3 ms·

> In the context of this topic and the near term, this looks like blue states implementing universal healthcare, and letting red states figure it out themselves

> In the context of this topic and the near term, this looks like blue states implementing universal healthcare, and letting red states figure it out themselves… The risk here will be sick people (and their high costs) moving. As with how Chicago's illegal gun problems mostly come from Indiana.

kelseyfrog 1y ago
We already deal with this problem in higher education by having out-of-state tuition and in-state tuition priced at different levels. A period of residency is required to access in-state tuition. Does residency fraud exist? I'm sure of it. Despite the UC and CSU systems not publishing residency fraud statistics, such fraud is universally described as being extremely difficult to execute. I cannot overstate this point. Students routinely depict residency fraud as being more difficult to do than simply paying out of state tuition. The high cost of committing residency fraud makes cancels out any expected payoff. Furthermore, most instances of detected fraud appear to be technical and clerical errors, not intentional deception. What are in-state residency requirements, and how difficult is the requirement? Evidence for residency includes: - Obtaining a California driver’s license or ID card - California vehicle registration - California voter registration - California state tax returns - California bank accounts - Employment in California - Lease, mortgage, or property ownership in California - Severing residential ties to your former state (e.g., closing out-of-state bank accounts, surrendering non-CA licenses) Additionally, one year and one day of residency is commonly the required threshold to qualify for in-state tuition. The question becomes, is this effective enough at reducing fraud rather than can fraud be eliminated. I'm sure, like with any system, fraud detection and remediation are part of the operating costs and measured in terms of recovery rate/rate of return - the KPI we're discussing.
- ceejayoz 1y ago
  I'm not talking about fraud, though. I'm talking about genuinely moving.
  - kelseyfrog 1y ago
    It is fraud to move to California for the sole purpose of education[1]. Likewise, genuinely moving to California for the sole purpose of benefiting from universal healthcare is also, in my opinion, fraud. People genuinely moving to California would presumably pay out of state healthcare fees until their residency was established. Don't you agree that these fees could be set in a way that served as a barrier to doing what you suggest? Is there a case that isn't covered by this that you're thinking about? 1. Cal. Code Regs. Tit. 5, § 54022 - Physical Presence. "Physical presence within the state solely for educational purposes does not constitute establishing California residence regardless of the length of that presence." https://www.law.cornell.edu/regulations/california/5-CCR-54022 https://www.law.cornell.edu/regulations/california/5-CCR-540...
    - ceejayoz 1y ago
      That just means college students living off-campus don't suddenly get in-state tuition rates after a year or two. Sick people are allowed to like California's weather enough to move there. The ADA would also apply when trying to restrict residency in a way it would not for education.
      - kelseyfrog 1y ago
        > Sick people are allowed to like California's weather enough to move there. Perfectly fine. They shall pay out of state rates until they meet the threshold. > The ADA would also apply when trying to restrict residency in a way it would not for education. Can you elaborate? In the best case, it's difficult to predict how courts would rule on this. Any relevant case law? Legislation?
        ceejayoz 1y ago
        > They shall pay out of state rates until they meet the threshold. I'm not arguing they'll move and obtain residency on day one. I'm arguing it may still make sense to move, pay out of pocket for the 366 days, and gain residency for some folks. The ADA's Title II would seem to forbid "you can't be a resident, ever, if you've got expensive healthcare costs" sort of rules at the state level, yes? That would clearly not be equal treatment for people with medical disabilities.
toomuchtodo 1y ago
Most people cannot afford to move. 60 percent of Americans cannot afford a basic quality of life. Those who can move will move to states that can afford this, and are the economic engines of the US economy (California is the world's fourth largest economy, for example). Those who voted for this and don't believe in subsidized healthcare should stay where they are, as I presume they believe universal or subsidized healthcare is "socialism" they don't want. I support the rapid reduction of healthcare services in those areas [1]. I pay taxes (>$100k/year total state and federal tax burden), I support universal healthcare, and I am willing to pay more for everyone to be covered. [1] https://ruralhospitals.chqpr.org/Overview.html https://ruralhospitals.chqpr.org/Overview.html
- ceejayoz 1y ago
  > Most people cannot afford to move. That calculus gets a little different for some folks if the move comes with subsidized universal healthcare and better social services. > Those who voted for this and don't believe in subsidized healthcare should stay where they are, as I presume they believe universal or subsidized healthcare is "socialism" they don't want. We agree, but "The Only Moral Abortion is My Abortion" rule applies. https://joycearthur.com/abortion/the-only-moral-abortion-is-my-abortion/ https://joycearthur.com/abortion/the-only-moral-abortion-is-...
  - toomuchtodo 1y ago
    If you can’t change their mind, and you can’t change their vote, and rural voters die faster than urban voters because of lack of access to healthcare services, state universal healthcare is the best we can do until electorate turn over through rural age out can improve political outcomes. Until then, we are held hostage by the irrational and unsophisticated with votes, which is unfortunate but the reality of the situation. It’s exhausting being dragged by low empathy unsophisticated humans frankly, I am personally over it. I was naive about human nature, hard lessons learned.
    - giantg2 1y ago
      "and rural voters die faster than urban voters because of lack of access to healthcare services, state universal healthcare is the best we can do until electorate turn over through rural age out can improve political outcomes." Is there any evidence that universal healthcare would address the facility and physician shortages in rural areas? It won't make much difference if you give people coverage if they still can't exercise that coverage, or just get subpar care in many rural facilities. It seems that many rural hospitals have turned into glorified helipads to transport many patients to bigger cities. For example, the uninsurance rate for urban vs rural is only 1-2%. It seems like that wouldn't explain the larger gaps in health outcomes. It seemsbother factors would be more important.
mostlysimilar 1y ago
If blue states can build enough housing to welcome refugees from collapsing red states then great. Caring for people and building bigger concentrations of healthy people is a good thing, especially as the House is proportional to population.
- ceejayoz 1y ago
  This would be far more likely to concentrate non-healthy people, and all their costs. The needy in red states will move for access to care; the red states will see a healthier and cheaper population as a result.
  - toomuchtodo 1y ago
    I am willing to bet $10k to a 501c3 charity of the winner’s choice this doesn’t happen and that the thesis is deficient. Let me know if you want to take the bet, we’ll use Longbets.org to officiate.
    - ceejayoz 1y ago
      Gonna gently suggest to you that someone who can go "I'll put $10k in escrow for a few decades over an internet comment" perhaps may struggle to understand the desperation of someone with a disabling chronic illness to get access to medical treatment. (And their lack of means to match such a bet, no matter their confidence in the position.)
      - toomuchtodo 1y ago
        On the contrary, I financially support several people who are disabled and will never work again (to bridge them until they qualify for age tested benefits). I bought a piece of land in the Midwest, and am building tiny homes for them one by one. I previously did a short stint as a Guardian ad Litem in Florida for disadvantaged children who needed an independent advocate, and I act as a patient advocate today for folks who need healthcare and have a hard time accessing it. My deceased mother could not claim Social Security disability while genuinely disabled, and I was first hand involved in the process to see how the system is built to prevent entitled beneficiaries from claiming disability benefits up to her early death at 60. I am resourced (out of luck), but also high empathy and intimately familiar with the struggles you mention. The bet isn't only because I can afford it, but because I am so familiar with the data I know I'm right. This is why I am for universal healthcare, see no other path forward, and I hope this better explains the mental model my arguments in this context are based upon.

