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Comment by lostapathy | Hacker News Reader

Trivial inter-state mobility is a big obstacle for states doing grand social programs individually.

If a state provided universal healthcare for residents, it'd quickly be overwhelmed with "hard cases" from other states where coverage is a problem. Which would drive up costs, and taxes, and drive productive/healthy people out.

See the current inter-state shipping of homeless people, especially those who suffer mental illness, that is often done via bus tickets paid for by local governments looking to shed those people.

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Canada it is a "state"/provincial system. All provinces manage their own. Canada doesn't get inundated with Americans because if they do come, patients will be charged like private health care. If the patient's home province has universal health care, both province's will just work it out.

In general, we don't dump problems on to other provinces. It's bad form and federal courts will fix that quick especially with so much money on the line. If Florida state sends patients to a universal health care NY state for care, you can bet, NY State will be suing either residents of Florida for medical bills or Florida State directly.

Americans going to Canada for care is a totally different thing, and not relevant to my prior point.

All of Canada has universal healthcare, which again makes Canada a completely different discussion from my earlier comment. There isn't the kind of huge discrepancy between provinces as we'd have if some US states had universal healthcare and some had the status quo.

To your argument about states suing one another - we literally already have localities giving mentally ill people bus tickets out of state, and that's been unable to be stopped via the court system. I'm not dealing in hypotheticals here, I'm talking about things that already happen.

> In general, we don't dump problems on to other provinces. It's bad form and federal courts will fix that quick especially with so much money on the line. If Florida state sends patients to a universal health care NY state for care, you can bet, NY State will be suing either residents of Florida for medical bills or Florida State directly.

That was kind of the point OP was trying to make - in the US there are quite a few states that would do this without blushing. Without the Federal government instituting a framework and legal mechanism to prevent it, there is no way any individual state can do it on their own.

The system here only works because the Canada Health Act requires every province to have a universal health insurer for provincial residents and mandates each province accept the insurance of the others. If only Ontario had a provincial insurer or the provinces didn't have to accept each other's programs there would be a ton of game theory style manipulation.

Any state trying to implement a single payer system would get crushed as tons of individuals and even other states tried to milk the system (like putting homeless people on a bus with a one way ticket).

States would need a "suicide pact" of sorts to ensure a bunch of states made the leap at the same time. There actually is such a plan to subvert the electoral college to ensure the popular vote winner always wins the presidency, but that's a relatively simple pact around single law. Health care laws a incredibly complex and rather than try some kind of weird multi-state pact you're better off fighting for a national law.

People also want trivial inter-country mobility.

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