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A few reasons:
- States are not currency sovereigns in that they do not create and control their own currency. All the money the state uses come from revenues they collect in taxes, fees, sales, etc. This is not the case for a national government, which creates all the money it needs for whatever it wants to spend money on. This gives the national government a lot more spending power than any state could possibly have, regardless of the state's GDP.
More importantly, though,
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All states except Vermont have statutory or (state) constitutional requirements to have a balanced budget every year. This means they cannot run a budget surplus or deficit. Any surplus has to be spent or returned to taxpayers and any deficit needs to be resolved that year. This makes it incredibly difficult to run large programs like a M4A over time. When the state runs into a budget shortfall, the M4A system would be the first on the chopping block.
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Insurance companies fight HARD against anything that hurts their business. This is specifically why Obamacare (the ACA) didn't include a public option despite Obama campaigning hard for a public option in the 2008 election. Insurance companies got their stooges in the Democratic Party to kill the public option when the ACA debates were going through Congress. They do the same in states when states try to do something about the healthcare industry. And if insurance companies publicly talk about a proposed bill causing them to raise rates or pull out of a market, that's a huge political stick to swing.
New York State Medicaid is basically that, if you make under $28,000 a year or something like that. I was on it for a while. It’s good. everything is free.
The only problem is that not every provider accepts it. But most in the city do.
I hate those arbitrary cut offs for aid. Oops, you got a raise and now make $28,100 sorry no more medicare. It locks people into low paying jobs because if they make too much, they instantly loose all the benefits that their little raise doesn't match.
if we're not going to do free-for-all, it should at least be on a very large scale,
make less then 28k = 100% covered,
29, 99% covered
30, 98% covered
...
All the way up to when 128k = 0% covered
(You'd have fix healthcare prices too, procedures/medicines are priced so insurance looks like they are doing you a favor "you only had to pay $700 for this $25,000 procedure and the $600 follow up medicine will only cost you $100 a week")
Agreed. All cut-offs for everything should have a ramp-down rather than full to zero. Lose $1 of benefit for every $X above the threshold. You should never be worse off for making a few bucks more.
Same with Washington and I think Oregon too. They call it by different names.
Are they closer to a public option than NY? NY really isn't a public option.
No, it's similar to NY. You have to be at a certain income level. Washington State is a rich state of billionaires and millionaires with Costco, Microsoft, Amazon, Boeing, etc that have headquarters here or are a major presence, but they don't pay their fair share of taxes. That's one of the biggest problems.
Washington's Apple Health is great. Easy and accessible. The state could definitely expand that to everyone.
Support Whole Washington! That’s basically exactly what they are trying to do. I try to volunteer anytime I can.
It's "basically that." But it's not "actually that."
A public option would provide necessary health care at zero cost. Without regard to your income. Without regard to your job.
This creates a situation, where if you earn a little bit more, you get "taxed" a lot. And quite frankly, sometimes it's better to earn less and get healthcare than to earn more and lose it.
Also, I'm under the impression, and could be wrong about this, but I believe NYC gets the funding for the NYC state of health from the federal government. So it can be held as ransom, by bullies like Adams or Trump.
I'm suggesting that NYC should do an actual public option not using federal money. Instead binding together with other states to increase leverage and lower costs.
The people overall want it, but the r's shut that shit down any chance they can. Take a look at Canada if you want to see the far rights trying to take down their public option. Right now, the administration is trying to take away Social Security and Medicaid.
But Democrats have majorities in California and NYC and other blue states. The republicans aren't necessary for this to happen. I think?
Yeah Dems say they want this stuff on TV, but when push comes to shove, they do whatever they can to prevent it from actually passing. Case in point was the ACA where they bailed on the single payer option in order to maintain the private insurance scheme with a plan written by Mitt Romney. They claimed they did this to "reach across the aisle" and gain Republican support but they had a super majority and didn't need Republican support. Zero Republicans voted to support this plan.
I know in Washington State, everyone thinks it's a blue state. Yes, we vote blue overall, but the actual politicians lean right as they cater to the oligarchs that have set up shop here. The oligarchs don't pay their fair share in taxes.
Our governor, which I held my nose to vote for btw, is a POS. He's a republican in democrat clothes. Every state has a different political climate.
The oligarchs basically act like mob bosses. That's why Boeing left for Chicago, they didn't like that there were so many unions and regulations here. The workers would never have stood for the shit that passed through inspection because they had decades of experience. As soon as they separated the white collars from the blue collars, you could see the disasters coming. It actually took a bit longer than I personally expected.
What I'm saying is, it's complicated. The greeds run everything, not sure how to fix it.
