Why does socialized health care need to come from the federal government and not the state?

Sure. Works for me. It used to be on the County level back in the 60’s before Medicare killed it.

Just don’t get sick if you travel out of state. ;)

I am so up in the air on states vs. fed on tons of issues, I think states are great places to test out ideas, see if they work. But then if something is tested and working well, I like the idea of the federal gov’t stepping in and spreading it across the land. I move a lot and I HATE that some states feel like they are 50 years behind, all within my same country. In the end I lean towards doing most things on a Federal level I think. I want public schools to reach minimum federal standards, I don’t want a child in Alabama to have a different advantage or disadvantage from a child in Wisconsin. Same with health care, I don’t want my coverage to change if I work for GM or I work I work for Microsoft or I live in Maryland or I live in California. I’m an American, I feel like the country is mine to live in and explore, I don’t want to be limited. This is also why I hate that health insurance is given as a benefit through my employeer. Give me the money and let me pick a plan. It would make the plans more competitive if they were answering to the individual, rather being handed 5000 employees by a company decision. That’s my rant. :)

@jake “shoving it down our throats” shows a severe ignorance to the plans being discussed.

Also, what’s stopped the states from doing so in the first place? Find any one of the single states that have bothered even trying? None of them have. If the states fail to do something, it is indeed up to the federal gov’t to step in.

You want to be pissed at the Presidency for suggesting it? Be pissed at your governor for not suggesting it first.

@MrItty We are agreeing again. :)

From the European Union perspective, it does not need to. In Europe, each country has their own health care system, and there are union level rules about what sort of care must be available to Union citizens outside of their own country (and I assume also about emergency care to people outside of the Union, but I don’t know about that).

Of course, we are much less strictly a federal union than the United States, so the analogy might not apply.

@Janka So, are you saying that each state would have provisions for treating and covering people from other states? I think in the USA we would more likely have provisions for the state you reside in to cover you when you are out-of-state, so it would be the opposite of what you describe, if I understand correctlt? Interesting.

State-level plans have been tried. Massachusetts is the best known example, but Washington, Oregon, Hawaii and Tennessee have also attempted reforms of varying degrees. All state-level programs face the following problems:

State budgets are constitutionally prohibited from running a deficit. This make any benefit programs they run way more vulnerable to economic downturns; right when people need them the most, the state is least able to provide (this has been the undoing of Hawaii’s, Oregon’s, Washington’s and Tennessee’s plans). The federal government is able to insulate benefits programs from economic swings.

Whenever states attempt to force insurance reforms that make insurance more affordable and less rapacious, the insurers can simply pull up stakes and retreat to more insurer-friendly states, leaving less choice and less competition. This has happened in Oregon.

States vary hugely in wealth. Massachusetts’ plan has had relative success largely because Mass is one of our wealthiest states (median household income $8000 above the national average). There were far fewer uninsured there to begin with, and more people there can pick up their entire insurance bill. Poorer states would never be able to pull this off on their own.

edit: Of course I read @Harp ‘s answer AFTER I wrote mine.
@Mritty, Oregon has tried. I don’t know the details, but they do have some sort of health plan for the uninsured, but I don’t know if it has income restrictions or not.

@MrItty I am not ignorant of the plans being discussed and as previously mentioned there ares several states that have tried it. I personally don’t think it’s a good Idea at all. I also strongly believe it is not the federal governments job to do it. @Harp Debt is exactly the reason I think its a bad Idea. Federal agencies seldom run a tight ship and our national debt is already astronomical.

@jaketheripper so then your question isn’t “Why not leave it to the states?” but “It shouldn’t be done at all!”

@jaketheripper
The economic buffer effect that I was talking about doesn’t mean that health care should just be financed by piling it onto the long-term national deficit. I think Obama’s been crystal clear on his opposition to doing that. But states have to balance their budgets every year. In disastrous years, like this past one, state budgets get absolutely devastated in ways that the federal budget does not. I know because I work for a state and am currently witnessing the train wreck. Under those circumstances, I’d rather know that the feds are guaranteeing my health coverage than that the state is. The ability to run a deficit, as much as we may dislike deficits, does provide a shock-absorbing effect that protects essential services.

