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Comment by kmonsen | Hacker News Reader

This came up in the VOX in the weeds on healthcare policy some time ago. Their conclusion from the people that had looked into it is that it is sort of impossible for states to do this. Can't really remember the reasons.

There was another state that was trying something like this, I believe it was Vermont.

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> Their conclusion from the people that had looked into it is that it is sort of impossible for states to do this. Can't really remember the reasons.

adverse selection is the usual objection raised. If you can live in Montana while you're healthy, and move to New York when you're sick, then New York effectively becomes the dumping ground for the nation's sick and ends up picking up a hugely disproportionate amount of the tab without the revenue base to make it up.

That said, since coastal states make up a disproportionate amount of the economic activity anyway... they may be able to power through it, especially if they can all get onboard with it at the same time. It's not like de-facto cash transfers to the poorer "heartland" states are a new thing in the US.

People don’t move for various reasons, and now sick people are going to move for healthcare?

It’s not financially possible. The tax rate will be so high healthy people will then leave and you’ll be left with a fat bill for your sick population.

You have it backwards, you won’t get more sick people you’ll have less healthy people covering the bills.

The inability to run deficits is the killer here.

I'm guessing the economy of scale for such a buy in isn't enough, and that states would have to take out as much debt as their yearly budgets or even more. Even a Elizabeth Warren's proposed solution was something like 17x the federal budget.

States wouldn't be able to borrow on anything like that scale to fund a healthcare program. Any major increases in healthcare spending would have to be funded by huge tax increases.

> increases in healthcare spending

FWIW, New York's current Medicaid budget alone puts it between San Marino and Israel for per capita healthcare spending. Widening the net a bit, that's between Italy and the UK.

NYS has a bigger population than all of Canada which seems to do make universal healthcare work.

There’s comments above that explains it “working”. Here’s a site that explains it better. TLDR, taxes go up a lot, private spending for medical procedures slightly falls. Quality of care drops. Pretty well a losing proposition all the way around.

https://www.heritage.org/health-care-reform/report/how-socia...

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