kelseyfrog 1y ago

We already deal with this problem in higher education by having out-of-state tuition and in-state tuition priced at different levels. A period of residency is required to access in-state tuition. Does residency fraud exist? I'm sure of it. Despite the UC and CSU systems not publishing residency fraud statistics, such fraud is universally described as being extremely difficult to execute. I cannot overstate this point. Students routinely depict residency fraud as being more difficult to do than simply paying out of state tuition. The high cost of committing residency fraud makes cancels out any expected payoff. Furthermore, most instances of detected fraud appear to be technical and clerical errors, not intentional deception. What are in-state residency requirements, and how difficult is the requirement? Evidence for residency includes: - Obtaining a California driver’s license or ID card - California vehicle registration - California voter registration - California state tax returns - California bank accounts - Employment in California - Lease, mortgage, or property ownership in California - Severing residential ties to your former state (e.g., closing out-of-state bank accounts, surrendering non-CA licenses) Additionally, one year and one day of residency is commonly the required threshold to qualify for in-state tuition. The question becomes, is this effective enough at reducing fraud rather than can fraud be eliminated. I'm sure, like with any system, fraud detection and remediation are part of the operating costs and measured in terms of recovery rate/rate of return - the KPI we're discussing.

ceejayoz 1y ago
I'm not talking about fraud, though. I'm talking about genuinely moving.
- kelseyfrog 1y ago
  It is fraud to move to California for the sole purpose of education[1]. Likewise, genuinely moving to California for the sole purpose of benefiting from universal healthcare is also, in my opinion, fraud. People genuinely moving to California would presumably pay out of state healthcare fees until their residency was established. Don't you agree that these fees could be set in a way that served as a barrier to doing what you suggest? Is there a case that isn't covered by this that you're thinking about? 1. Cal. Code Regs. Tit. 5, § 54022 - Physical Presence. "Physical presence within the state solely for educational purposes does not constitute establishing California residence regardless of the length of that presence." https://www.law.cornell.edu/regulations/california/5-CCR-54022 https://www.law.cornell.edu/regulations/california/5-CCR-540...
  - ceejayoz 1y ago
    That just means college students living off-campus don't suddenly get in-state tuition rates after a year or two. Sick people are allowed to like California's weather enough to move there. The ADA would also apply when trying to restrict residency in a way it would not for education.
    - kelseyfrog 1y ago
      > Sick people are allowed to like California's weather enough to move there. Perfectly fine. They shall pay out of state rates until they meet the threshold. > The ADA would also apply when trying to restrict residency in a way it would not for education. Can you elaborate? In the best case, it's difficult to predict how courts would rule on this. Any relevant case law? Legislation?
      - ceejayoz 1y ago
        > They shall pay out of state rates until they meet the threshold. I'm not arguing they'll move and obtain residency on day one. I'm arguing it may still make sense to move, pay out of pocket for the 366 days, and gain residency for some folks. The ADA's Title II would seem to forbid "you can't be a resident, ever, if you've got expensive healthcare costs" sort of rules at the state level, yes? That would clearly not be equal treatment for people with medical disabilities.