I remember one state which attempted it. Remember that nutty Howard Dean? He attempted to make health care available to all of Vermont residents. Unfortunately, he did not succeed, and I don’t know the whole story behind it, but I think his particular plan just cost too much.

I think allowing it to be a state-run program would be a fine idea. I’m not opposed to it. Though, there are poorer states where it may not work as well.

I don’t know that the federal government is/will be shoving it down our throats.

That’s all I’ll say on the matter. :)

@MrItty I’m opposed to socialized health care but i was curious why those who are for it don’t go that route. I don’t think the federal government should make a state do this if it doesnt want to
@Harp to provide health care to everyone in the U.S. either taxes must go way up or we pile it on to our debt

@jaketheripper I think because most of us have no confidence most states will do it. Especially, the states in the bible belt.

@jaketheripper : The plan is that only the top 2% of wealthy people will be taxed for this. I don’t know if that’s what will really happen or not… Also, Obama said in his speech that improvements on Medicare will pay for “most of” this program. I’m not sure I buy that either. $900 billion dollars?

@jaketheripper The thing is, we’re already paying more for our health care, as a nation, than we would under a universal plan. If you’re as concerned about inefficiencies as you say, then you should be absolutely furious about the way health care currently operates. If you decry wasteful bureaucracy, then you should take a look at the “private bureaucracy” of your insurance company. Here’s an interesting fact: Blue Cross/Blue Shield of Massachusetts employs 6,682 people to cover 2.7 million subscribers. That’s more than are employed to cover Canada’s 25 million citizens under their national plan. And do I need to mention the salaries and bonuses of insurance execs? Overhead and profit margin add 15–20% to the cost of private insurance. The overhead for the Medicare program, meanwhile, is 3%.

You’re also already paying for the health care of the uninsured, because the insured and taxpayers are picking up the bills each time they go to the emergency room for routine health care. Wouldn’t you rather they be in a lower cost program, since you’re going to be paying for it either way?

I could go on and on about the inefficiencies in our current way of doing things. If you’re insured, all of that inefficiency gets rolled into the cost of your coverage. We pay way more than any other industrialized country for health care, and have less to show for it in terms of overall health than most.

A survey was just released yesterday showing 75% of doctors in favor of a government-run “public option” for health insurance. These are people who deal with Medicare and Medicaid all the time, so they know how government programs operate. Plus, they’re among the higher income Americans and would be first in line for any additional tax burden.

Does it disturb you so much to see taxes raised for the top 2% of Americans that you’d rather everybody else keep paying for the inefficiencies of what we have now?

@Harp I want the system to be more efficient also. I have all sorts of personal stories about repeat tests and unfair pricing. Here is my question, does the plan that is being proposed really address this problem? It seems like it is proposing a gov’t option for the uninsured, or requiring private insurance to insure. But, is it centralizing records in any way?

@JLeslie It sets up a panel of health care professionals charged with identifying ways of maximizing efficiency. One of the obvious options, and one that Obama has publicly advocated many times, would be interoperable electronic medical records. So the answer is that while we don’t know exactly what the panel would recommend (since it has yet to be created), the expectation is that this would be on the list.

The greatest possible efficiencies would come from a single-payer system, which isn’t even being considered. But the mere existence of a public option out in the insurance marketplace will go a long way toward keeping the costs of even private insurance down. They will have to bargain with providers and drug companies in ways they currently don’t, because the public insurer will be out there doing this aggressively.

@jaketheripper
”I also strongly believe it is not the federal governments job to do it.”

The federal government’s job is to do what the voters voted it in to do. And since the people voted Obama and his propositions into office, it has become the federal government’s job to do it. Simple as that.

@Harp Thank you for taking the time to answer my question. I too like the single payer idea, I have said it before, but I don’t see that happening anytime in the near future. so since it seems it is off the table, I want to be sure I am ok with what is being proposed. I tend to be on the extreme ends of this topic, single payer or more competitive than it is now, as I mentioned in my first answer above.

