How vouchers would address a bevy of insurance issues

Ezra Klein references Dr. Mark Smith, CEO of the California Health Care Foundation, for his explanation of how health insurance is
a four-legged stool of various needs it tries to address. Smith explained his analysis to the America's Health Insurance Plans a few weeks ago:

It’s a strange business you're in. What you are selling is four different things. Why do we want people to have health insurance? I always get some variant of four answers. 1) We want people to be protected against rare, unpredictable and uncontrollable catastrophic events. 2) We want people to be covered so they can have their preventive services paid for. They’re not rare, they’re not unpredictable. But if we have them put it on their Visa, they don’t do it. So we prepay for it. 3) So you can get discounts, and don’t have to pay rack rate at the doctor. But that’s not insurance, it’s market leverage. 4) so people who have chronic diseases don’t have to pay for the cost of their care, transferring assets from the known healthy to the known unhealthy. Each of these is a socially useful function, but they operate very differently. Saying you need to protect assets from financial loss is a difficult proposition for someone who has no assets to protect.

And, here’s how Western European style voucher programs to shop for your own insurance, versus a stereotypical single payer national healthcare plan, can address that.

The vouchers give you enough money to buy insurance that meets No. 4, even if you're not totally healthy, and No. 1.

You then choose, essentially, how much more you want to pay out of your own pocket for Nos. 2 and 3.

Ideally, we would learn from what works well and not so well in European countries to even let the voucher money be split into multiple payments, such as, perhaps, a castastrophic health insurance policy, a prescription discount policy and a wellness policy where basic checkups would be connected to a certifiable wellness plan.

Vouchers free you not just from rack rate hospital costs, but from rack rate one-size-fits-all insurance coverage.

Insurers don't want to do that because then they can't be lazy; they'll have to actually sell you plans that fit your needs.

And, folks, THAT is why, in some ways, a voucher-based plan might be a tougher sell than a single-payer. But, in other ways, it might be an easier sell within the medical world.