What if the Road to Single-Payer Led Through the States?

[Greenbeard]

Ro Khanna is about to drop a bill designed to make it easier for states that want to experiment with single-payer to do so. The biggest policy barriers to state-level single-payer have arguably been ERISA preemption (which prevents states from regulating self-insured employer health plans, which constitute the majority of lives in employer-based insurance) and re-purposing federal funds from existing programs into the state’s single-payer program (which can to some degree be done now through various waivers in the ACA, but more easily and comprehensively under this new bill).

It’ll be interesting to see exactly what this legislation looks like but it sounds like it would allow states that want to give it a go and provide proof of concept to proceed. Would it get any takers? (Obviously Khanna has California in mind.)

What if the Road to Single-Payer Led Through the States?

As presidential hopefuls campaign on a national “Medicare for all” system, a California congressman is pushing for a different path to universal coverage: letting the states go first.

Ro Khanna, a Democratic representative, will introduce legislation Friday that lets states bundle all their health care spending — including Medicare, Medicaid, Affordable Care Act dollars and more — to fund a state-level single-payer system.

The policy could create something akin to Medicaid for all. It would be 50 separate programs, jointly funded by the state and the federal government, with local officials making decisions about whom to cover, how much to pay doctors, and what benefits to cover.

Presumably the bill won’t get far but it’s a worthwhile concept. Let’s see if the Tenth Amendment crowd goes to bat for it.

 

[jmotivator]

Ro Khanna is about to drop a bill designed to make it easier for states that want to experiment with single-payer to do so. The biggest policy barriers to state-level single-payer have arguably been ERISA preemption (which prevents states from regulating self-insured employer health plans, which constitute the majority of lives in employer-based insurance) and re-purposing federal funds from existing programs into the state’s single-payer program (which can to some degree be done now through various waivers in the ACA, but more easily and comprehensively under this new bill).

It’ll be interesting to see exactly what this legislation looks like but it sounds like it would allow that states that want to give it a go and provide proof of concept to proceed. Would it get any takers? (Obviously Khanna has California in mind.)

What if the Road to Single-Payer Led Through the States?


Presumably the bill won’t get far but it’s a worthwhile concept. Let’s see if the Tenth Amendment crowd goes to bat for it.

Let the states opt out of Medicare and Medicaid and levy their own taxes to cover their own state programs. I have no problem with this. People who don't want single payer can leave the state for a state system they would prefer.

 

[Chomsky]

Ro Khanna is about to drop a bill designed to make it easier for states that want to experiment with single-payer to do so. The biggest policy barriers to state-level single-payer have arguably been ERISA preemption (which prevents states from regulating self-insured employer health plans, which constitute the majority of lives in employer-based insurance) and re-purposing federal funds from existing programs into the state’s single-payer program (which can to some degree be done now through various waivers in the ACA, but more easily and comprehensively under this new bill).

It’ll be interesting to see exactly what this legislation looks like but it sounds like it would allow states that want to give it a go and provide proof of concept to proceed. Would it get any takers? (Obviously Khanna has California in mind.)

What if the Road to Single-Payer Led Through the States?


Presumably the bill won’t get far but it’s a worthwhile concept. Let’s see if the Tenth Amendment crowd goes to bat for it.

"states are the laboratories of democracy"

 

[trouble13]

Ro Khanna is about to drop a bill designed to make it easier for states that want to experiment with single-payer to do so. The biggest policy barriers to state-level single-payer have arguably been ERISA preemption (which prevents states from regulating self-insured employer health plans, which constitute the majority of lives in employer-based insurance) and re-purposing federal funds from existing programs into the state’s single-payer program (which can to some degree be done now through various waivers in the ACA, but more easily and comprehensively under this new bill).

It’ll be interesting to see exactly what this legislation looks like but it sounds like it would allow states that want to give it a go and provide proof of concept to proceed. Would it get any takers? (Obviously Khanna has California in mind.)

What if the Road to Single-Payer Led Through the States?


Presumably the bill won’t get far but it’s a worthwhile concept. Let’s see if the Tenth Amendment crowd goes to bat for it.

In principle it should of been done state by state to begin with. Let conservatives have a free market healthcare system and progressive states have their socialized approach.

Sent from my SM-G965U using Tapatalk

 

[swing_voter]

What I've always assumed is that states who have free health care would be flooded with sick people from states without free health care.

Used to be that Minnesota had excellent welfare for it's citizens. It was flooded by the poor from states with lesser welfare and Minnesota finally gave up and reduced their welfare.

 

[jmotivator]

"states are the laboratories of democracy"

You guys seem to slowly be moving towards the small central government that conservatives have been talking about all this time.