I would argue that prices are already kind of set by the government through medicare, would you agree?

@ragingloli so whatever the president decides to do with the federal government is fine because we voted on our president and representatives?

@jaketheripper
You should consider becoming a lawyer. You have a great talent of maliciously twisting around anything someone says.

”so whatever the president decides to do with the federal government is fine because we voted on our president and representatives?”

See, that is not what I said.
Just like in business relations, Obama made an offer to his potential future employer, the voters. This offer explicitly included healthcare reform. The employer, the voters, chose to accept Obama’s offer, whose job it is now to fulfill it within the framework of constitutional restrictions. This includes healthcare reform.

@jaketheripper
In other words, if I wanted to contract someone to paint my living room and one of the competitors offers to do my electrics as well, since his company also does electrics, and I choose to contract this competitor, then it is his job to do both the painting and the electrics.

@JLeslie Medicare is not in direct competition with most private plans because of the specific segment of the population it serves. The rates it negotiates with providers are not automatically given to private insurers as well. In 2006, fees paid by private insurers averaged 20% higher than those paid by Medicare.

The creation of a public option would pose its own challenges because it could, theoretically, exercise so much market pressure that private insurers could not compete. That’s not the goal; this is meant only as a tool by which competitive pressures can be exerted to keep costs down and efficiencies up. So, like the Fed uses interest rates judiciously to regulate financial markets, the public insurer’s payment structure would have to be carefully regulated to keep the health care market open, but efficient.

@jaketheripper I’m not sure why you ask about socialized health care. Certainly, no one is talking about socializing health care. No one is talking about socializing anything. Unfortunately. What people are talking about is reforming health insurance and expanding coverage. The health care delivery system will remain exactly the same, and the country will be safe from any socialistic reforms.

Most proposals talk about cost containment measures, but that’s nothing new. This country has been trying to contain health care spending for decades now, and costs just keep on merrily rising. Which leads to higher numbers of people without insurance, who then have to get care for which they can not pay, which forces providers to raise the cost for those who are insured, which raised health care costs even faster. It’s a really bad cycle, and the private sector has no way to take care of it—at least, not unless the mandate to provide care to everyone who shows up at a hospital is removed.

Is that what you are in favor of? Letting people die? Of course not. And yet, that is what will happen if we are to institute a free market in health insurance. We can’t have it both ways. We can’t have free competition in health insurance and health provision without being willing to let people die due to a lack of access to care. We can’t have competition to keep prices down if we do any regulation at all. It’s all or nothing. One single health insurance program for all, or acceptance of lower average life expectancy.

It is nearly impossible to conceive of how the current system drives up costs. It is practically impossible for the average person to understand how the current system guarantees profits for insurance companies (by allowing them to only insure healthy people) and forces the public to pay for the folks with the highest health care expenses (the poor and the elderly). People seem to be able to only see what is right in front of them. My health insurance. Don’t want to lose that because it works for me! My taxes, because they are already too high.

There’s a disconnect for average people. They simply don’t understand how to maximize their long term self-interest. See, the funny thing here, is that by raising taxes to pay for health care, people’s take home, after tax income will go up!!!!

How? Well, when everyone is covered, health care costs go down for any number of reasons. The cost-shifting is eliminated, so administrative costs go down. Administrative costs go down because providers only have to deal with one insurer, instead of hundreds, all with different forms and different coverage plans.

In addition, overall health care costs go down because people no longer have to get primary care at hospitals (which can’t turn them away, by law). They can now get primary care at physicians’ offices, which costs anywhere between one-fifth and one-tenth as much as primary care in the Emergency Room. This saves even more money, because people can get care much earlier in the course of a health problem, and thus prevent hospitalizations. I’ve seen estimates that perhaps as much as 20% of all hospitalizations could be avoided if everyone had access to primary care. Twenty percent!!!!

So, we raise taxes to pay for universal care, and everyone goes apeshit! No more taxes! Never mind, that if taxes go up, and everyone has health insurance, then health care spending will plummet! That means health insurance costs will drop significantly. That means that employers have to spend less on health insurance, and they can then pay more in salary. A lot more!

