Polimom Says

Vouchers, healthcare, and nationalization

There’s been an excellent debate / discussion going on about school vouchers (here, here, and here), and the reasons they’re being resisted by some (many?) folks. Unions, and their motives / purposes, are interesting topics, but I have a separate question altogether.
Megan McArdle wrote (on the subject of school vouchers):

1) A voucher system which required lottery admission, gave out more money on the basis of disadvantage, and required schools to meet certain standards, would be preferable to the current system.
2) We can’t, however, get there, because there are too many political obstacles.

a) It would be unconstitutional
b) It’s not feasible politically
c) It’s not feasible institutionally

3) Therefore maybe we can muck around with charters, but don’t go crazy!
Point 1 we agree on; I think it’s fair to say that a voucher should not be used at Tom’s House of Arithmetic and Billiards. We undoubtedly will quibble about the details, but that’s a negotiation for later.
Point 2a seems silly in the context of a national healthcare debate; if nationalising the healthcare system can be done under the commerce clause, I bet I can find room for education, too.
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Can somebody explain to me why, exactly, nationalization has become The Vehicle for a healthcare system? There are a number of interesting state initiatives under consideration (or in the fledgling stages of implementation), and frankly, that’s about as wide an umbrella as I think can be efficiently managed.
We have federally-funded programs (Medicare and Medicaid) that are handled differently:

Medicare, as McArdle describes, is effectively a voucher program, wherein the beneficiary takes his “voucher” to the (participating) provider of choice.
Medicaid, however, is managed at the state-level, but funded jointly by federal and state tax dollars.

Has there been a comparison of these two models in terms of efficiency, quality, and rate-leverage?
I agree that the healthcare crisis is an enormous problem. I’m very interested in proposals and solutions — but I cannot get behind any plans that rely on the federal government’s management.