Strong state governments and limited federal government.

 

[Chomsky]

You guys seem to slowly be moving towards the small central government that conservatives have been talking about all this time.

Strong state governments and limited federal government.

There's a time & place for both. I'm on the record here in claiming Thoreau's,

"the government that governs least, governs best".

I bet I wrote that quote at least a half-dozen times. But that's not to say I don't support federal government and programs that I believe are needed & appropriate. I'm pro single-payer, for instance.

 

[jmotivator]

There's a time & place for both. I'm on the record here in claiming Thoreau's,

"the government that governs least, governs best".

I bet I wrote that quote at least a half-dozen times. But that's not to say I don't support federal government and programs that I believe are needed & appropriate. I'm pro single-payer, for instance.

.... so you are for individual states determining their own program... AND a top down, one size fits all federal program???

Does not compute.

Also, sure, anyone can say "I support federal government and programs that I believe are needed & appropriate"... the belief in a federal system assumes there are programs at the federal level that are "needed & appropriate" otherwise what is the point of a federal system at all? I don't believe a federal health system is any more necessary in the US than it is in the EU, which functions more like a small Federal organization of strong state governments.

 

[Chomsky]

.... so you are for individual states determining their own program... AND a top down, one size fits all federal program???

Does not compute.

Also, sure, anyone can say "I support federal government and programs that I believe are needed & appropriate"... the belief in a federal system assumes there are programs at the federal level that are "needed & appropriate" otherwise what is the point of a federal system at all? I don't believe a federal health system is any more necessary in the US than it is in the EU, which functions more like a small Federal organization of strong state governments.

I'm speaking in generalities, here.

I want the least government feasible, but some things are best done at the federal level. I also believe states are indeed the laboratories of democracy - sometimes what states discover/implement is left to the state, other times it is adopted by the other states or the federal government. I see no conflict, here.

Now as to healthcare specifically, I believe that as best done by a national single-payer opt-in program like the current Medicare or Medicaid.

 

[Bullseye]

Ro Khanna is about to drop a bill designed to make it easier for states that want to experiment with single-payer to do so. The biggest policy barriers to state-level single-payer have arguably been ERISA preemption (which prevents states from regulating self-insured employer health plans, which constitute the majority of lives in employer-based insurance) and re-purposing federal funds from existing programs into the state’s single-payer program (which can to some degree be done now through various waivers in the ACA, but more easily and comprehensively under this new bill).

It’ll be interesting to see exactly what this legislation looks like but it sounds like it would allow states that want to give it a go and provide proof of concept to proceed. Would it get any takers? (Obviously Khanna has California in mind.)

What if the Road to Single-Payer Led Through the States?


Presumably the bill won’t get far but it’s a worthwhile concept. Let’s see if the Tenth Amendment crowd goes to bat for it.

A while back California thought about trying single payer - not surprisingly the cost estimates ran about as much as the state's current expenditures on everything else; it should be noted that California is essentially a one party - Democrat - state, so those studies weren't done by tight-fisted conservatives. Good luck to any state that can actually create a plan that works.

 

[Obscurity]

The state by state approach is an interstate commerce issue. I cannot freely travel or I'll have to, for example, buy insurance in backwards Mississippi, if ever I decided to go there.

That's a primary issue. It locks people into their home states and restricts freedom of movement.

 

[Obscurity]

A while back California thought about trying single payer - not surprisingly the cost estimates ran about as much as the state's current expenditures on everything else; it should be noted that California is essentially a one party - Democrat - state, so those studies weren't done by tight-fisted conservatives. Good luck to any state that can actually create a plan that works.

Single payer without eliminating the poison pill republicans love to stick in - that costs are not allowed to be controlled - is one big reason why it's hard to budget for.

You need to be able to dictate pricing, like everywhere else in the civilized world.

 

[diz]

The state by state approach is an interstate commerce issue. I cannot freely travel or I'll have to, for example, buy insurance in backwards Mississippi, if ever I decided to go there.

That's a primary issue. It locks people into their home states and restricts freedom of movement.

Insurance is already sold and regulated state by state. I guess that's why people never move.

 

[Obscurity]

Insurance is already sold and regulated state by state. I guess that's why people never move.

It's not even about moving. It's also about travelling. Only in this country do you have a chance of going bankrupt thanks to a medical emergency because you have the audacity to go... on vacation.

 

[dcsports]

The state by state approach is an interstate commerce issue. I cannot freely travel or I'll have to, for example, buy insurance in backwards Mississippi, if ever I decided to go there.

That's a primary issue. It locks people into their home states and restricts freedom of movement.

Not really. Insurance is regulated on a state-by-state basis now - you can go out of state to use it. It would lock you into that one option though.

