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> 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 s

> 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_...

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_...