this post was submitted on 05 Apr 2025
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I want to know why I'm wrong- because this question has been eating at me for years- and I secretly blame the Democrats for all of the health insurance problems.

Why can't California and New York bind together in an interstate compact, and create medicare for all of their citizens?

California and New York have GDP's above most other countries in the world. In general, democrats hold majorities. Tell me why I shouldn't blame the democrats for:

  1. Doing Obama care half assed, when something like 80% people wanted a public option.

  2. Not just doing it themselves. For instance even NYC by itself has a GDP above Denmark, and NYC is filled to the brim with the super rich.

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[–] [email protected] 1 points 1 hour ago

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.

[–] [email protected] 1 points 2 hours ago

NYC has a very viable option in MetroPlus, the city healthcare option for Medicade

[–] [email protected] 2 points 2 hours ago

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.

[–] [email protected] 2 points 3 hours ago

Can you imagine the influx of people to those states?

[–] [email protected] 21 points 13 hours ago (1 children)

Short answer : Neoliberals

Longer answer : the Democratic Party apparatus in both those states is FULLY controlled by the 1980s-Republican-Party-esque wing… and they have ZERO interested in anything economically meaningful. Their role is to act as a backstop against “the left.”

The best you’ll get from Nancy “let me grab some more gelato from my 2nd dedicated Sub-Zero brand freezer” Pelosi and Gavin “I want to do more podcasts with Steve Bannon” Newsom is kneeling in Kente Cloth and military weapon contracts covered with 🏳️‍🌈 decals.

[–] [email protected] 2 points 2 hours ago

This is literally why I rename "centrist" Democrats to Republicrats.

[–] [email protected] 5 points 17 hours ago (1 children)

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.

[–] [email protected] 4 points 16 hours ago (3 children)

Does this imply that a state funded health insurance for all will operate at a net loss?

[–] [email protected] 9 points 10 hours ago

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.

[–] [email protected] 4 points 12 hours ago (1 children)

In the same way that the USPS operates at a loss

[–] [email protected] 1 points 2 hours ago

It uh... actually doesn't.

[–] [email protected] -1 points 12 hours ago (1 children)

Yes, of course. Health care generates revenue for health care providers, not the state. For the state it’s just another expense on the balance sheet.

The problem with universal health care is that 70% of expenses go to treat 10% of the population. These are often very sick people near the ends of their lives. Frequently the money doesn’t appreciably improve their health or well-being, it merely provides many expensive (and often painful) treatments that extend their lives.

This is the really ugly side of health care that we don’t like to think about because it involves difficult discussions about quality of life and death. We would much rather not think about these things and instead throw more money at the problem. Unfortunately, medical technology has advanced a lot in these areas and so there is an ever-growing array of treatment options to extend life without restoring quality of life.

[–] [email protected] 0 points 10 hours ago

They're called taxes, look it up

[–] [email protected] 19 points 1 day ago (1 children)

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.

[–] [email protected] 1 points 9 hours ago (1 children)

I'm very interested in reading about this. But not much comes up when I search. What did California find out?

[–] [email protected] 1 points 9 hours ago (2 children)

It has been years since I have read about it. I can't find it now either. However, my search did mention that having single payer healthcare will cost California $500 billion annually, double the state's entire annual budget as of 2024. https://www.wordandbrown.com/NewsPost/Single-Payer-2024

For now, California has been subsidising healthcare costs through existing programmes.

[–] [email protected] 1 points 17 minutes ago

California's annual budget is $60 per person? Healthcare would cost $125 per year? What are these numbers?

[–] [email protected] 1 points 3 hours ago

It's honestly insane how expensive all this shit is.

[–] [email protected] 14 points 1 day ago

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.

[–] [email protected] 15 points 1 day ago (2 children)

Lol, California unemployment is capped at 450/week. No chance we can afford universal medicare

[–] [email protected] 1 points 9 hours ago

I was getting 450/week 10 years ago. It's pretty crazy they haven't raised it.

[–] [email protected] 7 points 15 hours ago

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.

[–] [email protected] 82 points 1 day ago* (last edited 1 day ago) (6 children)

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.

[–] [email protected] 2 points 12 hours ago* (last edited 12 hours ago)

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

[–] [email protected] 30 points 1 day ago (4 children)

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")

[–] [email protected] 5 points 1 day ago

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.

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[–] [email protected] 33 points 1 day ago (3 children)

Same with Washington and I think Oregon too. They call it by different names.

[–] [email protected] 10 points 1 day ago (1 children)

Washington's Apple Health is great. Easy and accessible. The state could definitely expand that to everyone.

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[–] [email protected] 21 points 1 day ago (2 children)

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.

[–] [email protected] 15 points 1 day ago (5 children)

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.

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[–] [email protected] 22 points 1 day ago* (last edited 1 day ago)

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

[–] [email protected] 17 points 1 day ago* (last edited 1 day ago) (4 children)

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.

[–] [email protected] 7 points 1 day ago (2 children)

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.

[–] [email protected] 0 points 12 hours ago

Yeah but we’re clearly no longer using the Constitution

[–] [email protected] 3 points 1 day ago

Yeah, look at any number of things (including Medicaid implementation) that have been left up to the states and what a complete dumpster fire they are.

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[–] [email protected] 38 points 1 day ago* (last edited 1 day ago) (7 children)

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?

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[–] [email protected] 22 points 1 day ago (5 children)

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.

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[–] [email protected] 7 points 1 day ago (1 children)

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.

[–] [email protected] 2 points 12 hours ago* (last edited 12 hours ago)

https://masscare.org/

At a glance, looks like it would cover anyone working 20 hrs/wk in MA

[–] [email protected] 8 points 1 day ago

Mostly because we're stuck supporting the red states that suck at the Federal titty.

[–] [email protected] 5 points 1 day ago

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.

[–] [email protected] 16 points 1 day ago (4 children)

They can. Cali at least has a partial plan.

Hell even a city could.

Hawaii already does.

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[–] [email protected] 11 points 1 day ago (1 children)

What do you consider Medi-Cal to be? 🤨

[–] [email protected] 8 points 1 day ago* (last edited 1 day ago) (2 children)

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?

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[–] [email protected] 7 points 1 day ago (2 children)

Because they don't want to.

Full stop.

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