Public Health Care - Why not at state level first? - Page 4

TomCollins · #31 03-14-2007, 06:43 PM

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.

slickpoppa · #32 03-14-2007, 06:55 PM

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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.

slickpoppa · #33 03-14-2007, 07:04 PM

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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.

slickpoppa · #34 03-14-2007, 07:36 PM

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).

timotheeeee · #35 03-14-2007, 08:48 PM

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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.

timotheeeee · #36 03-14-2007, 08:48 PM

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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

AzDesertRat · #37 03-14-2007, 08:58 PM

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.

timotheeeee · #38 03-14-2007, 09:10 PM

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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.

pvn · #39 03-14-2007, 10:37 PM

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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

slickpoppa · #40 03-14-2007, 10:47 PM

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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.