 

[Greenbeard]

What I've always assumed is that states who have free health care would be flooded with sick people from states without free health

Perhaps, though several states had more generous health programs than the rest of the country prior to the ACA without huge adverse consequences.

The state by state approach is an interstate commerce issue. I cannot freely travel or I'll have to, for example, buy insurance in backwards Mississippi, if ever I decided to go there.

That's a primary issue. It locks people into their home states and restricts freedom of movement.

I doubt any state pursuing single-payer would decline to cover medically necessary emergency services out-of-state. So that’s not much of a barrier.

 

[madman]

You guys seem to slowly be moving towards the small central government that conservatives have been talking about all this time.

Strong state governments and limited federal government.

Who are you kidding? Conservatives bitch and moan about how the produce section the the local grocery story is managed.

give us a break

 

[Bullseye]

Single payer without eliminating the poison pill republicans love to stick in - that costs are not allowed to be controlled - is one big reason why it's hard to budget for.

You need to be able to dictate pricing, like everywhere else in the civilized world.

There aren't enough Republicans in the California Legislature to field a baseball team. The state is TOTALLY dominated by Dems. I think the highest-ranking Republican is the Dog Catcher in Visalia. :lamo

ETA: I was sorely minded to leave this post as was and see how many proglibs would call me on my "data". But I'm in a good mood so I'll say upfront exaggeration and hyperbole was used in the production of this post. No actual proglibs were hurt in its posting.

 

[dcsports]

Ro Khanna is about to drop a bill designed to make it easier for states that want to experiment with single-payer to do so. The biggest policy barriers to state-level single-payer have arguably been ERISA preemption (which prevents states from regulating self-insured employer health plans, which constitute the majority of lives in employer-based insurance) and re-purposing federal funds from existing programs into the state’s single-payer program (which can to some degree be done now through various waivers in the ACA, but more easily and comprehensively under this new bill).

It’ll be interesting to see exactly what this legislation looks like but it sounds like it would allow states that want to give it a go and provide proof of concept to proceed. Would it get any takers? (Obviously Khanna has California in mind.)

What if the Road to Single-Payer Led Through the States?


Presumably the bill won’t get far but it’s a worthwhile concept. Let’s see if the Tenth Amendment crowd goes to bat for it.

I think health insurance absolutely should be reviewed on a state-by-by state basis. This is where it should start.

However, I think the approach is stupid. She's discussing taking a couple of programs that work, if not well, at least OK (Medicare and Tricare) and a program that works, if barely (Medicaid) and cannibalizing them to create a new program. That's silly. It's ridiculous to think that a state could create a program from scratch, and have it function as well as these others out of the gate. PLUS, those programs are already providing coverage for their members - adding members would require adding money.

A better approach would be to either expand Medicaid (which the state already runs) or make something to 'fill the gap'. If it works well, then you can later talk about folding the others into it.

She does bring up a great point (indirectly) that the ACA needs to be moved out of the way. It's blocking opportunities for innovation in the states by locking up the individual marketplace.

 

[ludin]

Ro Khanna is about to drop a bill designed to make it easier for states that want to experiment with single-payer to do so. The biggest policy barriers to state-level single-payer have arguably been ERISA preemption (which prevents states from regulating self-insured employer health plans, which constitute the majority of lives in employer-based insurance) and re-purposing federal funds from existing programs into the state’s single-payer program (which can to some degree be done now through various waivers in the ACA, but more easily and comprehensively under this new bill).

It’ll be interesting to see exactly what this legislation looks like but it sounds like it would allow states that want to give it a go and provide proof of concept to proceed. Would it get any takers? (Obviously Khanna has California in mind.)

What if the Road to Single-Payer Led Through the States?


Presumably the bill won’t get far but it’s a worthwhile concept. Let’s see if the Tenth Amendment crowd goes to bat for it.

THis has been tried before and been an utter failure.

VT attempted to implement single payer and it failed miserably.
even the democratic Gov of VT said it wouldn't work.

Why single payer died in Vermont - POLITICO
The costs were astronomical and they would have had to raise state income taxes by 10% or more to pay for it.
He concluded the 11.5 percent payroll assessments on businesses and sliding premiums up to 9.5 percent of individuals’ income “might hurt our economy.”

CA looked at it as well it would have doubled their current budget and they had no way of paying for it.

There was another state that looked at it as well i think it was MN.
and CO tried it last year and it failed miserably as well.

