There is no need to complicate things... These will involve bureaucracy, unnecessary costs and inefficiency... The rebate doesn't work, because what you end up paying for the shitty services, bureaucracy and mismanagement is always way more then the rebate you get and the government will ever increase the "basis" you have to pay...
The voucher would be a lesser evil, since it would promote competition at least, but it is still a very poor choice because it doesn't allow the type of personalization that health services require.
These suggestions always address the point that "health care is expensive" trying to dilute costs, but nobody talks about the reasons it is expensive. THAT IS MUCH MORE IMPORTANT QUESTION, one that I addressed in my first post.
That said, first one has to bring down costs and increase efficiency by freeing the health care market from the the unions, bureaucracy, protectionism... And then begin to really consider additional options, IF NECESSARY(WHICH I HARDLY THINK WILL BE NECESSARY).
Here is a great lecture on the subject:
As a Libertarian, I used to think as Friedman did. Friedman is talking here of the "free enterprise"* solution to unaffordable medical care costs. He is speaking of the evils of what economists now call "regulatory capture." I think he is correct in regard to regulatory capture. If, in the U.S., we simply moved to Single Payer without addressing the problem of regulatory capture we wouldn't accomplish much.
His assumption, however, that high cost (~1965) is due to advances in medicine and people demanding more sophisticated medical treatment is on very shaky ground, though it is a popular assumption made by those trying to find excuses for our absurd medical costs.. It ignores today's reality that medical care is just as sophisticated in the other developed nations as it is in the U.S.; yet costs in these other countries are far lower. It is more likely, IMO, that high costs in the U.S. are to a significant extent due to regulatory capture favorable to providers in combination with the buyer, i.e., the patient, not being able to walk away from a deal they don't like. The latter is characteristic of medicine everywhere, but the regulatory climate is far different elsewhere. It is far less favorable to providers. I think Friedman is both right and wrong. He is right about regulatory capture holding up prices, but wrong about the cost effects of advances in medicine. This latter factor should actually reduce costs; not increase them as he seems to have suggested. But in the presence of regulatory capture these advances can not work their magic, which would otherwise reduce costs.***
In most countries there are prescribing pharmacists (this is a major cost saving feature that regulatory capture in the U.S. prevents, and something Friedman did not mention) and , importantly, regulatory capture, in general, is largely absent from the national health plans of other countries. Absence of regulatory capture, however, should not be confused with absence of regulation, these are two quite different kinds of regulation. Participation in national plans elsewhere is mandatory so there is true cost sharing. The healthy share the costs of the Sick. There are tight cost controls, and if insurance companies are involved, e.g., Switzerland, they are highly regulated in favor of the patient and uniformity, despite different companies being involved. The national health plan is the same throughout the entire country. (There is no opting out of parts of the plan by specific provinces to screw up the works, as in the U.S.)
And too, while people in other countries sometimes find it advantageous to purchase supplemental insurance that augments their national plan no country other than the U.S. has duel health plans, one private the other public, which must be paid for simultaneously, but can't be used simultaneously. I'm speaking here of our way of paying for medicare our entire working lives and beyond into old age while simultaneously paying for private health insurance during our working years. No one yet has convinced me that this isn't an absurd idea. We offer up to the private, for profit insurers the low risk younger population; then we dump the elderly in their sick and waning years onto medicare that they have also paid for, while letting the private companies off the hook. Of course we wouldn't want to cut the private insurers out entirely of the profitable elderly market, so we generously let them sell supplemental policies to the elderly. In all the sane countries of the world people pay just one health premium for their Uniform National Health Plan,. We are the only country that gets to pay two premiums. This is a plan that only a "stable, genius" might come up with. I think I know where we could find one.
The weakness in Friedman's 1965 argument, I believe, is his failure to recognize that a critical element for a satisfactory free market solution is missing in many instances of U.S. provider-patient interaction. In those instances the customer cannot shop and walk . Because of this missing component, providers, if allowed, can charge far more than would be the case in a true free market* transaction. Hence the need for regulation!; but not the kind of regulatory capture that exists in the U.S. I think our brand of U.S. capitalism, which is warping more and more toward "corporatism" or fascism with regulatory capture as a prominent feature, makes us incapable of solving our health care problems without a genuine crisis occurring first.**
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* There is a dichotomy of meaning to the phrase "free enterprise". Friedman is using the expression in the noble sense where everyone is free to enter the market on equal terms and the buyer and seller can both walk away from a deal they don't like. The other more pernicious meaning of the same phrase, "free enterprise," is synonymous with laissez faire and refers to the absence of government oversight of business so that businesses are free to do whatever they like, including form Cartels and Monopolies and lobby for regulations that facilitate capture of a market and the shutting out of would be competition. This latter definition is the business man's definition. It has also become, judging by actions rather than words, the definition adopted by certain government operatives, including many in Congress today.
**There was a time in the U.S. prior to the introduction of Medicare, when medical costs were far more affordable (prior to the 1930s there was no concerted effort to limit the number of new physicians). There was no laws preventing a physician or hospital from turning away a patient. Most physicians, however, considered it their duty to treat the indigent as well as those who could pay. Physicians were almost all in private practice and they varied their charges according to the patients ability to pay. During the depression the attending physician at a birth might receive a freshly plucked chicken in payment! Hospitals for patients who could pay might turn away those who could not. In Cities there were separate facilities for charity patients. There was at that time a vast difference between the standard of care for the indigent and that for those of means. That would not be acceptable today. If one were to pass down the hall of the Cook Country Charity Hospital in the Chicago of the 1930's the scene with gurneys lining the walls would have been vastly different than what you would find in a Chicago Hospital in 2018.
***A cost factor that I omitted and Friedman did not mention (it was far, far less important in 1965) is the horrible inefficiency of the U.S. system, with duplication of tests, poor communication among providers to the same patient, mountains of paperwork and layers of personnel between the patient and an actual physician. If one was in a contest to design the most inefficient system possible, this U.S. Health delivery system is the one you would design.
