Public Health Care - Why not at state level first?
 

To those who want the government to nationalize health care in the US, why does this have to be at a national level? It seems like it would make more sense to make this a statewide issue. Many states are larger than a lot of countries that provide the same thing. So size can't be an issue. Having it as a state issue would allow a form of competition between other states, so those that did it most efficiently would likely get rewarded. States also allow easier divisions where larger portions of the population might support it (California would support a government health care scheme before Montana).

So big government zealots- where am I wrong? Why is a state-by-state basis for this a poor idea?

Re: Public Health Care - Why not at state level first?
 

Because if we go state by state, we aren't helping everybody. Hopefully we'll go ahead and form a global government soon so we can give all 6.6 billion humans health care.

Re: Public Health Care - Why not at state level first?
 

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Because if we go state by state, we aren't helping everybody. Hopefully we'll go ahead and form a global government soon so we can give all 6.6 billion humans health care.

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I still contend that if it is a good idea that people will want, getting it going in a few spots will make it spread faster. Then the stragglers can be struck as Luddites (or want it themselves because of the wonderful results) will soon covert their states as well.

Re: Public Health Care - Why not at state level first?
 

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So big government zealots- where am I wrong? Why is a state-by-state basis for this a poor idea?

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State by state is fine. I support socializing health care at either the federal or state level, just so long as it gets done.

Re: Public Health Care - Why not at state level first?
 

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So big government zealots- where am I wrong? Why is a state-by-state basis for this a poor idea?

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State by state is fine. I support socializing health care at either the federal or state level, just so long as it gets done.

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Agreed. The means aren't the issue. Just the ends. If the market could ensure everyone had healthcare, I'd support that too.

Re: Public Health Care - Why not at state level first?
 

It won't work state by state, because unless you force it on the whole country at once, people will just move to states that aren't drowning under the social and economic cost of socialized health care.

Re: Public Health Care - Why not at state level first?
 

I agree and disagree.

Firstoff, it will reduce the costs to employers in these states because they won't be burdened with those costs. If more people move in, you could change residency and eligibility requirements so that someone coming in from another state won't be eligible until they meet those requirements.

That being said, I am still against the plan of moving health care to the state and/or federal level.

Re: Public Health Care - Why not at state level first?
 

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So big government zealots- where am I wrong? Why is a state-by-state basis for this a poor idea?

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State by state is fine. I support socializing health care at either the federal or state level, just so long as it gets done.

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Do you agree that the state by state method is easier? Although it may never get implemented in a place like Montana where very few people would want it. I look at it two ways:

1) National first- slower to get support, but gets everyone under the program
2) State first- faster at first, and means many people will never get on board.

Doesn't having a decentralized system make more sense? If someone screws up, it won't take down the whole thing (just the one state that theres a problem). It allows more choices for people (although they do have to move, but its easier to move states than countries).

Where am I wrong in thinking this is the better way to do things.

Re: Public Health Care - Why not at state level first?
 

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So big government zealots- where am I wrong? Why is a state-by-state basis for this a poor idea?

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State by state is fine. I support socializing health care at either the federal or state level, just so long as it gets done.

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Agreed. The means aren't the issue. Just the ends. If the market could ensure everyone had healthcare, I'd support that too.

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Yesssssss....the govt is so efficient in every other part of our lives....I can't wait til the run the health care system too.

People at Mcdonalds move faster than people at the DMV or the post office. Can't wait to hit the ER with an arterial bleed and wait in line behind someone with a hangnail (who is at the ER cause it's "free")

If you want a better way...offer younger healthier people a healthcare insurance option covering only severe injury and illness. They would pay out of pocket for anything else. When you hit a certain age....you may want to move into a more comprehensive plan.

By the way we do have universal healthcare already in emergency situations. People are not dying in ERs because they dont have a plastic card in thier purse or wallet.

Re: Public Health Care - Why not at state level first?
 

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So big government zealots- where am I wrong? Why is a state-by-state basis for this a poor idea?

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State by state is fine. I support socializing health care at either the federal or state level, just so long as it gets done.

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Agreed. The means aren't the issue. Just the ends. If the market could ensure everyone had healthcare, I'd support that too.

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Yesssssss....the govt is so efficient in every other part of our lives....I can't wait til the run the health care system too.

People at Mcdonalds move faster than people at the DMV or the post office. Can't wait to hit the ER with an arterial bleed and wait in line behind someone with a hangnail (who is at the ER cause it's "free")

If you want a better way...offer younger healthier people a healthcare insurance option covering only severe injury and illness. They would pay out of pocket for anything else. When you hit a certain age....you may want to move into a more comprehensive plan.

