If so you might not be qualified to be a republican governor.
Wouldn't it be much better to hire your friends as IT consultants, make broken systems as confusing as possible, and continuously change the rules, and then starve the half-assed system of funding in an attempt to keep people from signing up for coverage at all? What makes this plan doubly republican-friendly is that all players are your donors and most victims are minorities.
The federal money is an extortion scheme.
The way federal programs nominally work is that people with money pay taxes to fund the programs. The people with money disproportionately live in certain states, which is the justification for making it a federal program -- then you can have a uniform national program even if some states don't have the tax base to provide it themselves.
But then the representatives from the states with money make it so the federal government doesn't fund the entire program. This benefits them first because they can shift some of the tax burden from the rich taxpayers in their state to the poorer taxpayers in some other state where any of the program's beneficiaries are. It tries to force every state to fund part of the program from their own tax base even if the people in that state didn't want it, because the alternative is to pay the federal taxes anyway but not get any of the federal money.
Then it benefits rich people again because the rich states, of course, implement the programs and get the federal money, but any state that refuses the scheme that disadvantages them is still paying federal taxes and gets nothing. So now you're getting a transfer of wealth from poorer states to richer states -- a penalty the representatives from the richer states intended when they constructed the program that way.
But the poorer states may not have the money to fund the state's portion of the program, and in any event refusing it is the only way the state government has to protest the federal program being constructed in that way. It puts pressure on that state's federal representatives to reform or remove the program.
So don't blame the poorer states for not implementing the program, blame the richer states for passing it without funding it.
Residents who do not have private or public health coverage still get health care. They go to the ER when they need help and they receive care in the most transactional and expensive way possible. The cost for this care is paid by all the other residents who do have private care (via higher prices) and in their taxes.
The goal of Medicaid is not to pay for more care, it is to better organize the care that is being provided, and in doing so, improve outcomes and lower the overall cost.
One reason Medicaid expansion has seen steady adoption, even in “red” states, is that earlier implementations have shown that this happens and the program is a net improvement.
Implying that a federal program is unnecessary because the states would have the incentive to do something anyway, but could then tailor the program to the geography and economy of their state instead of having something imposed on them that was drafted by Washington lobbyists.
> The goal of Medicaid is not to pay for more care, it is to better organize the care that is being provided, and in doing so, improve outcomes and lower the overall cost.
The problem is not that the patient pays otherwise, it's that the state if they want to implement Medicaid and get the federal money their tax base is paying taxes for regardless, has to put up even more money only to have the federal program dictate how they can spend their own money. That's the extortion -- they remove money from the state's tax base and only give it back if the state provides even more money and implements the program under the federal terms.
It gives the state no opportunity to make their own choices, which might have been more cost efficient. It destroys the "laboratories of democracy" the federal system was intended to have before lobbyists found a bunch of ways to cheat the constitution and take everything over centrally.
> One reason Medicaid expansion has seen steady adoption, even in “red” states, is that earlier implementations have shown that this happens and the program is a net improvement.
The main reason is because states can't afford to run their own equivalent program under their own terms when the federal government is raiding their tax base and then only returning the money with strings attached -- one of the major ones being that they have to spend even more of their tax dollars on the program whose terms are dictated by the federal program.
And this is not the only federal program that operates this way. So much of the poorer states' budgets go to spending money in order to get federal tax dollars under federal terms that they can't afford to do something different. Both accepting and refusing the money leaves them with not enough resources to do something on their own -- if they refuse it they end up with less money than they started with because tax dollars leave the state only to fund the program in other states, but if they accept it they have to pay even more and lose the ability to make their own choices.
It's unsurprising that many states would knuckle under to that level of coercive pressure -- the coercion is the intent. Otherwise the program would be a block grant, or simply not exist at the federal level so that federal taxes would be lower and state taxes higher, allowing similar programs to be operated by the states.