The plan was to be funded by a new 10 percent tax on basically everything:

CO
A 6.67 percent employer-side payroll tax plus a 3.33 percent employee-side payroll tax; most economists think the former tax would be reflected in lower take-home pay for employees
A 10 percent tax on all nonwage income, like capital gains, self-employment, Social Security benefits, etc.
proposal that concluded that while it would roughly break even in its first year, it would have a quite large deficit by year 10: $7.8 billion, or 13.9 percent of revenue.

it was an utter friggen mess.

 

[Integrityrespec]

Ro Khanna is about to drop a bill designed to make it easier for states that want to experiment with single-payer to do so. The biggest policy barriers to state-level single-payer have arguably been ERISA preemption (which prevents states from regulating self-insured employer health plans, which constitute the majority of lives in employer-based insurance) and re-purposing federal funds from existing programs into the state’s single-payer program (which can to some degree be done now through various waivers in the ACA, but more easily and comprehensively under this new bill).

It’ll be interesting to see exactly what this legislation looks like but it sounds like it would allow states that want to give it a go and provide proof of concept to proceed. Would it get any takers? (Obviously Khanna has California in mind.)

What if the Road to Single-Payer Led Through the States?


Presumably the bill won’t get far but it’s a worthwhile concept. Let’s see if the Tenth Amendment crowd goes to bat for it.

Never will pass Congress. Not in the House of the Senate. The medical lobby has too many hands in too many political pockets.

 

[ludin]

I think health insurance absolutely should be reviewed on a state-by-by state basis. This is where it should start.

However, I think the approach is stupid. She's discussing taking a couple of programs that work, if not well, at least OK (Medicare and Tricare) and a program that works, if barely (Medicaid) and cannibalizing them to create a new program. That's silly. It's ridiculous to think that a state could create a program from scratch, and have it function as well as these others out of the gate. PLUS, those programs are already providing coverage for their members - adding members would require adding money.

A better approach would be to either expand Medicaid (which the state already runs) or make something to 'fill the gap'. If it works well, then you can later talk about folding the others into it.

She does bring up a great point (indirectly) that the ACA needs to be moved out of the way. It's blocking opportunities for innovation in the states by locking up the individual marketplace.

we already have state run items to begin with they utterly suck. we can easily fix healthcare by the eliminating state lines and opening everything up to actual market forces.

 

[ttwtt78640]

THis has been tried before and been an utter failure.

VT attempted to implement single payer and it failed miserably.
even the democratic Gov of VT said it wouldn't work.

Why single payer died in Vermont - POLITICO
The costs were astronomical and they would have had to raise state income taxes by 10% or more to pay for it.
He concluded the 11.5 percent payroll assessments on businesses and sliding premiums up to 9.5 percent of individuals’ income “might hurt our economy.”

CA looked at it as well it would have doubled their current budget and they had no way of paying for it.

There was another state that looked at it as well i think it was MN.
and CO tried it last year and it failed miserably as well.

The plan was to be funded by a new 10 percent tax on basically everything:

CO
A 6.67 percent employer-side payroll tax plus a 3.33 percent employee-side payroll tax; most economists think the former tax would be reflected in lower take-home pay for employees
A 10 percent tax on all nonwage income, like capital gains, self-employment, Social Security benefits, etc.
proposal that concluded that while it would roughly break even in its first year, it would have a quite large deficit by year 10: $7.8 billion, or 13.9 percent of revenue.

it was an utter friggen mess.

RomneyCare almost worked in MA but depended on massive federal subsidies and, of course, was not UHC.

 

[jmotivator]

I'm speaking in generalities, here.

I want the least government feasible, but some things are best done at the federal level. I also believe states are indeed the laboratories of democracy - sometimes what states discover/implement is left to the state, other times it is adopted by the other states or the federal government. I see no conflict, here.

Now as to healthcare specifically, I believe that as best done by a national single-payer opt-in program like the current Medicare or Medicaid.

I don't think the success of programs at the state level translate to a federal program. Some programs require a nimbleness that a federal government can not match. For this reason I wouldn't even suggest some states run a single health care system at the state level, I think big states like Texas and California, should they choose to go that route, would be wise to create internal, independent, smaller systems that can adequately track and adjust to local changes in population. Canada was at least smart enough to realize this and create wholly independent health care systems run y the individual provinces, and Canada has a smaller population in total than Texas or California.

The only things that jump immediately to mind as needing a federal scope are the military and a federal justice system that, if nothing else, presides of disputes between the states. Outside of that I can think of little that couldn't be handled by the states. And, having said that, even the federal military is broken up in to largely autonomous organizations and sub-organizations for the same reason that everything else should be, there is an inherent decline in effectiveness as scales increase.

 

[jmotivator]

Who are you kidding? Conservatives bitch and moan about how the produce section the the local grocery story is managed.

give us a break

Argument through hyperbole is no argument at all.