4 ms·

I think the best approach is for the US to move more concerns to the state level. E.g., it would be great if states would start implementing their own universal

by hagy 6y ago

I think the best approach is for the US to move more concerns to the state level. E.g., it would be great if states would start implementing their own universal healthcare for their residents. States commonly have more internally aligned political goals and therefore can move quicker. It also has the benefit of allowing different states to experiment with different solutions and all states can learn from the results. Lastly, inter-state mobility is much higher than inter-country and this will allow residents to congregate in a state that matches their political desires. E.g., if someone doesn't like the tax burden of states that provide more services then they can move to a state that provides fewer.

harryh 6y ago
it would be great if states would start implementing their own universal healthcare for their residents This isn't really feasible because residents of one state with no universal healthcare + lower taxes could easily move to another state with universal healthcare + higher taxes when they get a serious illness.
- Cerium 6y ago
  Full benefits could phase in over time. You could get increasing discounts on public services until you reach full state membership. This would be no different than out of state school fees.
  - harryh 6y ago
    The Supreme Court has ruled ideas like this unconstitutional. https://www.latimes.com/archives/la-xpm-1999-may-18-mn-38325-story.html https://www.latimes.com/archives/la-xpm-1999-may-18-mn-38325...
    - unethical_ban 6y ago
      Just another example of the failures of the Constitution in the modern era. The Federal government is the only one that can reasonably do Universal Healthcare, or any kind of economic stimulus in crisis, but it fails. States are powerless to try to fix it on their own.
    - hagy 6y ago
      Durational-residence requirements still exists. E.g., paying in state vs. out of state tuition at a state university, which commonly requires a year of residency. [0, 1] State-provided healthcare could be provided in a similar fashion through state-administrated health insurance that has different rates for in state and out of state. There could be a durational-residence requirements for in state pricing. [0] https://repository.law.umich.edu/mlr/vol104/iss3/5/ https://repository.law.umich.edu/mlr/vol104/iss3/5/ [1] https://www.law.cornell.edu/constitution-conan/amendment-14/section-1/durational-residency-requirements https://www.law.cornell.edu/constitution-conan/amendment-14/...
      - harryh 6y ago
        From footnote [1] which you generously provided: "If the purpose of the requirements was to inhibit migration by needy persons into the state or to bar the entry of those who came from low-paying states to higher-paying ones in order to collect greater benefits, the Court said, the purpose was impermissible" It's obviously hard to know for certain what SCOTUS will do, but under that standard it sounds like having health care benefits only available to long term residents would be on very shaky legal ground.
    - VLM 6y ago
      The trivial solution is to tie residency to property ownership or property lease, and payment of property tax. Then use the prop tax to pay for the health care, because almost all health care is local anyway. Have the hospital or clinic or whatever bill the municipal taxing authority wherever you live; for most people the house you live in. Determining residency is not rocket surgery; could steal the entire system from state income tax codes.
      - harryh 6y ago
        Accounting details like that do not address the Constitutional concerns.
- kmclean 6y ago
  You can have residency requirements. In Canada you have to be present in most provinces for half the year and live there for a certain amount of time before you get free health care.
lostapathy 6y ago
Trivial inter-state mobility is a big obstacle for states doing grand social programs individually. If a state provided universal healthcare for residents, it'd quickly be overwhelmed with "hard cases" from other states where coverage is a problem. Which would drive up costs, and taxes, and drive productive/healthy people out. See the current inter-state shipping of homeless people, especially those who suffer mental illness, that is often done via bus tickets paid for by local governments looking to shed those people.
- Rua4yGUZ4lT1Bbv 6y ago
  People also want trivial inter-country mobility.
- eumenides1 6y ago
  Canada it is a "state"/provincial system. All provinces manage their own. Canada doesn't get inundated with Americans because if they do come, patients will be charged like private health care. If the patient's home province has universal health care, both province's will just work it out. In general, we don't dump problems on to other provinces. It's bad form and federal courts will fix that quick especially with so much money on the line. If Florida state sends patients to a universal health care NY state for care, you can bet, NY State will be suing either residents of Florida for medical bills or Florida State directly.
  - lostapathy 6y ago
    Americans going to Canada for care is a totally different thing, and not relevant to my prior point. All of Canada has universal healthcare, which again makes Canada a completely different discussion from my earlier comment. There isn't the kind of huge discrepancy between provinces as we'd have if some US states had universal healthcare and some had the status quo. To your argument about states suing one another - we literally already have localities giving mentally ill people bus tickets out of state, and that's been unable to be stopped via the court system. I'm not dealing in hypotheticals here, I'm talking about things that already happen.
  - 6y ago

by hagy 6y ago

harryh 6y ago

it would be great if states would start implementing their own universal healthcare for their residents This isn't really feasible because residents of one state with no universal healthcare + lower taxes could easily move to another state with universal healthcare + higher taxes when they get a serious illness.

