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Quite a few US states are bigger than EU countries which manage to run their own decent systems. (e.g. NY: 19 million, Switzerland: 8 million.) What's the argum

Quite a few US states are bigger than EU countries which manage to run their own decent systems. (e.g. NY: 19 million, Switzerland: 8 million.) What's the argument against letting them run it? Maybe there have to be some federal ground rules. But having wider experimentation would seem like a good thing, for discovering good ways to run a system.

harryh 8y ago
It could work but you'd probably have at least a moderate free loader problem with it being so easy to move from state to state. There would be nothing to prevent a healthy person from living in a low tax/no gov't health care state until they get sick and then moving to a high tax state/state paid for care.
- komali2 8y ago
  There would be as much to prevent that as exists today. Very few people actually move from their hometowns, no matter how bad things get.
  - harryh 8y ago
    The issue is that a big % of medical expenses come from a small % of people. It would only take a relatively small number of these people moving to make a big difference in expenses. And it's the people with the highest expenses who would have the most incentive to move.
    - komali2 8y ago
      Sounds like, if true (I was under the impression that a big % of medical cost is due to artificial cost inflation due to the existence of insurance companies), the people costing the system the most amount of money are the least able to move, because they're, you know, dying. Or have some other debilitating condition that requires them to stay with the doctors that know what's going on.
      - tptacek 8y ago
        You're slicing the expense on a different axis than he is. Stipulate any amount of overhead and overpricing due to a given health care regime (fully public and managed like the VA, public/private like Medicare, private insurance, whatever). Within that regime, a very small percentage of health care consumers will make up a disproportionate amount of the expense. It doesn't matter how you fund it or how efficiently you deliver it, because the disparity is on the demand side. 5% of BCBS TN's customers made up over 75% of their total expense! Those customers are perfectly capable of moving. Many of them are simply chronically ill, with things like kidney disease. But anyone who's been on a plane in the US lately can tell you that the elderly have no trouble getting around, either.

harryh 8y ago

It could work but you'd probably have at least a moderate free loader problem with it being so easy to move from state to state. There would be nothing to prevent a healthy person from living in a low tax/no gov't health care state until they get sick and then moving to a high tax state/state paid for care.

komali2 8y ago
There would be as much to prevent that as exists today. Very few people actually move from their hometowns, no matter how bad things get.
- harryh 8y ago
  The issue is that a big % of medical expenses come from a small % of people. It would only take a relatively small number of these people moving to make a big difference in expenses. And it's the people with the highest expenses who would have the most incentive to move.
  - komali2 8y ago
    Sounds like, if true (I was under the impression that a big % of medical cost is due to artificial cost inflation due to the existence of insurance companies), the people costing the system the most amount of money are the least able to move, because they're, you know, dying. Or have some other debilitating condition that requires them to stay with the doctors that know what's going on.
    - tptacek 8y ago
      You're slicing the expense on a different axis than he is. Stipulate any amount of overhead and overpricing due to a given health care regime (fully public and managed like the VA, public/private like Medicare, private insurance, whatever). Within that regime, a very small percentage of health care consumers will make up a disproportionate amount of the expense. It doesn't matter how you fund it or how efficiently you deliver it, because the disparity is on the demand side. 5% of BCBS TN's customers made up over 75% of their total expense! Those customers are perfectly capable of moving. Many of them are simply chronically ill, with things like kidney disease. But anyone who's been on a plane in the US lately can tell you that the elderly have no trouble getting around, either.