Go back far enough (even some of the early primary debates also include elements of it) and Trump was very much pro-healthcare. Single payer isn’t unimaginable from him - mostly because nothing is unimaginable from him, perhaps the worst problem with serial flip-floppers.
I’m not holding my breath in that regard, but he might go ape. Or, perhaps Orangutan.
I see what you did there. You realize, this goes on your permanent record?
States can and should try to create their own health care systems. The federal government should just stay out of it at this point.
Sure, everybody knows that, the bigger the entity, the more inefficient the government. Wasn’t that etched into the stone tablets Moses brought down? Mississippi can take advantage of its environment, where mud and leeches are easily available! Around here, if you can’t cure it with a sauna, you’re most likely done for anyway.
I don’t know about all that, but in any union the top government will tend to be as good as the states that make it up. There will always be states that have better governments than the federal government and those states should take the lead on experimentation.
Did anyone ever mention the federalism concerns to you, in your many years of wondering?
I agree that if one is to have universal health care, it should be administered by the states, but your position is unrealistic and basically amounts to a stealth way of making sure that the status quo never changes.
Consider, for example, the impact on a liberal state like California if it were to enact UHC and a bunch of neighboring red states did not. Someone tried to suggest that if red state types are not flocking to job-rich states now they won’t do it for health care, either, but that misses the point that good jobs are something you have to qualify for, and if you’re a rural type in a red state and probably low on education and experience you can’t just decide that you’re going to move to Silicon Valley and work for Google or Apple. But all you have to do to qualify for health care is be there, and I can see especially retired folks who are mobile, on limited income, and with health concerns deciding to move for just that reason, joined by the sick, unemployed, and underemployed from all the red states.
And that’s just one reason that all states would need to participate with at least comparable basic benefits under some kind of federal guidelines reflecting a national commitment to basic human rights. A related factor is that there has to be federal involvement because UHC would obviate Medicare and other federal health programs, so instead of state residents being taxed for something they don’t need, the state should get federal funding assistance for their UHC system.
Are you saying that if one state offers superior entitlements and opportunities for care that those in nearby states that don’t have these things may decide to move, and that this would be some kind of drain on the state that enacts those benefits? Would that be a bad thing if say, CA decided to enact UHC and all the highest cost folks from Nevada decided to move to CA?
Could it be that maybe the Republican party in Mass. is not the same as the Republican party nationally? A Republican in Mass. may not be aligned with the positions of a Republican in say, Oklahoma. Nah, gotta be racism.
It’s very easy to fix that problem. You’re assuming a single payer, free at the point of service system, which is unlikely. But even if that was offered, it can be offered only to permanent residents, just like college tuition benefits. Of course, since California caters to its illegal population, they probably won’t want to do that, but that’s their problem. If anyone is free to come from Mexico for free health care, anyone is free to come from Arizona and Nevada too.
Bringing up race in regards to Obama is an easy thing to do, as the poster upthread did, but in my opinion almost always wrong. People may not like Obama because of his race, but they aren’t going to make policy decisions because of his race. It is far more likely and in keeping with your idea that Obama was attacked because he is a Democrat more than because of his hair. And that is something Republicans (and Democrats) in Mass. and Oklahoma agree on. If Ted Kennedy had won the White House, the opposition to ACA would have been the same.
This is the problem with having a patchwork quilt of states that do and do not cover things. UHC in some states would could turn those states into Florida where older people flock.
I think that could be mitigated by having relatively long residency requirements, and of course US citizenship. That would prevent the crossing the border crowd for instant treatments. But longer term, I think it would make UHC states more of a magnet for people in general as they abandoned the conservative, get sick and die if you don’t have a good enough job to get proper healthcare states.
If that population influx could be handled properly, that might not be the worst thing. Let California and Oregon and Washington state inflate even more, construct large scale modern aqueduct systems to move water from the areas of surplus to California. More congressional districts in California and liberal states over time, and a diminution of power from conservative states as they stick to their ideology until no one but older people want to stay there.
I do not expect medicare to go away btw in the rest of the nation, and it would be nice if we changed federal laws that have healthcare benefits tied to your job be considered taxable income. You do not need to start fully, perhaps 10% of the total benefits value per year can be tacked onto your yearly income total, increasing by 10% each year until the end of the decade all of health benefits related to employment are extra taxable income that cuts into your pay.
If that happened, I think people would want to decouple health benefits from employment REAL quick. Not sure if that would ever happen, but that would speed things along to a better change imo.
Meanwhile, in liberal states that signed onto a common healthcare framework, since employers would no longer be on the hook for healthcare costs, more capital would be freed up for increased investments, profit, and yes, salaries for employees. The stupid restrictions on hourly employees not being given full time for fear of triggering healthcare requirement benefits would be diminished so that would increase employment.
I’d imaging that even with a higher tax environment in said states, the total cash flow into companies and people could actually INCREASE.
