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Doesn't have to be national — Canada's single payer healthcare system 1) is Provincial, 2) came about gradually from Province to Province. Saskatchewan was the

• sudosysgen 6y ago
  Not really, US States are much less powerful and represent a smaller fraction of the whole than Canadian provinces. A US state wouldn't have the power in practice to implement universal healthcare.
  • bhupy 6y ago
    What? US States are 1) far more powerful than Canadian Provinces, to the extent that anything not explicitly delegated to the Federal government by the Constitution is left to the States (10th Amendment) 2) nearly every single state in the US has a GDP per capita on par with whole European nation-states, which is more than enough to fund a single-payer system
    • sudosysgen 6y ago
      Canadian Provinces are more powerful than US States, because not only do they have jurisdiction on whatever isn't explicitly delegated to the Federal government, but there are many topics that the Federal government cannot ever touch. In practice, Canadian Provinces are much more powerful and have much more power than US States, because much of the funding that US states are reliant on comes from the Federal government, mainly because the US Federal government is allowed to do things that the states already do and thus to require the funding for it, which means that many state programs are in fact funded by the Federal government. This means that the Federal government, if it disagrees with a decision of a State, can cripple it by withdrawing funding. This is not the case for Canadian Provinces. Finally, in the US, there are (many) areas of dual authority, where both the Federal government and the State government has authority over an issue. This is very rare in Canada, where the Federal government only exerts dual authority in cases where either the Province fails to uphold a mandate (because Federal decisions, instead of being directly enforced, are often mandated then implemented by the Provinces, while this is much rarer in the US), or when it was originally an explicitly Federal prerogative that the Feds decided to share. Another huge difference is that US States have no authority on interstate matters such as commerce and travel, whereas Canadian provinces are allowed to tax goods from another province, or even to close borders between two provinces (although this is rarely used, it is a power exercised in times when it matters). So essentially, de jure States and Provinces are more or less equal in autonomy, but in practice Provinces have much more sovereignty. The economies of scale that make public healthcare work require you to either control the market or a significant portion of it in order to strong arm the suppliers, A few US states such as California might be able to, but the Federal government would very likely interfere.
      • bhupy 6y ago
        > much of the funding that US states are reliant on comes from the Federal government, mainly because the US Federal government is allowed to do things that the states already do and thus to require the funding for it, which means that many state programs are in fact funded by the Federal government. Besides Medicaid, the vast majority of State-administered services are paid for through State taxes — a combination of income, sales, and property taxes. The vast majority of Federal taxes go toward Medicare, Social Security, the US Military, and Medicaid — all of those comprise 80% of the Federal budget. Besides Medicaid, none of those other things are State-level programs. > This means that the Federal government, if it disagrees with a decision of a State, can cripple it by withdrawing funding. This only applies to Federal highway funding. The Federal government has little control over how States fund their public K-12 schools, public universities (for eg Georgia funds its University system by taxing the lottery), electricity, water, sewage, police departments, fire departments, local public transportation, or public libraries. Further, the Federal government recently cut taxes, making way for States to fill in the gap to further cement control over their own finances. In fact, there is nothing stopping States from increasing the marginal tax rate back to WW2 levels. > So essentially, de jure States and Provinces are more or less equal in autonomy, but in practice Provinces have much more sovereignty. Not sure how you think this. US States are arguably more sovereign than Canadian provinces. The States exert more control over the affairs of the Federal government through its equal representation in the Senate. While Canada also has a Senate, in reality, it's like the Queen in that it totally lacks democratic legitimacy and could not actually stop major legislation from the House of Commons without sparking a Constitutional crisis. The Senate basically can force the Commons to vote on amendments, but does not block the government's agenda. This is simply not the case in the US. Every State has its own Constitution, Legislative Branch, Executive Branch, and a State judiciary that enforces its own Constitution. Most US States even have their own military[1]. Americans are Constitutionally citizens both of the Federal republic and of the state in which they reside. > The economies of scale that make public healthcare work require you to either control the market or a significant portion of it in order to strong arm the suppliers, A few US states such as California might be able to, but the Federal government would very likely interfere. Yes, and every state has the ability to do this. Pharma providers, Hospitals, and doctors would be forced to accept a State single payer insurance plan, or they would have to either leave the state or go out of business. A provider in Chicago isn’t competing for patients in Florida. Pharma companies that supply medicine and supplies can either decide to accept lower revenues in a State, or stop operating in the state. The resulting vacuum from doing so presents an opportunity for new Pharma entrants (perhaps even homegrown in those states). [1] https://en.wikipedia.org/wiki/State_defense_force https://en.wikipedia.org/wiki/State_defense_force
  • amiga_500 6y ago
    Surely New York could bankroll this.
    • sudosysgen 6y ago
      They could indeed bankroll it, but I don't know that they would have the bargaining power to make it cost-effective.
      • amiga_500 6y ago
        Nearly 20 million people. Sweden seemed to do okay with their health system, with half that.
        • sudosysgen 6y ago
          Sweden is negotiating from a position of unshakable and absolute sovereignty, where if a drug company or medical supplier insists on an unreasonable price they can realistically pretend to either nationalize the company, switch to a state-owned competitor, in the case of suppliers and so on, or even decide not to observe the patent. Sweden is also insulated from lobbying in a way New York isn't, and is not reliant on direct and conditional funding from a higher government. New York has neither of these options.
          • bhupy 6y ago
            New York can FORCE Pharma providers, Hospitals, and doctors to accept its single payer insurance plan. These drug companies and medical suppliers would have to either cease to operate in NY or go out of business. The resulting vacuum from doing so presents an opportunity for new Pharma entrants, either other incumbent competitors, or new homegrown upstarts in NY. The demand doesn't go away, an there's revenue to be made.
            • sudosysgen 6y ago
              Sure, but the state of NY still has to respect patent law.
  • zeckalpha 6y ago
    Note that California has about the same population as all of Canada