I don’t know how feasible this is, but would it be possible or workable to have a confederation of liberal leaning states to sign onto common framework of healthcare policy that implemented a more robust universal healthcare scheme?
I think it would be a mistake to try the Vermont model, where a tiny zero population state tried to go it alone, but if California/Oregon/Washinton/NY/etc banded together, they would be harder to strong arm due to their own market power. Would that even be legal?
Conservatives often say the states are the laboratories of democracy, well why not provide a genuine experiment? The conservative states can maintain the shit sandwich of employer based healthcare and private insurance with no subsidies.
And liberal states can have a more robust universal healthcare scheme implemented. The exact kind I am not specifying because that can be hashed out later, but ideally it would have more teeth than what obamacare tried.
There are some basic problems I can forsee, and many more I cannot. One big one is if the liberal states succeed in proving superior healthcare that covers all state residents at a much lower total cost, what is to stop the marginalized populations from conservative states whose primary health policy for the less well to do is die on the street if you don’t have enough money to pay? Unfair characterization? Fine, wait until the person without the money to pay for care is so sick and near death they are two shades away from the grave before they get a micro stay in a hospital before they are ejected back on the street. I am sorry but I don’t have a lot of fair minded views of conservative attitudes on healthcare policy. If it came to you keeping a few percent more tax dollars vs help keep people from dying for lack of care, I have no faith you’d choose the latter. And in that choice it exposes the lie you tell yourselves and others that you give a shit.
Will there be an exodus into liberal states to gain care? If we require state residence will that create a migration to liberal states? Great for the census long term, but in the short term what will that look like? It’s issues like that, along with the legal constraints that make me wonder how feasible something like this would be.
But if it was feasible, I think the drug prices for these areas would be a lot lower, if the big population center states set price caps on drugs, they would lose a lot of money if they chose not to sell them there for inflated costs. The drug companies would sue, would they win? Could a system be constructed in such a way to allow the system to function?
I’m asking all of this because I have very little faith we will get something more robust on a federal level, unless Trump turns out to be a genuine liberal Manchurian candidate, that single ray of hope left over in the pandoras box of his presidency.
I’m under the impression that Obamacare is pretty damn similar to the Ronmeycare legislation passed in Massachusetts – which always made me wonder why the GOP was so against the ACA (gee, you think it was somehow related to the fact that Obama is a Dem or African-American or both?). So it’s clear that it’s possible for states to enact some form of universal healthcare.
I think the stumbling block may be related to Medicaid. That is, can a state devise a program that wouldn’t cause them to lose federal funds allocated for Medicaid?
As to whether poor people would flood the state to get (finally) decent healthcare, I’m not sure what would happen. On one hand, the thread on rural hunter-gatherers has made it clear that these people won’t move to urban areas to get jobs, preferring to stay in poverty in the area they’ve always lived. (OK, I’m misstating the argument somewhat.) OTOH, while you might not want to move to get healthcare for yourself, you may be willing to do so for a child.
I wouldn’t be surprised to see California do this, perhaps in an alliance with Washington and Oregon. I also wouldn’t be surprised for such a plan to have a requirement that a person would have to be a resident for a certain length of time (say a year) before the universal healthcare would be effective. I suspect in such a case, you could buy your way into the plan by paying a hefty premium for it – this would allow employers to offer health care for new hires from outside the region.
Could these states put in price controls like other countries do? Seems like the problem is they wouldn’t be powerful enough, or they’d be constrained by existing laws, or it would be a new system pasted on top of the crappy old one.
As for out of staters coming in, they could build a big, beautiful wall.
If it was like Obamacare then you wouldn’t have to charge an extra premium for incoming employees that are on an employer’s plan since presumably they wouldn’t be subsidized by the state. You could probably not even charge an extra premium for those without employer healthcare, simply provide no subsidies for a year or so so they’d have to pay market rates.
Since Massachusetts already has it, it clearly could happen. Furthermore, MA has not imploded, gone bankrupt, been invaded by hobos, or suffered from a zombie apocalypse. (Not that I’m holding them up as a model for others, just to point out that it has been done).
It might also be worth noting that one of the problems hospitals and clinics suffer from is the patchwork quilt of insurance we have in the US. Every state has separate regulations for insurance and different coverage for in/out -network and in/out -state. Take states like New Jersey and New York that see lots of cross-state commuting: if they joined forces and adopted a substantially similar healthcare system, hospitals and clinics would see real savings in their billing departments.
There are a couple of pretty fundamental assumptions in this statement that are unfortunately common and completely wrong. People (please stop referring to them as “hunter-gatherers”; they’re human beings with hopes and fears just like you and me) don’t just stay in rural impoverished regions because they are afraid of urban areas or don’t want to leave their small town life, but also because they lack the vocational skills to obtain sustainable work in an urban employment environment, and even if they did they are too impoverished to be able to pick up and move. Without some kind of vocational assistance and training program, expecting people living in disadvantaged rural areas is just displacing the problem from those areas into cities, and all of the strife and crime that concentrated poverty creates.
The other is that the way to assure universal health care is to treat it like a government-backed insurance industry. The medical insurance industry has been notoriously unable to effectively control costs, and in fact has created an adversarial system where hospitals and medical care service companies try to spread their costs of supporting uninsured and underinsured patients on insurance companies, which fight back by limiting and denying coverage, and the pharmaceutical industry makes off like bandits providing treatments which are often unneeded and misleading or outright false information to doctors on the therapeutic uses and benefits of their products. The result is that costs are very unevenly distributed and do not resemble any kind of free market valuation, which gives lie to the notion that we should treat health care like other consumer commodities or services, notwithstanding that it is often difficult for a layman to make a credible or detached evaluation of the cost versus benefit for many services.