Notice that of all the people who downvoted that comment, not a single one attempted to defend having the program as a coercive centralized mandate from the federal level -- which was the criticism -- and instead the only argument is that a program of that nature is good. But whether the general idea is good or not is a separate question from which level of government should construct it.
Especially when it turns out that a lot of people the money is coming from aren't actually rich, and a lot of the "people" the money is going to aren't poor people at all but major corporations.
Many state elected leaders, however, have strong individual incentives to avoid any change that exposes previously hidden costs to their constituents, because then their opponents can accuse them of raising spending and/or taxes. (Even though they all know the cost has been there hidden all along.) This is the same incentive structure that inclines state politicians against spending state money on environmental protection, workplace safety, infrastructure, and many other areas where the federal government ends up taking the lead.
You seem pretty plugged in and sympathetic to the point of view of state elected officials. The idea that federal taxes are money stolen from states, for example, is a classic state politician talking point.
But I think you might be surprised how many federal actions are secretly supported by state officials who publicly campaign against them. They get to benefit from the material improvements delivered by the federal program, while blaming Washington for out of control spending, unfair coercion, etc.
But this is just defending the general concept of such a program, not a reason it has to be constructed at the federal rather than state level.
> Many state elected leaders, however, have strong individual incentives to avoid any change that exposes previously hidden costs to their constituents, because then their opponents can accuse them of raising spending and/or taxes.
How is it that federal elected leaders are immune from this incentive? And if they are, isn't that bad, because they would then for the same reason have no incentive to implement programs efficiently?
> The idea that federal taxes are money stolen from states, for example, is a classic state politician talking point.
It's a straightforward economic effect. Bob earns his wages which are then spent by some combination of Bob, the state government and the federal government. If the federal government takes more then the state government and Bob get less, and Bob is going to be in a bad way if there isn't enough left to make rent.
Meanwhile if the federal government uses the money for Medicaid then the state doesn't have to collect the money the federal government spends on it, but then it's the federal program setting the terms -- and if the state doesn't like those terms, Bob still has to pay all of the same federal taxes. The state can't use his money to operate their own program instead.
Federal spending is currently ~25% of GDP, which is more than it is for most states -- and a huge chunk of the money attributed to states is the state portion of the money required to implement federal programs. By the time you also pay for state programs whose funding couldn't reasonably be reallocated to something else, there is nothing really left. The states have lost the ability to try to do better because the federal government has locked up all the money.
> But I think you might be surprised how many federal actions are secretly supported by state officials who publicly campaign against them.
Well of course they do. They're opportunistic politicians. If they can't reasonably implement useful programs because the money they'd have to spend is already going to the feds then their remaining option is to claim credit for not spending it.
The point is, what would happen if the states were actually left with both the problems and the resources to solve them?
States opting not to open their own exchange (grey): https://en.wikipedia.org/wiki/HealthCare.gov#/media/File:ACA...
States opting not to expand Medicaid (blue): https://upload.wikimedia.org/wikipedia/commons/4/47/Medicaid...
(The second chart had more blue at the time; opt-outs have gone from 26 down to 10 now.)
I'm glad they're not smart enough to do that though and people were able to get healthcare through the federal exchange. I hope these bigots continue to be evil and dumb, if they get smart then we're really in for a bad time.
Y'know the ACA originally had a public option in the bill. Guess which side killed that? Why did we even need an ACA-with-private-insurance-companies anyway? The ACA was initially copy of what was implemented in Massachusetts by Mitt Romney. It's frustrating that Democrats had to compromise just to end up with a system that only somewhat better than what it replaced, and then get blamed for the result.
It’s not a frustrating outcome of democracy. It’s a failure of democracy with one party trying to take over and destroy all other opinions by all means necessary, which includes an open revolt and election stealing.
> It’s a failure of democracy with one party trying to take over and destroy all other opinions by all means necessary
Lots of people talk shit but almost everybody is still going about their daily lives in a normal civil manner. Obviously the state of American democracy could be better, but don't pronounce the patient dead just because he tripped and got his knee bloodied.
