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For single-payer specifically, I’m not sure. If the federal government were indifferent, states could certainly try it; in fact Vermont did. Where I disagree i

For single-payer specifically, I’m not sure. If the federal government were indifferent, states could certainly try it; in fact Vermont did. Where I disagree is that the states are generally on par with the federal government or their Canadian counterparts. I gave some examples showing that this isn’t the case, legally (the upshot of those cases, if not the actual subject matter) or practically. The counterexamples you provided are’s compelling. In some cases the supporting facts are wrong (most of that $14B is not in bonds and the federal government can move agencies at will; in fact the USDA just shifted tons of people to Kansas). Others may be legally possible but are so politically implausible (Texas switching languages and dragging the federal government along). The Cap-and-Trade Agreement is on uncertain legal ground, even though cross-border part is comparatively weak. No argument that states do have powers, though sanctuary cities and marijuana legalization strike me more as selective enforcement/picking battles than actual reserved powers. Personally, I would very much like better healthcare and action on climate change, but I think it’ll need national coordination and I’m skeptical that the states can force that, even if they can sometimes slow-walk proposals forcing them to do things themselves.

bhupy 6y ago
> For single-payer specifically, I’m not sure. If the federal government were indifferent, states could certainly try it; in fact Vermont did. I mean, that's the whole point. If you can't even muster up the political will to do something at the state level, especially in deep-blue states, what hope is there of doing it at the Federal level? States need to prove that ideas work by actually trying them out and finding the right implementations. > Where I disagree is that the states are generally on par with the federal government or their Canadian counterparts. The argument is that States are on par with the Federal government and Canadian counterparts as it relates to healthcare policy and taxation, and I'm yet to hear a convincing argument to the contrary. Saskatchewan was able to enact single payer in 1947 despite being 1/20th the population of Canada at the time. Its ability to enter into relations with foreign governments or its political will to set a Provincial language is completely irrelevant to that. > Others may be legally possible but are so politically implausible (Texas switching languages and dragging the federal government along). The argument is about the structural right, not the political feasibility of it — and also nobody is arguing for dragging the Federal government along, even for healthcare. Personally, I would actually like to see States try out different approaches to healthcare — Denmark-style single payer, Germany-style public/private hybrid, Switzerland-style individual mandate, Singapore-style HSA-driven care — so that we can have empirical data to prove which systems are superior.

bhupy 6y ago

> For single-payer specifically, I’m not sure. If the federal government were indifferent, states could certainly try it; in fact Vermont did. I mean, that's the whole point. If you can't even muster up the political will to do something at the state level, especially in deep-blue states, what hope is there of doing it at the Federal level? States need to prove that ideas work by actually trying them out and finding the right implementations. > Where I disagree is that the states are generally on par with the federal government or their Canadian counterparts. The argument is that States are on par with the Federal government and Canadian counterparts as it relates to healthcare policy and taxation, and I'm yet to hear a convincing argument to the contrary. Saskatchewan was able to enact single payer in 1947 despite being 1/20th the population of Canada at the time. Its ability to enter into relations with foreign governments or its political will to set a Provincial language is completely irrelevant to that. > Others may be legally possible but are so politically implausible (Texas switching languages and dragging the federal government along). The argument is about the structural right, not the political feasibility of it — and also nobody is arguing for dragging the Federal government along, even for healthcare. Personally, I would actually like to see States try out different approaches to healthcare — Denmark-style single payer, Germany-style public/private hybrid, Switzerland-style individual mandate, Singapore-style HSA-driven care — so that we can have empirical data to prove which systems are superior.