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>We can disagree about the causes of social issues in America, and their solutions; but its inarguable that there has been no effort to systematically test and

>We can disagree about the causes of social issues in America, and their solutions; but its inarguable that there has been no effort to systematically test and deploy policy interventions at a national level in any kind of evidence based way. Why do we need to do these things at the national level? The federal government is intentionally not set up to be able do these kinds of things. Doing these things at the federal level is an exercise in Constitution avoiding mental gymnastics and you wind up with hacks like withholding federal money or insane interpretations of the commerce clause in order to get things done or your policy winds up hanging by a threat that SCOTUS can cut at any minute (e.g. Obamacare). Using policy to mitigate social problems does seem to work well at the state level (for any given problem there seems to always be a state that's doing a good job tackling the problem) because the states don't have to implement back handed legislative solutions or compromise things as many ways and generally run at smaller scale. (For example, there are at least a couple states that have decent universal healthcare programs.)

danans 7y ago
> Using policy to mitigate social problems does seem to work well at the state level (for any given problem there seems to always be a state that's doing a good job tackling the problem) In the case of healthcare, the coverage standards, cost controls, revenue collection and payments must be handled at the federal level, otherwise you will end up with huge differences in benefits between state programs, which will result in similar issues seen with insurance companies today. For example, today, insurance companies are often loathe to pay for expensive-upfront but cheaper long-term procedures because the typical time for customer retention is correlated with how long their customers stay at their job. They don't want to pay for the procedure that their competitor is going to get the cost savings from down the road. There is nothing to stop an unregulated US-state run universal health system from doing the same thing. Also, because US states by definition have open borders, it would encourage health care arbitrage in densely populated border areas, which would overstress the systems of states with better health coverage, leading to inevitable legal conflict between those states. This is not to say that states can't play a role in the day-to-day local administration of healthcare benefits - just as they do with Medicare today - but the baselines have to be defined at a federal level.

danans 7y ago

> Using policy to mitigate social problems does seem to work well at the state level (for any given problem there seems to always be a state that's doing a good job tackling the problem) In the case of healthcare, the coverage standards, cost controls, revenue collection and payments must be handled at the federal level, otherwise you will end up with huge differences in benefits between state programs, which will result in similar issues seen with insurance companies today. For example, today, insurance companies are often loathe to pay for expensive-upfront but cheaper long-term procedures because the typical time for customer retention is correlated with how long their customers stay at their job. They don't want to pay for the procedure that their competitor is going to get the cost savings from down the road. There is nothing to stop an unregulated US-state run universal health system from doing the same thing. Also, because US states by definition have open borders, it would encourage health care arbitrage in densely populated border areas, which would overstress the systems of states with better health coverage, leading to inevitable legal conflict between those states. This is not to say that states can't play a role in the day-to-day local administration of healthcare benefits - just as they do with Medicare today - but the baselines have to be defined at a federal level.