But this particular one? Not so much. Vastly better ones elsewhere, if only because they have less veto points and a better amendment process.
The bulk of it was largely designed around the specific circumstances of them 13 colonies->states, many of whom kind of hated each other, and full of appeasements to their different concerns at that time. Everything else has been retrofitted into it since then.
Which ones?
Canada? Japan? Australia? Germany? Even places with significantly unpopular governments like France and the UK don't have a situation where one of the houses of government can't function.
I think if the Italian government is more functional than the US then it's time to realize there is a real problem.
Here's a list of countries by GDP[1]. I'm looking at it and struggling to find a country that is (a) developed[2] and (b) a democracy and (c) doing worse in terms of functional governance than the US.
Turkey and Thailand are two options where they had attempted or actual coups, but neither are classed as developed.
[1] https://www.worldometers.info/gdp/gdp-by-country/
[2] https://www.oecd-ilibrary.org/sites/f0773d55-en/1/4/3/index....
There is neither a Constitutional nor a rational basis for a special unique exemption for past Presidents, and fortunately state and federal prosecutors seem to recognize that.
Sure, but using criminal process or any other power of office to punish partisan enemies is a problem whether or not the target is a past leader; there's no special danger around past leaders. if anything, there is less danger around past or current high government officials in general, and past Presidents in particular, because of the extraordinary degree to which those persons tend to be visible and well-connected politically.
Indictments on 91 felony charges across three different sovereignties in four different proceedings is...not what most people would describe as zero consequences.
(Also, there are several other active state criminal investigations relating to the fraudulent electors scheme, some of which have produced criminal charges against other people and any of which could very easily also result in further indictments for Trump.)
While I believe in due process, justice delayed is not justice.
And the body that should have sanctioned him (the elected government) voted down any punishment.
Pointing fingers is getting us nowhere. Someone needs to behave rationally and neither side is willing to do that. I don't really care who the worst offender is, we just need someone to step up and not be an offender
[1] https://www.healthsystemtracker.org/chart-collection/u-s-spe...
The group responsible for the actual legislation was the Affordable Care Today Coalition which consisted of a lot of different interests:
https://www.wbur.org/news/2007/04/10/affordability-clash-wbu...
To be clear: he shouldn't have voted against it. But if the Republicans wanted good outcomes neither should any of them.
https://publicintegrity.org/health/elimination-of-public-opt...
https://slate.com/news-and-politics/2009/10/did-sen-joe-lieb...
I think it's a mistake to view the two parties as representing two distinct ideologies, and further to believe either parties rhetoric about what constitutes their ideology.
Most of the game of US politics is to see how many terrible/unpopular deeds you can perpetrate against the public on behalf of the moneyed interests (not voters) that supported your campaign without losing votes to the opposition.
Wedge issues and propaganda keep people voting on party lines for candidates that only occasionally act in the majority interest of their own voters, let alone the interests of the greater public.
I love the irony in your bigoted comment.
Sometimes the stars align and the federal government builds a system that is actually nice to use.
But sometimes the system is a steaming pile of shit.
> But sometimes the system is a steaming pile of shit.
I'm pretty sure I've seen the same outcomes in private business too. Just look at the history of Windows, as one of very many examples.
See also, NEVI, where the government is spending billions of dollars to build chargers via a complicated system involving state managed programs. It was passed almost two years ago and hasn't deployed a single site.
That’s because you completely misunderstand how government bureaucrats think. You’re not paying for it - the taxpayers do
At least, I had much more faith in my state government (MA) to not half-ass this kind of thing.
California has a good system that is roughly standalone while NY has one (also good) that is integrated into other NY programs. Both fan out into a network of actual humans (mix of private and public sector) that help make it work for people who for whatever reason can't use the online service. It's hard for the feds to do something like that at scale -- for example to have it integrate into other lcal programs.