By the way we do have universal healthcare already in emergency situations. People are not dying in ERs because they dont have a plastic card in thier purse or wallet.

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Please do not hijack this thread. This has nothing to do with the merits of Universal Health Care or Public Health Care. I am simply asking why those who favor it don't agree that its smartest and best implemented at a smaller scale first.

Re: Public Health Care - Why not at state level first?
 

I would probably do it at the city level. FWIW I think all government should exist mostly at the city-state level.

Re: Public Health Care - Why not at state level first?
 

In my state of Illinois there is a bill up currently that would move towards state health care. Not sure of the exact details, maybe iron could fill you in.

My guess is that one reason that states don't try this themselves more often is that they are already going broke. Especially the blue states that would most want to but are currently propping up the red states financially.
http://www.taxfoundation.org/research/show/62.html

Re: Public Health Care - Why not at state level first?
 

There is definitely one very good argument for a national approach, but I'm saving it for later.

Re: Public Health Care - Why not at state level first?
 

State by state is a horrible idea for any welfare policy. The problem is free riding.

Re: Public Health Care - Why not at state level first?
 

The cost is too high for individual states, as a percentage of their current revenue. The increases needed would be, percentage-wise, astronomical.

Re: Public Health Care - Why not at state level first?
 

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State by state is a horrible idea for any welfare policy. The problem is free riding.

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How is free riding a problem? That's the entire point of socialized medicine.

Re: Public Health Care - Why not at state level first?
 

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The cost is too high for individual states, as a percentage of their current revenue. The increases needed would be, percentage-wise, astronomical.

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But if the federal government is currently using money to pay for this, that money could easily be used at the state (or city/county) level.

Re: Public Health Care - Why not at state level first?
 

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The cost is too high for individual states, as a percentage of their current revenue. The increases needed would be, percentage-wise, astronomical.

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But if the federal government is currently using money to pay for this, that money could easily be used at the state (or city/county) level.

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Wait, the feds are currently providing universal health care? Or are you saying that if states wanted to pay for this the feds would lower taxes by the appropriate amount to make it a net wash?

Re: Public Health Care - Why not at state level first?
 

That would be the idea, yeah.

Re: Public Health Care - Why not at state level first?
 

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State by state is a horrible idea for any welfare policy. The problem is free riding.

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My impression is that free riding is never a big problem in any venue. I may not be considering everything, of course. What I mean is that free riding strikes me as generally being a minor problem, never a big problem. So...I don't see how a minor problem makes any idea a horrible idea.

Re: Public Health Care - Why not at state level first?
 

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That would be the idea, yeah.

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So what money are the feds going to give up?

Re: Public Health Care - Why not at state level first?
 

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State by state is a horrible idea for any welfare policy. The problem is free riding.

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Please explain. In my system, you would only get coverage for free if you were a resident of that state.

Re: Public Health Care - Why not at state level first?
 

The answer is obvious. Blatantly obvious. Federalized control over your health care is the holy grail of authoritarianism. If it happens piecemeal, state by state, then it will only provide opportunities for people to see the flaws and get around it.

Picture Californians flocking to Nevada for their health care ... In fact, this is a likely scenario as there are currently THREE competing bills in the California assembly to socialize health care in California. If one of them gets signed I will probably jump through a lot of hoops to make sure I'm not considered a California resident anymore just so I can buy my own private coverage as a citizen of another state. I can't be the only one prepared to do what it takes to maintain control over their own healthcare.

natedogg

Re: Public Health Care - Why not at state level first?
 

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That would be the idea, yeah.

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So what money are the feds going to give up?

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Legalize drugs, end war in Iraq... who knows.

Re: Public Health Care - Why not at state level first?
 

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That would be the idea, yeah.

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So what money are the feds going to give up?

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Legalize drugs, end war in Iraq... who knows.

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So why wouldn't they just spend that on their own federal health care system, to extend their own bureacracy, instead of letting states increase theirs at the fed's expense?

Re: Public Health Care - Why not at state level first?
 

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State by state is a horrible idea for any welfare policy. The problem is free riding.

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How is free riding a problem? That's the entire point of socialized medicine.

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Mr. Jones needs a kidney transplant, but lives in a low tax state with crappy health care. So he moves to another state with high taxes and great care to get the kidney transplant, then moves back to the low tax state when he's healthy.

Obviously there are ways that states can combat such free riding problems, such as requiring residency for a certain period of time, but free riding is definitely an issue that would need to be dealt with.