The Affordable Care Act is about the least worst of politically viable options, and while it has expanded basic coverage to an estimated net of seventeen million people and to an extent closed loopholes and better unified the patchwork of state programs providing coverage, it has done absolutely nothing to control cost growth. And blaming the insurance companies or expecting them to somehow reform the medical system is impractical. A single payer type system for basic medical coverage, as fiscally and practically cumbersome as it may be, is probably the only way to get genuine universal coverage and provide enough leverage over medical and pharmaceutical cost growth, and it would require a collection of states (or a really large populous state like New York or California) to force medical providers to adhere to cost guidelines without severe impact on coverage.
Colorado-Care, a statewide single payer insurance plan, was resoundingly defeated on the 2016 ballot in this bright blue state. Even the Democratic political leaders of the state came out against it.
So, sadly, I have lost hope for a sensible single payer plan at the state level.
What makes CO a “bright blue” state? HRC only got 48% of the vote there. CO has a relatively strong libertarian bent, and Gary Johnson got one of his best showings in that state. I don’t think you can say much about actual liberal states (for example, HRC got 62% of the vote in CA) based on what happens or doesn’t happen in CO.
One of the biggest problems with the current US setup is that its a kludge of systems, often duplicating work, each with its own bureaucracy, coverage and gatekeeping.
It seems to me that adding yet another system is unlikely to work. Unless funds could be diverted from Medicare, Medicaid, VHA etc.
I lost hope for single payer after both Vermont and Colorado shot their plans down. Colorado voted against single payer 80-20, which is even worse than single payer got when places like Oregon tried it 20 years ago.
What would be a good idea is opening up the exchanges so people can buy into medicare, medicaid and/or the VA system.
Creating a strong public option will provide 2/3 of the cost savings of single payer.
So while single payer programs will reduce health expenditures by 25% over 10 years, just having a strong public option will reduce costs by 16%.
So I think that is what states should look into. If possible, open up state exchanges so people can buy into programs like medicare, medicaid and the VA. That’ll drive down costs.
One problem (I imagine) with states trying to go it alone is that we have a nationally distorted pricing system since most people get HC insurance through their employers, and those premiums can be written off as a business expense. A state can’t break itself free from that pricing structure just because it institutes single payer UHC.
I live in Colorado, and I support the single-payer concept, but I voted “no” on ColoradoCare because it was completely bonkers. It sounded good when you heard the basic idea—all state residents are covered, no exceptions—but when you actually got into the details of the proposal, it was a horrifying mess. There were TONS of unanswered questions about what would be covered at what levels, and how it would interact with existing insurance and with entities outside the state. The people behind the proposal were just saying “We’ll figure all that out once it passes.” There was also widespread skepticism that CC could be sustained at the proposed taxation levels, particularly in view of the failure of the Vermont system. We were basically being asked to nuke the existing system and cross our fingers.
For me, the deal-breaker was that retirees and the self-employed would be taxed at 10%—and retirees on Medicare wouldn’t even be able to use CC as their primary coverage. (People with jobs would have paid 3.33%.) When questioned about this, the CC proponents said that retirees should take comfort in knowing that they were paying for other people’s health care (translation: sucks to be you). Oh, and they also threw in a nice goodie for the affluent: income about $350K was exempt. Yay for rich people!
There’s lots more I could get into, but I don’t want to turn this into a thread hijack. Anyway, ColoradoCare was fucking nuts, and it should have lost even worse than it did.
A state single payer + Medicare + Medicaid + VHA + etc is not really going to work I think. As far as I know, every other developed nation has one system, sometimes regionally administered, and private healthcare to fill in the cracks. Bar Canada.
One huge issue is that some states would get medical refugees from other states. What’s to stop the ill or the elderly to flocking to a state where healthcare is universal? No state can do that, it would bankrupt them.
That seems likely at first glance, but then you have to stop and consider where these people would be flocking from and to.
Basically rural red states would be flocking to the wealthier and more liberal blue states who would undoubtedly be pushing these agendas. Thing is, if these rural people didn’t move for the jobs (and the healthcare that jobs provide either through raw cash or employee benefits) these more liberal states have to offer, it doesn’t seem likely that they would move for the healthcare itself.
Even if the above is untrue, you could always concede to the necessity of long-term residency requirements, or perhaps a “you must have been paying into the program for x years before benefits start” rule, but I suspect rules like these would not be well received by the public who presumably want maximum coverage for the greatest number of people not soon but yesterday.
If that was the cost of getting something better vs the current cluster f*ck of a system, oh well. We live in an imperfect world, not a utopian dream. So those people will just need to suck it up. And frankly, my dream scenario would be for the liberal states to be free to engage in their preferred healthcare model, with conservative states trying the models they like, and see how the results shake out.
I am sick of all the talk about how conservative and libertarians ideas ALWAYS produce better results, how the free market is the best of all possible solutions to any and all problems, including healthcare. I think it’s time this talk and bullshit got put to an actual experimental test once and for all, same with the more liberal single payer plans.
What will the healthcare cost increases be in liberal states with UHC plans vs conservative market based states? I would LOVE to see that self righteous know it all smirks slapped off those arrogant conservative faces. Libertarian faces most of all, to see their world view turn to ash before their eyes with no more excuses. Or maybe they will be vindicated, either way, I am tired of the talk, I want to see proof and experiments run.
Let me be the first one to predict this: President Donald Trump will propose single payer.
He’s not an ideologue. The insurance and drug companies didn’t get him elected. The GOP didn’t either. He’ll say he’s a great negotiator, and he’ll great the best deal for the American people.