Medicare Vouchers

Billy Bob asked what I thought about Medicare vouchers.  I like the concept.  I like anything that gives consumers more control and/or more incentive to shop.  But I'm not sure the idea is really practical.  Unless your real goal is to get rid of government participation in the provision of health care.

The problems I see:

1. Too easy to cut - the utility of vouchers depends on the worth of the voucher.  A voucher for $100 is of limited utility if what you want/ need costs $1000.  Or $10,000.  This problem is compounded by the fact that vouchers will be easy to make ever more useless:  with medical costs rising at 12% per year, all you have to do to make them nearly useless is to wait.   The value of vouchers is almost completely dependent on the willingness/ability of Congress to approve increases in their value at a rate that equals the rate of inflation in medical costs.  
2. Too complicated - the people this would affect are all over 65.  Shopping for a good deal in the insurance exchanges will be well beyond the competencies of many (maybe most) of the people who will be using the vouchers.  Witness the mess in the prescription drug benefit arena.
3. Too susceptible to graft - I admit it ; this point is paternalistic.  But the enormous complexity of the choices that will face seniors in trying to decide how to use their vouchers will create openings for the scam artists.  The problem with Paul Ryan is that he believes everyone is (or should be) just like him in terms of their abilities to weigh options and analyze cost/benefit ratios.  Also he believes everyone should by themselves be able to duplicate the analyses he gets from the staff of a US congressman.

I think this is the essential flaw in the current Republican hubris:  they actually believe that everyone is (or if they had any gumption and initiative would be) JUST LIKE ME!!!