Re: Public Health Care - Why not at state level first?
 

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State by state is a horrible idea for any welfare policy. The problem is free riding.

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How is free riding a problem? That's the entire point of socialized medicine.

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Mr. Jones needs a kidney transplant, but lives in a low tax state with crappy health care. So he moves to another state with high taxes and great care to get the kidney transplant, then moves back to the low tax state when he's healthy.

Obviously there are ways that states can combat such free riding problems, such as requiring residency for a certain period of time, but free riding is definitely an issue that would need to be dealt with.

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This can easily be dealt with by requiring minimum residency requirements or not covering preexisting conditions. Why aren't these people moving to Canada now then coming back? It doesn't seem like a huge problem.

Re: Public Health Care - Why not at state level first?
 

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State by state is a horrible idea for any welfare policy. The problem is free riding.

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How is free riding a problem? That's the entire point of socialized medicine.

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Mr. Jones needs a kidney transplant, but lives in a low tax state with crappy health care. So he moves to another state with high taxes and great care to get the kidney transplant, then moves back to the low tax state when he's healthy.

Obviously there are ways that states can combat such free riding problems, such as requiring residency for a certain period of time, but free riding is definitely an issue that would need to be dealt with.

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It would have to be dealt with only if it were to turn out to be a major problem.

Re: Public Health Care - Why not at state level first?
 

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State by state is a horrible idea for any welfare policy. The problem is free riding.

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How is free riding a problem? That's the entire point of socialized medicine.

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Mr. Jones needs a kidney transplant, but lives in a low tax state with crappy health care. So he moves to another state with high taxes and great care to get the kidney transplant, then moves back to the low tax state when he's healthy.

Obviously there are ways that states can combat such free riding problems, such as requiring residency for a certain period of time, but free riding is definitely an issue that would need to be dealt with.

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Who said anything about "great" care? Begging the question 101.

Anyway, what about the people who live in that state the whole time? They aren't free-riding? That's who I was talking about. To keep out the riff-raff, I suppose you'll need to erect some walls, and probably issue papers to all citizens so they can be identified as needed.

Interestingly, I don't know anyone who's moved to canada to get (e.g.) a free kidney transplant. I do, however, personally know *lots* of people who have come from countries with "free" (or "great" if you prefer that term) health care to the US to get private health care (e.g. luekemia treatment).

Re: Public Health Care - Why not at state level first?
 

"Since 2000, employment-based health insurance premiums have increased 87 percent, compared to cumulative inflation of 18 percent and cumulative wage growth of 20 percent during the same period." - National Coalition on Healthcare

Let me first state that all theories about socialized, government subsidized, or government run healthcare are HORRIBLE ideas. Whenever the federal government gets their hands on a taxpayer dollar, they inherently stamp that dollar into a nickel via beauracracy and waste. On average, privatizing an industry reduces costs of that product or service by 66%, compared to the federal government running it.

"Although nearly 47 million Americans are uninsured, the United States spends more on health care than other industrialized nations, and those countries provide health insurance to all their citizens" - National Coalition on Healthcare

Well this statement is very misleading. Most countries providing socialized healthcare to their citizens do so with HORRIBLE consequences. In countries with socialized healthcare the quality of care is a fraction of what it is in the United States. Example: The waiting list to get an MRI in Canada is on average 60-90 days. The Canadian government caps the the amount drug companies can charge for a drug. It is 3% over production cost. Production cost does not include research costs, which are 90% of the cost of a drug or more. So either drug companies don't sell their drugs in Canada, or they raise the price of them in the United States to cover the cost of research. Countries with socialized medicine also pay a huge penalty by stunting the growth of their economies via the high taxes that must be levied on their citizens to pay for healthcare.

As far as 47 million Americans being uninsured. All children and pregnant mothers under the poverty level have access to FREE healthcare. Anyone entering a hospital, whether a citizen, immigrant, or illegal alien, with a life threatening situation, will receive treatment. Hospitals are very considerate when it comes to negotiating a payment plan should you incur costs you cannot afford. Hospitals are also very considerate when it comes to collecting on unpaid accounts. Whether or not Americans take advantage of any of these benefits is difficult to control. This is why you end up with a silly number like 47Million "uninsured."

The real problem. Insurance costs are skyrocketing. Companies that don't shop for cost-effective plans for their employees aren't encouraging competition in the marketplace. Why are insurance costs skyrocketing? Lack of competition and cost of paying claims.