And if we go to single payer, then business no longer has to pay any health care insurance premiums at all!!! Wow! That’s fifteen thousand dollar a year extra that they can add to people’s salaries. Hmmm. My taxes go up two or three thousand a year. Oooh. Bad! Wait! My salary goes up fifteen K???? Hmmm. Net gain of 12k in salary, or savings of two to three K by stopping the increase in taxes? Which would you take?

Of course, salaries wouldn’t go up right away. Business would keep some for themselves. But, unlike in health insurance where there is no free competition, and can’t be as long as hospitals must care for everyone who walks through their doors, there is much more competition in other sectors of the economy. Business has to pay higher salaries in order to compete with other businesses who are using the extra money (saved through elimination of health insurance premiums) to snap up the best workers. Workers have more money, and spend more, driving up demand. Business hires more people.

But it’s not just that. Businesses become much more competitive internationally. They no longer have the cost of health insurance premiums, just like most businesses around the world. They can reduce the cost of products and sell more, driving up demand for American products.

You see? Everyone benefits, and in so many ways, with universal coverage. Sure, we pay higher taxes, but so what? For every dollar in higher taxes we pay, we might get two dollars in return in higher salary. I don’t know about you, but even if a dollar in taxes get’s me one dollar and ten cents in higher salary, that’s a deal I’m going to take!

Of course, conservatives seem to never be able to see the big picture. They seem to only see what’s in front of their noses. Higher taxes. They totally discount the return on investment, if the investment is in more government services. They just can’t even see it. All for ideological reasons. Conservatives shoot themselves in the foot—well, they shoot all of us with their opposition to universal coverage.

Ideologically, conservatives can’t seem to accept that doing things through national programs saves us all a lot of money—and heartache. Life expectancy goes up. People have fewer lost days of work because they are healthier. Hell! Even happiness goes up!!! But, because most people can’t see the big picture, they only see that taxes go up, and they kick and scream about that. It’s not just conservatives who kick and scream. It’s all the people that conservatives have persuaded that government is less efficient. Government is bad.

Well, that makes me sick! Fortunately, I have a really good, employer provided health insurance plan. But the 47 million uninsured in this country create a hidden cost. I am taking a five to ten thousand dollar hit in salary because of people’s opposition to higher taxes. Like I say. That makes me sick! Maybe because I’m more selfish than any conservative—conservatives who like to piss money away because they can’t see the big picture. Shudder!

Plus if done at the national level, our health care system could, in theory, use its massive purchasing power to get drugs and such for cheaper. At a state level they wouldnt have as much leverage

American friends..just do it..the world will not end. If you can afford to bailout all of those asinine Wall Street execs, then how about helping out the true helpless? You will be proud of your generosity. I can’t say it should match our canadian system, which has flaws, but I truly hope you come up with something that will aid all who are not covered, in whatever way that transpires. Help out your neighbor, it is the American way..

@ragingloli – if you accepted the painter who does electrics because you wanted your painting and electrics done, would you be upset if he didn’t do your electrics (or your painting)?

@laureth
i would not only be upset, it would be breach of contract.

@ragingloli – which is why the big O is pushing so hard for reform.

Provide some examples of how state- or federal control of an institution has improved it..

I work for a state-run clinic that provides equipment (like custom wheelchairs, communication technology, etc.) for people with disabilities. Many of our clients would be veging out in bed for the rest of their (shortened) lives if it weren’t for the assistance the state provides them. The private sector totally fails to provide a valid option for these people because the profit motive is incompatible with the this particular need.

There are lots of other examples of services that the government assures because they’re too fundamental to the overall functioning of society to leave to the whims of the market. I don’t hear people arguing that the government should get out of the air traffic control business, for instance. Nor do I hear anyone trying to get rid of the FDIC.

The current state of health care in the US is both an instance of the private sector not covering the bases because of the incompatibility of the profit motive with the nature of the need, and of an issue that is fundamentally vital to the functioning of the country.

The Government is here to help.