I would think the state insurance is secondary to Medicare.
~Max
From the summary of that case,
The argument I would make is that the waiting period is needed to combat medical fraud where the individual moves to the state for the express purpose of receiving medical benefits, receives expensive medical services, and leaves the state. This is called medical tourism. The state has a compelling interest in providing medical benefits for its residents and only seeks to discriminate between new and existing residents as is necessary to further this goal.
~Max
Did you not read the bit I quoted that included part of the decision? It said reasons of “minimization of opportunity for fraud […] were not compelling enough to justify a classification that infringed a fundamental interest.” I mean, who knows how a court would decide in a state medical insurance system but you have little reason to be confident in your lawyering the matter.
The US has the largest immigrant population in the world and has more immigrants than Canada has people. And less land. Stop slacking up there.
Yeah it’d be impossible to get a photo ID for all the poor people. That’d be racist! Those comments seem to be a jab at the photo ID for voting debate.
I did read that, and I’ve been reading the case too.
I don’t think there are any other less drastic means to prevent medical tourism. And I do think medical tourism would bankrupt the state insurance program. Finally I do believe the state has a compelling interest in providing coverage for its residence. If there are no alternatives that compelling interest extends to the durational residency requirement. The fraud isn’t double payments as it is in that case, so inter-state cooperation is not an alternative.
I’m not sure what that court meant by saying the durational residence didn’t apply to existing residents for fraud purposes, but I would think existing residents have to show proof of 6 months (or however long) residence before they would become eligible for the state insurance.
~Max
Not really a jab, but more pointing out that the same arguments against requiring photo ID for voting would necessarily have to apply equally to requiring some kind of ID for healthcare.
I mean, are we really going to say that we can’t have old/infirm/poor people not voting because they can’t spare the time/effort/money to go get a photo ID, but we’re going to deny them healthcare because they can’t spare the time/effort/money to go get their state health ID card? (which would presumably involve photo ID anyway)
I don’t think anyone wants to do that, so the alternative would be to take anyone who comes, regardless of the state they live in.
And for the dumbasses who keep saying “Derp! Western Europe can do it, why can’t we?”, the whole crux of the OPs question is how we manage co-sovereign states within a Federal system who have DIFFERENT systems- i.e. a single payer in one, and not in another.
Nitpicking the differences can be fun, but like I said there’s more than a few precedents of striking down durational residential requirements and that Cornell article notes that where it has been upheld, such as with in-state college tuitions, the reasoning is murky. So while us randos on the internet can imagine that none of that applies to a state insurance plan, the reality is they’d be on shaky legal ground.
In fact, here’s a challenge for you Max: instead of trying to find differences in the cases I cited, try to find a case where durational residency requirements were ultimately upheld and tell us how it’s similar to a state medical insurance scheme.
I’ll admit that I am acting rather apologetic. The case law indicates that any durational residency requirement will see a tough fight in court. I can’t find case law supporting my position in this thread.
That’s not enough to shoot down the idea in theory, but perhaps politically. I suppose a locality (eg: city) could make a test case before the whole state gets behind the plan.
~Max
I gather the problem isn’t the requirement for the card, but the acquisition* of* the card. We have provincial agencies that are specifically set up to distribute health insurance cards and in my province at least, it can be tied in with your driver’s license so you renew both at once and have the same picture on each, easy-peazy. Compare that to American calls for voter ID that were coupled with efforts to make that ID more difficult for some citizens to get, or for forms of ID that some citizens were less likely to have.
Bureaucracy isn’t your problem; partisan dishonesty is.
This is an unfriendly and overly confident remark. We may have to discuss this further in the Pit.
I think it might just take some imagination to form it in a way that can’t be defined as a residency requirement and/or a benefit. The first thing that springs to mind would be to make it an insurance plan where the longer you’ve been paying premiums, the more coverage you get. So first year, 1% of your medical expenses are covered and by year five 100% are covered. Premiums would be paid out from a salary or payroll tax. For unemployed or disabled people, they can make a purely paper bump in their benefits that is simultaneously deducted as a premium. Dependents get the same care as the one paying the premiums. So you’d go through a transition initially where private and public were both being used then you have a de facto residency requirement.
That’s too complicated. I understand it, but it is just too complicated to roll out. Doctors and patients both want a clear line - either the doctor will get paid or not / either the patient has coverage or they don’t.
~Max
Yes, it’s the acquisition of the card; basically when some states tried to enact a requirement that registered voters show a photo ID when voting, there was a great outcry of injustice about how many people don’t have photo IDs, and the usual reason was that they couldn’t afford to take off work, had health problems precluding them from going to get the ID, or that whatever fees and/or requirements (i.e. birth certificate primarily) and/or transport costs involved with getting the IDs were too onerous. Basically the contention was that there are people who, for whatever reason, can’t get drivers’ licenses or the equally free
So what I’m saying is that those reasons are equally valid for why someone might not be able to have a health care ID card, or really any sort of mandatory card/identification at all.
How is it any more complicated than the current system? As you said earlier, the doctor’s office checks your insurance benefitse regardless.
So make the cards very easy to get and don’t freak out when some dumbass tries to start a moral panic about fraud or abuse, because the greater good is more important.
By scaling coverage over time you are partially counteracting one of the major selling points of a single-payer program: that it will be easier for doctors to handle and for patients to understand.
~Max
Forgetting an ID card shouldn’t be a problem so long as they are enrolled and “in the system”.
Getting an ID card (and thus being enrolled), just like registering to vote, can and should require positive identification.
~Max
I think many of us are more talking about residents of say, AZ, driving over for a day to get free Health care in say CA.
Well, I wouldnt call them dumbasses but, yeah the whole "Western Europe can do it, why can’t we?" argument, repeated endlessly- is a very poor one.