sell coverage at any price to people with pre-existing conditions. It’s little wonder that growing numbers of senior citizens were going uninsured.’’ (Incidentally, older folks can be charged five times what younger people pay under the ACHA. The classics never go out of style).

Writing in Time Magazine, here’s what AARP President

had to say about premium care back in January: “While Speaker Ryan has dubbed his voucher-based approach ‘premium support,’ no one should be misled by the benign-sounding term. This is a clear downgrade of the Medicare benefits people have earned throughout their working lives, and the use of buzzwords like ‘modernization’ and ‘choice’ cannot hide the fact that seniors will be asked to bear more risk at greater personal cost.”

Vouchers represent a static sum, which might sound nice in theory but don’t hold up under the harsh light of reality. The health of human beings is not static. Vouchers would seem to be a clunky solution should you wander out of your Goldilocks health zone.

It’s easy for all this to get lost in the flood of 24/7 news alerts consuming our time these days. But there are some nasty things like the voucher push lurking underneath. We’d best keep our eyes peeled.


Jim Buchanan is editor of special projects for the Sylva Herald. He also writes a column for AARP.