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> What happens to your healthcare as a Californian the minute you travel out of state? The same thing that happens to your healthcare when you travel out of co

by bhupy 7y ago

> What happens to your healthcare as a Californian the minute you travel out of state? The same thing that happens to your healthcare when you travel out of country — this is an edge case that systems don't typically have to adjust for. California's single payer healthcare system could even guarantee travel health insurance up to a certain amount. It's something that happens so rarely that the state can probably cover it. The vast majority of healthcare costs go towards non-emergency care, anyway. > Something so important should not be in the hands of states. There's a reason we don't have every state building separate armies and nuclear arsenals. Why have them create their own disparate patchwork of healthcare approaches? Well we're not talking about armies or nuclear arsenals here. Decentralized healthcare isn't a novel concept, that's how it works in the European Union: there are open borders, no need for work visas between states, and yet they all have different healthcare systems with varying degrees of generosity. In Switzerland, healthcare is a matter entirely left to the Cantons and is outside the purview of the Federal government. In Canada, the single payer system is Provincial, and came about exactly like this: as a so-called "patchwork". Saskatchewan was the first Province to offer single payer in 1947, followed by Alberta in 1951, etc. By 1961, all Provinces had some form of a single payer healthcare system. > The strength of any nation's economy relies on the health of its citizens, as we are now learning the hard way. Sure, but we're at an electoral deadlock at the Federal level, partly owing to the structural nature of the Federal government that heavily encourages doing things at the State and local level. The political will to do this exists in many States, it's just a matter of executing on it.

pembrook 7y ago
> In Canada, the single payer system is Provincial, and came about exactly like this: as a so-called "patchwork". Saskatchewan was the first Province to offer single payer in 1947, followed by Alberta in 1951, etc. By 1961, all Provinces had some form of a single payer healthcare system. I was not aware of this example. You make some very good points, especially re: deadlock at the federal level. However I do wonder if the way tax revenues are distributed in the United States makes this a non-starter. For example, maybe California can afford it with 10% state tax rates. But what about states with 0% tax rates? Meanwhile a large bulk of your tax dollars is going to a single payer federal heathcare system already (medicare & medicaid). It seems the current structure of the US would lend itself more an implementation of single payer at the federal level, via an expansion of our existing single payer systems.
- bhupy 7y ago
  > For example, maybe California can afford it with 10% state tax rates. But what about states with 0% tax rates? IMO state taxes are WAY too low. Any state that wants to fund a single payer system should raise their taxes. We all just got a massive Federal tax cut in 2017, so there's a lot of slack to work with there. States that have the political will to enact a Federal single payer system likely have the political will for their Federal income tax to increase by X%. Why, then, does it matter if this X% tax increase happens at the Federal level vs the State level? The taxpayer is still out the same amount of money net-net. Switzerland is actually a great example of what a sustainable decentralized taxation regime can look like. The Federal marginal tax rate is 9%, while the Cantonal tax rate can be anywhere from 10% to 26%, depending on the Canton[1]. This kind of a system also makes it very difficult to enact broad tax cuts, because you would have to capture every single Canton's legislature — not a scalable attack. > Meanwhile a large bulk of your tax dollars is going to a single payer federal heathcare system already (medicare & medicaid). > It seems the current structure of the US would lend itself more an implementation of single payer at the federal level, via an expansion of our existing single payer systems. Sure, but while we wait years for the Federal consensus to expand this to materialize, we're better off acting NOW at the State level, and we can do this by simply passing a State level single payer system that exempts people over the age of 60. Over time, the Federal government might reduce Medicare to allow States to continue to increase coverage to old people, especially once States like California and New York support that. Medicaid is already jointly funded and wholly administered by States. [1] https://en.wikipedia.org/wiki/Taxation_in_Switzerland#Taxes_by_canton https://en.wikipedia.org/wiki/Taxation_in_Switzerland#Taxes_...

by bhupy 7y ago

pembrook 7y ago

> In Canada, the single payer system is Provincial, and came about exactly like this: as a so-called "patchwork". Saskatchewan was the first Province to offer single payer in 1947, followed by Alberta in 1951, etc. By 1961, all Provinces had some form of a single payer healthcare system. I was not aware of this example. You make some very good points, especially re: deadlock at the federal level. However I do wonder if the way tax revenues are distributed in the United States makes this a non-starter. For example, maybe California can afford it with 10% state tax rates. But what about states with 0% tax rates? Meanwhile a large bulk of your tax dollars is going to a single payer federal heathcare system already (medicare & medicaid). It seems the current structure of the US would lend itself more an implementation of single payer at the federal level, via an expansion of our existing single payer systems.

bhupy 7y ago
> For example, maybe California can afford it with 10% state tax rates. But what about states with 0% tax rates? IMO state taxes are WAY too low. Any state that wants to fund a single payer system should raise their taxes. We all just got a massive Federal tax cut in 2017, so there's a lot of slack to work with there. States that have the political will to enact a Federal single payer system likely have the political will for their Federal income tax to increase by X%. Why, then, does it matter if this X% tax increase happens at the Federal level vs the State level? The taxpayer is still out the same amount of money net-net. Switzerland is actually a great example of what a sustainable decentralized taxation regime can look like. The Federal marginal tax rate is 9%, while the Cantonal tax rate can be anywhere from 10% to 26%, depending on the Canton[1]. This kind of a system also makes it very difficult to enact broad tax cuts, because you would have to capture every single Canton's legislature — not a scalable attack. > Meanwhile a large bulk of your tax dollars is going to a single payer federal heathcare system already (medicare & medicaid). > It seems the current structure of the US would lend itself more an implementation of single payer at the federal level, via an expansion of our existing single payer systems. Sure, but while we wait years for the Federal consensus to expand this to materialize, we're better off acting NOW at the State level, and we can do this by simply passing a State level single payer system that exempts people over the age of 60. Over time, the Federal government might reduce Medicare to allow States to continue to increase coverage to old people, especially once States like California and New York support that. Medicaid is already jointly funded and wholly administered by States. [1] https://en.wikipedia.org/wiki/Taxation_in_Switzerland#Taxes_by_canton https://en.wikipedia.org/wiki/Taxation_in_Switzerland#Taxes_...