Cerium 6y ago
Full benefits could phase in over time. You could get increasing discounts on public services until you reach full state membership. This would be no different than out of state school fees.
- harryh 6y ago
  The Supreme Court has ruled ideas like this unconstitutional. https://www.latimes.com/archives/la-xpm-1999-may-18-mn-38325-story.html https://www.latimes.com/archives/la-xpm-1999-may-18-mn-38325...
  - unethical_ban 6y ago
    Just another example of the failures of the Constitution in the modern era. The Federal government is the only one that can reasonably do Universal Healthcare, or any kind of economic stimulus in crisis, but it fails. States are powerless to try to fix it on their own.
  - hagy 6y ago
    Durational-residence requirements still exists. E.g., paying in state vs. out of state tuition at a state university, which commonly requires a year of residency. [0, 1] State-provided healthcare could be provided in a similar fashion through state-administrated health insurance that has different rates for in state and out of state. There could be a durational-residence requirements for in state pricing. [0] https://repository.law.umich.edu/mlr/vol104/iss3/5/ https://repository.law.umich.edu/mlr/vol104/iss3/5/ [1] https://www.law.cornell.edu/constitution-conan/amendment-14/section-1/durational-residency-requirements https://www.law.cornell.edu/constitution-conan/amendment-14/...
    - harryh 6y ago
      From footnote [1] which you generously provided: "If the purpose of the requirements was to inhibit migration by needy persons into the state or to bar the entry of those who came from low-paying states to higher-paying ones in order to collect greater benefits, the Court said, the purpose was impermissible" It's obviously hard to know for certain what SCOTUS will do, but under that standard it sounds like having health care benefits only available to long term residents would be on very shaky legal ground.
  - VLM 6y ago
    The trivial solution is to tie residency to property ownership or property lease, and payment of property tax. Then use the prop tax to pay for the health care, because almost all health care is local anyway. Have the hospital or clinic or whatever bill the municipal taxing authority wherever you live; for most people the house you live in. Determining residency is not rocket surgery; could steal the entire system from state income tax codes.
    - harryh 6y ago
      Accounting details like that do not address the Constitutional concerns.
kmclean 6y ago
You can have residency requirements. In Canada you have to be present in most provinces for half the year and live there for a certain amount of time before you get free health care.

lostapathy 6y ago

Trivial inter-state mobility is a big obstacle for states doing grand social programs individually. If a state provided universal healthcare for residents, it'd quickly be overwhelmed with "hard cases" from other states where coverage is a problem. Which would drive up costs, and taxes, and drive productive/healthy people out. See the current inter-state shipping of homeless people, especially those who suffer mental illness, that is often done via bus tickets paid for by local governments looking to shed those people.

Rua4yGUZ4lT1Bbv 6y ago
People also want trivial inter-country mobility.
eumenides1 6y ago
Canada it is a "state"/provincial system. All provinces manage their own. Canada doesn't get inundated with Americans because if they do come, patients will be charged like private health care. If the patient's home province has universal health care, both province's will just work it out. In general, we don't dump problems on to other provinces. It's bad form and federal courts will fix that quick especially with so much money on the line. If Florida state sends patients to a universal health care NY state for care, you can bet, NY State will be suing either residents of Florida for medical bills or Florida State directly.
- lostapathy 6y ago
  Americans going to Canada for care is a totally different thing, and not relevant to my prior point. All of Canada has universal healthcare, which again makes Canada a completely different discussion from my earlier comment. There isn't the kind of huge discrepancy between provinces as we'd have if some US states had universal healthcare and some had the status quo. To your argument about states suing one another - we literally already have localities giving mentally ill people bus tickets out of state, and that's been unable to be stopped via the court system. I'm not dealing in hypotheticals here, I'm talking about things that already happen.
- 6y ago