Health care in the US

On September 30 2009 09:29 TheFeared wrote:
If the state were to pay for their own health care, who would pay for it? More taxes? Middle class?

On September 30 2009 09:50 Foucault wrote:
I don't like the idea of richer people paying much more than less rich people. I mean of course it depends on how you got your wealth but if you worked hard for it I don't think you want to fork it over just like that.

On September 30 2009 10:16 Macavenger wrote:
States all (well most, I think California and a couple others might be an exception?) have to balance their budgets each year. They can't deficit spend. Considering that the states generally have very little to do with health care currently aside from implementing federal programs with federal money (again, a couple exceptions - Vermont has a pretty good program, from what I hear), they basically have no money to start with to get state run health care going. Many are going through deep cuts to current obligations like education and such right now due to the recession. Aside from large tax increases to fund an entirely new program, which is politically impossible even in most blue states, there's no money to do it at the state level. The Federal government could in theory do some deficit spending to get the program started and expect to come out cost neutral in the long run based on reduced costs to Medicare/Medicaid, but that seems not to have enough political support.

I can't speak for every state, but I know my own - New Hampshire - isn't exactly doing great in terms of the budget. And since states don't really have the same ability that the federal government has to borrow money shamelessly, it is more of a direct concern.

I don't know, maybe you are right. If one state started offering its citizens health care, maybe others would follow. But until the issue is dealt with on a national scale, the health care industry in our country isn't going to change.

Its an excellent question and for every minute I spend thinking about it, I change my mind about it. Maybe another redditor will have a more enlightened view on the issue than I.

Well, there are a couple problems in execution of that idea. Although I do like the concept myself. First of all the States to not have the power to coin money so either the states would need to raise taxes (most states require voter approval to raise taxes so good luck with that...California anyone?) or the states would get the money from the federal government which give the federal government all the leverage it needs to tell the states exactly how to operate their health care systems. The later is the exact reason why the drinking age is 21 in almost every state because the federal government threatened to take away tons of highway funding if the "recommended" drinking age wasn't followed.

It seems like a good idea to have states compete by choosing to offer, or not offer universal health insurance, but it's not as easy as you'd think. I live in Kentucky, which tends to be near the bottom whenever measurements of education, health, employment, etc, are made. But, the state and local governments here have done very well for their citizens over the last couple of decades by attracting two major employers to the state - Toyota makes most of the US Camrys, Venzas and Avalons here, and UPS uses Louisville as their air hub. Both businesses have had a large spin-out effect, where related businesses thrive nearby. In both cases local govts here had to compete with other states to entice these businesses to locate here.

But, here's the key difference WRT healthcare - to entice employers to come here, the state govt largely just had to build some roads and runways, and also forgo some future tax revenue as an incentive. To cover the immediate cost of subsidizing health insurance for low income people who lack it, state govts would be required to spend a lot of cash up front, which they routinely lack, as someone else noted.

Maybe the biggest difference between any spending by a state govt vs the federal govt is this - only the latter can print its own currency, and thereby manipulate its value. The US federal budget has almost always been run with a deficit, while most state constitutions require a balanced budget, every year. So, the feds can keep printing money to pay for new spending, at least until China &co stops buying our debt. To cover a new health insurance program, the state governments would have to make large, offsetting budget cuts elsewhere, or have big tax increases. The former are already happening due to the weak economy, and the latter are political suicide.

On September 30 2009 10:26 Ingenol wrote:
My question is why nobody considers a completely private system. Perhaps because this would involve fixing the judicial system such that everyone and their mother isn't filing lawsuits and especially medical/malpractice lawsuits all the time. Hopefully it would also involve a complete overhaul of the ridiculous medical school and licensing system in this country. There is a lot of potential wealth (read: jobs/opportunities) that gets completely stifled by the ridiculous bureaucracy of the government/FDA/hospitals/insurance companies. The end result is that the consumer--those who need healthcare (EVERYONE!)--loses, and loses badly.

I'm in agreement that the system is horrendous and needs to be changed, I simply think the president wants to change it in the wrong direction.

Every Massachusetts resident would be required to have health insurance on July 1, 2007, under a landmark healthcare bill the Legislature could send to Governor Mitt Romney as early as today.

The bill also creates an entity to administer the new subsidized healthcare program and to help businesses and individuals find suitable plans.

As for the requirement on individuals, those who don't get coverage would first lose their personal income tax exemption. Eventually, they could face a yearly fee to the state equal to half of the lowest-cost available insurance plan.

''No other state in the country has advanced healthcare to this degree both in coverage and quality, and it's something that I think every member of the Legislature will be able to be very proud of," said state Senator Richard T. Moore, an Uxbridge Democrat and lead Senate negotiator.

The 10-member commission, which includes key legislators and members of Governor Deval Patrick's administration, voted unanimously to largely scrap the current system, in which insurers typically pay doctors and hospitals a negotiated fee for each individual procedure or visit. That arrangement is widely seen as leading to unneeded tests and procedures.

Instead, the group wants private insurers and the state and federal Medicaid program to pay providers a set payment for each patient that covers all that person's care for an entire year and to make the radical shift within five years. Providers would have to work within a predetermined budget, forcing them to better coordinate patients' care, which could improve quality and reduce costs.

I gotta say, you are all dumb as fuck.