How do we fix this? Well President Bush suggested taxing those that have expensive insurance (policies over $15K anually), giving a tax credit to those with cheaper plans, AND making company paid insurance premiums taxable! Not the worst idea, but definitely not one I would like to see implemented. What I would like to see:

1. Encourage competition in the insurance marketplace. Cost to enter the market is large, their are licensing issues, and it just isn't something the small business owner can decide they are going to do. However, the government should make sure they are finding the right balance between encouraging competition and protecting the consumers. (I mean, that is what government is actually supposed to be doing, correct?)

2. Encourage Americans to go to medical school! Government spending should be on INFRASTRUCTURE, that way our capitalistic economy can grow without worrying about the logistics of infrastructure. Part of infrastructure is education! While I am against federally governed schools, I do think that government grants for college are a GREAT tool!. If economists are really concerned that our healthcare costs are outpacing our economy growth, then why not build some more doctors and nurses via government grants to medical/nursing schools!?!? Doing this will also raise the average standard of living for students coming from lower income families, who may have never gotten the opportunity to receive an education in such a profitable field. These are also the same people who come from families that are, and who were probably going to be, one of the 47Million "uninsured."

3. Immigrate more medical students to the United States. By increasing the supply of doctors and nurses in the industry, it will drive down the costs of healthcare, which will in turn drive down the costs of insurance.

4. Negotiate with countries such as Canada who are leeching off of American consumers by capping the margin on drug sales.

5. Grow the economy as a whole! Increasing taxes to pay for coverage, or to encourage cheaper private coverage, is just going to stifle the growth of the economy. We should be looking for ways to grow our economy faster than the costs of healthcare, via tax breaks, foreign and domestic markets that remain untapped, and numerous other methods that Americans have been persuing as Capitalists for 230 years!

Re: Public Health Care - Why not at state level first?
 

Thank you for once again hijacking my thread. There is a button at the top that says "New Thread" if you want to create your own unrelated post.

Natedogg has hit the nail on the head here. The problem with a decentralized welfare state is the people that pay for it will leave, leaving just the benefeciaries who put nothing into the system. I knew no liberals would admit it, but I knew nate would come through.

Re: Public Health Care - Why not at state level first?
 

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State by state is a horrible idea for any welfare policy. The problem is free riding.

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How is free riding a problem? That's the entire point of socialized medicine.

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Mr. Jones needs a kidney transplant, but lives in a low tax state with crappy health care. So he moves to another state with high taxes and great care to get the kidney transplant, then moves back to the low tax state when he's healthy.

Obviously there are ways that states can combat such free riding problems, such as requiring residency for a certain period of time, but free riding is definitely an issue that would need to be dealt with.

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This can easily be dealt with by requiring minimum residency requirements or not covering preexisting conditions. Why aren't these people moving to Canada now then coming back? It doesn't seem like a huge problem.

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That's a bad comparison because there is a huge difference between becoming a citzen of a Canada and becoming a citzen of another state. There are no restrictions on moving to another state. But you can't just show up in Canada and demand citizenship. First you need to become a permanent resident, then it takes a minimum of three year to become a naturalized citizen. And that's assuming that you have a valid means of becoming a permanent resident in the first place, which is not guaranteed.

So if people could just rent an apartment in Canada and demand health care, then yeah that would be a fair comparison.

Anyway, I never said the free rider problems could not be overcome, I was merely pointing out that free rider issues do exist in response to PVN's query about how free riding could be a problem.

Re: Public Health Care - Why not at state level first?
 

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Who said anything about "great" care? Begging the question 101.

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Relax man, I'm not some socialist who thinks government health care is automatically awesome. I probably should have said "better" if that would make you happy.

We are talking about a hypothetical here in which different states have different health care systems. In that scenario it is certainly possible (though not guaranteed)that states that charged higher taxes for health care would have better state health care than those states with lower tax rates. In such a secenario, the high tax states would be concerned about people from the cheap tax states free riding on their better health care.

And as I mentioned in my previous post the Canada comparison is silly because there are a lot more restrictions on Canadian citizenship and virtually no restrictions on state citizenship. You'd be long dead before you could get a free kidney transplant in Canada. I bet if you could just rent an apartment in Canada and get free health care, a lot of poorer Americans would go to Canada for free health care.

Re: Public Health Care - Why not at state level first?
 