toomuchtodo 1y ago

Most people cannot afford to move. 60 percent of Americans cannot afford a basic quality of life. Those who can move will move to states that can afford this, and are the economic engines of the US economy (California is the world's fourth largest economy, for example). Those who voted for this and don't believe in subsidized healthcare should stay where they are, as I presume they believe universal or subsidized healthcare is "socialism" they don't want. I support the rapid reduction of healthcare services in those areas [1]. I pay taxes (>$100k/year total state and federal tax burden), I support universal healthcare, and I am willing to pay more for everyone to be covered. [1] https://ruralhospitals.chqpr.org/Overview.html https://ruralhospitals.chqpr.org/Overview.html

ceejayoz 1y ago
> Most people cannot afford to move. That calculus gets a little different for some folks if the move comes with subsidized universal healthcare and better social services. > Those who voted for this and don't believe in subsidized healthcare should stay where they are, as I presume they believe universal or subsidized healthcare is "socialism" they don't want. We agree, but "The Only Moral Abortion is My Abortion" rule applies. https://joycearthur.com/abortion/the-only-moral-abortion-is-my-abortion/ https://joycearthur.com/abortion/the-only-moral-abortion-is-...
- toomuchtodo 1y ago
  If you can’t change their mind, and you can’t change their vote, and rural voters die faster than urban voters because of lack of access to healthcare services, state universal healthcare is the best we can do until electorate turn over through rural age out can improve political outcomes. Until then, we are held hostage by the irrational and unsophisticated with votes, which is unfortunate but the reality of the situation. It’s exhausting being dragged by low empathy unsophisticated humans frankly, I am personally over it. I was naive about human nature, hard lessons learned.
  - giantg2 1y ago
    "and rural voters die faster than urban voters because of lack of access to healthcare services, state universal healthcare is the best we can do until electorate turn over through rural age out can improve political outcomes." Is there any evidence that universal healthcare would address the facility and physician shortages in rural areas? It won't make much difference if you give people coverage if they still can't exercise that coverage, or just get subpar care in many rural facilities. It seems that many rural hospitals have turned into glorified helipads to transport many patients to bigger cities. For example, the uninsurance rate for urban vs rural is only 1-2%. It seems like that wouldn't explain the larger gaps in health outcomes. It seemsbother factors would be more important.

mostlysimilar 1y ago

If blue states can build enough housing to welcome refugees from collapsing red states then great. Caring for people and building bigger concentrations of healthy people is a good thing, especially as the House is proportional to population.

ceejayoz 1y ago
This would be far more likely to concentrate non-healthy people, and all their costs. The needy in red states will move for access to care; the red states will see a healthier and cheaper population as a result.
- toomuchtodo 1y ago
  I am willing to bet $10k to a 501c3 charity of the winner’s choice this doesn’t happen and that the thesis is deficient. Let me know if you want to take the bet, we’ll use Longbets.org to officiate.
  - ceejayoz 1y ago
    Gonna gently suggest to you that someone who can go "I'll put $10k in escrow for a few decades over an internet comment" perhaps may struggle to understand the desperation of someone with a disabling chronic illness to get access to medical treatment. (And their lack of means to match such a bet, no matter their confidence in the position.)
    - toomuchtodo 1y ago
      On the contrary, I financially support several people who are disabled and will never work again (to bridge them until they qualify for age tested benefits). I bought a piece of land in the Midwest, and am building tiny homes for them one by one. I previously did a short stint as a Guardian ad Litem in Florida for disadvantaged children who needed an independent advocate, and I act as a patient advocate today for folks who need healthcare and have a hard time accessing it. My deceased mother could not claim Social Security disability while genuinely disabled, and I was first hand involved in the process to see how the system is built to prevent entitled beneficiaries from claiming disability benefits up to her early death at 60. I am resourced (out of luck), but also high empathy and intimately familiar with the struggles you mention. The bet isn't only because I can afford it, but because I am so familiar with the data I know I'm right. This is why I am for universal healthcare, see no other path forward, and I hope this better explains the mental model my arguments in this context are based upon.