Yeah I think every states Medicaid is similar. It’s partly funded by the feds but only covers the lowest incomes
You need to figure out how to include all those of us paying into expensive private healthcare - including employer contributions
California and New York have GDP’s above most other countries in the world.
But Cali and New York do not reap the tax revenue of a country with the GDP of their size; they can only reap part of it, both because Federal taxes remove a portion of that taxable income, and because states are necessarily more limited in their options for taxation than national governments.
It's possible, don't get me wrong, but significantly more difficult.
Tell me why I shouldn’t blame the democrats for:
Doing Obama care half assed, when something like 80% people wanted a public option.
Bruh, do you not remember how Obamacare was passed?
I don't know about New York, but California calculated that they can't afford it on their own and need federal funding. Problem is, the politicians at federal level is beholden to for-profit medical sector.
California had a bill like that pass the legislature in 2022, and Governor Newsom ~~vetoed~~ somehow stopped it from making anything happen. I don't remember the details but he basically didn't want to upset the insurance industry, which I would have thought was the whole point of such a bill. He later backed some kind of watered-down bill which as far as I know did nothing.
https://calmatters.org/commentary/2023/10/newsom-resurrect-single-payer-health-care/
solri
Lol, California unemployment is capped at 450/week. No chance we can afford universal medicare
You should look up what benefits were set at in the '70s. California has absolutely slashed the amount they are willing to spend on community welfare.
The political will within those states isn't there. The two states have very large socially liberal rich populations which are a large part of Democrat support in the states. A lot of poor districts in those states are Republican, which will fight a state based Medicaid for all program tooth and nail.
If you mean just rely on state-level taxation, it'd create a incentive to work in (low tax) states that didn't provide state-subsidized health care, then retire in a state that does.
You want any kind of intergenerational wealth transfer to happen at the federal level, else you will tend to get those misincentives.
ITT: people who don’t understand that Medicaid is not Medicare, and that means-testing means a service isn’t “for all.”
Editing to add: Medicaid is funded mostly by the federal government, 69% vs 31% funding from the state. So even if it wasn’t means-tested (one has to have an income below a certain amount, or be disabled to a certain degree before qualifying) it would not meet OP’s definition, a single payer health insurance system funded by the state.
To answer OP’s question, a state funded single payer health insurance program would likely run afoul of the Commerce Clause of the constitution which states the federal government has jurisdiction over interstate commerce. UHC, Aetna, and other nation-wide insurance companies would absolutely sue over the state programs interfering with their right to conduct interstate commerce, and they would almost certainly win, even without a hard right SCOTUS like the current one.
Also, people who are just going, "eh, fuck the commerce clause, the states should just do their own thing!" totally forgetting the absolute shitshow this would unleash, both from private companies and conservative states.
The federal government can print its own money and therefore can pay for its debt with modest and predictable increases in inflation. The states cannot.
Does this imply that a state funded health insurance for all will operate at a net loss?
The state isn’t a business. Services don’t lose money, they cost money.
Instead of paying your insurance and having them take a profit out of it before providing the service, you pay taxes and the money goes more directly into the service.
It may sound unbelievable, but I got the closest to MC4A after moving to a deeply red state. I thank the coop that was able to hook it up with it! But the type of coverage I have currently should be available to everyone without the need for a lucky expert.
Can you imagine the influx of people to those states?
They can. Cali at least has a partial plan.
Hell even a city could.
Hawaii already does.
What do you consider Medi-Cal to be? 🤨
Medicaid, which services those with disabilities or who are below an income threshold. At least that's what I get from the wikipedia page.
If there's limited criteria for getting it, it's not "medicare for all", yeah?
I mean cali is about double NY but add in a few other blue states like illinois, washington, new jersey, massachusetts, and colorado and you will have more than doubled cali. and even though other blue states may not be as big any additions help make for a more robust pool. The big problem is people going to red states while young and healthy and then going to blue states if they get ill.
Your problem are the big healthcare companies that make absurd amounts of money of patients. Here in Germany we have many health care programs and MidiCare and I believe the state looks. The prices of medicine and treatment aren'tOver the top, inflated. Just look at the prices of some medicine In the states to the rest of the world.
Mostly because we're stuck supporting the red states that suck at the Federal titty.
NYC has a very viable option in MetroPlus, the city healthcare option for Medicade
NY has a bill floating around for this but it’s never gone anywhere.
Source: https://www.nysna.org/campaigns-healthcare-all/single-payer-system-new-york-state
They can. The issue is people want everything to be federal and ignore their own state. Most Americans can't even tell you what the first article of their own state's constitution is about. Or their own state house rep.
I imagine the answer is the same as to why we lack all of the other good things too: Rich people only care about themselves.