Another problem is that the Supreme Court has held the Constitution places restrictions on the ability of states to condition benefits on duration of residency:

"In Shapiro, we reviewed the constitutionality of three statutory provisions that denied welfare assistance to residents of Connecticut, the District of Columbia, and Pennsylvania, who had resided within those respective jurisdictions less than one year immediately preceding their applications for assistance. Without pausing to identify the specific source of the right, we began by noting that the Court had long “recognized that the nature of our Federal Union and our constitutional concepts of personal liberty unite to require that all citizens be free to travel throughout the length and breadth of our land uninhibited by statutes, rules, or regulations which unreasonably burden or restrict this movement.” Id., at 629, 89 S.Ct. 1322. We squarely held that it was “constitutionally impermissible” for a State to enact durational residency requirements for the purpose of inhibiting the migration by needy persons into the State."

Saenz v. Roe 526 U.S. 489 (1995).

Re: Public Health Care - Why not at state level first?
 

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I agree and disagree.

Firstoff, it will reduce the costs to employers in these states because they won't be burdened with those costs. If more people move in, you could change residency and eligibility requirements so that someone coming in from another state won't be eligible until they meet those requirements.

That being said, I am still against the plan of moving health care to the state and/or federal level.

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I'm pretty sure the Privileges or Immunities Clause of the 14th Amendment wouldn't allow this. I've seen a bunch of laws restricting welfare benefits to people that have been in a certain state for a certain amount of time, or else putting up some other requirement, struck down as violating this clause.

Re: Public Health Care - Why not at state level first?
 

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Another problem is that the Supreme Court has held the Constitution places restrictions on the ability of states to condition benefits on duration of residency:

"In Shapiro, we reviewed the constitutionality of three statutory provisions that denied welfare assistance to residents of Connecticut, the District of Columbia, and Pennsylvania, who had resided within those respective jurisdictions less than one year immediately preceding their applications for assistance. Without pausing to identify the specific source of the right, we began by noting that the Court had long “recognized that the nature of our Federal Union and our constitutional concepts of personal liberty unite to require that all citizens be free to travel throughout the length and breadth of our land uninhibited by statutes, rules, or regulations which unreasonably burden or restrict this movement.” Id., at 629, 89 S.Ct. 1322. We squarely held that it was “constitutionally impermissible” for a State to enact durational residency requirements for the purpose of inhibiting the migration by needy persons into the State."

Saenz v. Roe 526 U.S. 489 (1995).

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dammit you beat me to it

Re: Public Health Care - Why not at state level first?
 

Look at the way residency requirements are written for instate colleges and universities and they can be used as a guide. Those have passed judicial and other tests and I am sure they can be modified for use at the state or local level.

Re: Public Health Care - Why not at state level first?
 

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Look at the way residency requirements are written for instate colleges and universities and they can be used as a guide. Those have passed judicial and other tests and I am sure they can be modified for use at the state or local level.

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I've been wondering about in-state tuition and how it's allowed (we haven't touched that yet in ConLaw). But it's clear that residency requirements for welfare benefits are unconstitutional.

Although, I can definitely see some exemption being allowed for the states' 'compelling interest' (or whatever) in providing free health care for those who have shown an intent to stay in the state. There must be some kind of exemption, as is evidenced by in-state tuition laws.

Re: Public Health Care - Why not at state level first?
 

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Who said anything about "great" care? Begging the question 101.

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Relax man, I'm not some socialist who thinks government health care is automatically awesome. I probably should have said "better" if that would make you happy.

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NT RLY. That's still begging the same question.

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I bet if you could just rent an apartment in Canada and get free health care, a lot of poorer Americans would go to Canada for free health care.

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The fact that they won't let you do this should tell you a little bit about how precarious the financing of these "free" health care schemes is.

And I'm still wondering why people come from places with "free" and "better" health care come to the US every day for medical treatment.

And why people from the US travel to other countries with *even less* medical regulation.

http://en.wikipedia.org/wiki/Medical_tourism

Re: Public Health Care - Why not at state level first?
 

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Who said anything about "great" care? Begging the question 101.

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Relax man, I'm not some socialist who thinks government health care is automatically awesome. I probably should have said "better" if that would make you happy.

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NT RLY. That's still begging the same question.


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I meant one state's hypothetical free health care being better than another state's free health care, not necessarily better than private health care. Jeez, it's like your just looking for any statist bias to bash when it's not even there.

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I bet if you could just rent an apartment in Canada and get free health care, a lot of poorer Americans would go to Canada for free health care.

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And I'm still wondering why people come from places with "free" and "better" health care come to the US every day for medical treatment.

And why people from the US travel to other countries with *even less* medical regulation.


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Again, I never said free medical care was better than private medical. You're reading something that was not there. But someone who does not have any money at all would obviously prefer to be somewhere where they could get free health care.