But we need to test and see. Experiments, we need experiments. Just like they are planning with the universal basic income ideas. I wonder if this is something both parties could get behind in congress? A return to more federalism to test ideas out?
There would still be a problem of federal taxes paid where Liberal staters are kind of double paying for healthcare, taxes that go to medicare in addition to everything else the state provides already? Not sure how such a cluster of payments could and should be teased out.
I think most people have no problem restricting benefits to citizens and residents, they can probably make an exception for long time residents like the children of illegals in terms of schooling. Allowing open access to healthcare would be a recipe for disaster, not just with mexico, but other states as well. We will have to turn back the refugees from conservative states that are dying in the streets because their ideology blames them for not working hard enough to get a better job for better healthcare, and as they are want to say, if they are lucky, they might benefit from a private charity. Or not, it’s all up in the air.
I’m not sure I understand your question. It would surely be a good thing for the folks from Nevada to gain access to health care. My point, however, is that one of the most critical factors that makes UHC viable is spreading the risk over a known large population, so that the costs of health care are statistically predictable. If the population base becomes artificially skewed to those needing more than average care, then the system becomes more expensive and ultimately unsustainable, especially if the very demographic imposing the most expense contributes the least to revenues.
If you mean “permanent residents” as in “citizens and legal residents of the US”, then fine, good plan, but it doesn’t fix the problem of migration from non-UHC states to UHC states and the financial burden it imposes on the latter.
A few comments in passing. I’m not sure that it’s fair to say that California “caters to its illegal population” just because it’s enacted some measures, like drivers licenses being granted regardless of immigration status, that contribute to public safety.
Consider the situation where I live in Canada, a pretty progressively liberal province. The one absolutely iron-clad requirement for a health card is proof of citizenship or legal residency. Despite provinces administering their own health care systems and being able, at their discretion, to waive things like in-province residency requirements, they have no discretion whatsoever over the in-country legal residency criterion because it’s a federal requirement. So the idea that UHC would somehow automatically lead to a vast cadre of illegals jumping on the free gravy train is a bit of a red herring; sure it could happen if things were mismanaged, but there’s no reason it must necessarily follow.
Colorado-care didn’t pass because the insurance companies effectively bought the election through their donations. Funny thing about unlimited campaign contributions, huge corporations can outspend average Americans.
I was analogizing the situation with the whole US and the benefits it provides to those from other countries and the scenario where an individual state may provide benefits that would be taken advantage of by those from other states. It seems like if it’s not a viable model where those from other states would come to utilize the services provided in the host state, couldn’t that also be said for those from other nations that would come to utilize the services provided in a host nation?
You should look into the experience Tennessee and Oregon had with government run healthcare. And Vermont’s flirtation with single payer. In case you don’t want to I will give you the bottom line. In order to pay for universal healthcare a state basically has to triple its income tax. For most states income taxes are not a big deal in relation to federal taxes. But if a state doubles or triples its income tax and the surrounding states do not they are going to start losing businesses and young people while attracting the older and the sicker. This leads to a death spiral very quickly. That is why it is impossible at the state level.
A practical implementation would be to take all the money spent on medicare, medicaid, VHA etc, and transfer it to the states, while legislating that every citizen has a right to medically necessary healthcare from the state. (along with some definitions of what that means) Then let each state decide which way the requirement was most effectively met.
Sadly, that would be a nightmare to get through the US federal/states power balance.
You don’t see a distinction between the right of free movement in a free country and immigration from a foreign country? I do. I don’t think anyone would dispute that any American should have the right to live anywhere in the country that he pleases, and conversely I don’t think anyone would support open borders for immigration. I know that “open borders” is a term that’s been bandied about a lot lately, and it’s unfortunate that the right chooses to construct that straw man as their answer to those who oppose xenophobia.
The difference is that immigrants should be – and are – vetted based on their skills and ability to contribute, whereas the only real limitation on interstate movement would be a reasonable residency requirement to qualify for health care coverage in this UHC hypothetical. This is the practice in Canada, where the problem doesn’t arise because all provinces have opted in to the single-payer program – contrary to popular belief, they have no obligation to do so if they feel a private insurance system would serve them better. Not surprisingly, none have found such a system. So someone moving to a different province not yet meeting the residency requirement would be covered by his previous province’s single-payer program under a reciprocal arrangement, similar to how visitors from other provinces are covered.
I do see a difference interstate vs. inter-country. If we ignore that for a moment then the argument is quite similar. So it seems like you’re saying that this kind of generous benefit scheme only works if all potential participants pay for it, so to speak. I largely agree.
But you’re wrong about support for open borders. In this thread, the OP is supportive of the idea. And while most other responses were opposed, there were a couple other supporters of the idea in the thread.
In any event, I’m not sure what “the right” and strawmen have to do with anything thus far. I’d be fine if states want to construct their own UHC programs and attempt to make them work. Restricting benefits with some sort of residency requirement over time could be viable. Residency requirements are used in many other areas to prevent benefits accruing unduly to those newly entered into the states and that seems to work.