21
votes
What stops some US states from providing universal healthcare on their own?
I'm not very familiar with how government works in the US, and I've always had this question.
Like, if states are reasonably independent, and it seems like there are some states who lean way more into the socially liberal side of the spectrum from providing universal healthcare (or at least some better healthcare policies) on their own?
Nothing. There's legislative work being done right now in a number of states, such as California, with the goal of providing universal healthcare to residents. Though as someone who lives in a rather backward state, I'd rather it be implemented in the entire country at the federal level, this is definitely a model that could eventually achieve that goal; Canada actually got their healthcare system in that way, on a province by province basis.
Nice. Makes me wonder why wasn't it done sooner though. It's not as if it's a new thing in the developed world.
Even in hard blue states like CA, universal health care has been a fringe issue until very recently. 15 years ago, it would have been absolutely unthinkable to implement in the US. As you may already know, the US leans further right by default than any other developed western nation. Not only that, virtually all of us, regardless of party affiliation, have an individualistic bent. Liberals and Conservatives alike in the US tend to skew more individualist than collectivist than western European societies. The reasons for this are pretty complex, but suffice it to say, universal healthcare was seen for most of recent US history as something absolutely un-american and not even worth considering, not just by hardcore conservatives, but by virtually everyone.
Can you go into more detail on this? I've lived in the US all of my life and I've always wondered why individualism is so predominant here.
The idealist answer is that it seems from a history as a nation founded by rugged pioneers, escaping old world persecution to build a democratic nation of their own. The cynical answer is that it behooves those in power to ensure the working class is socially atomized, so as to dampen the power of collective action.
It's built into our federal documents and therefore our culture. This is sort of a result of the majority of people here being from somewhere else. Also the nation came into being at a time when freedom was becoming fashionable. Thomas Jefferson and others, some of them businessmen, slave owners, landowners and farmers, wanted to create a country that would of course benefit them. That our country has survived and even prospered is sort of proof that their approach worked, at least for a time. Yuval Harari has some very insightful things to say about the approach to freedom that he calls liberalism.
a lot of it rly comes from understanding oneself as working in order to get rich instead of for values like community, justice, etc. Steinbeck summed it up rly well with "Americans see themselves as temporarily embarrassed millionaires".
With that mindset, systemic problems get turned into "annoying hoops you have to jump through" instead of filtering mechanisms for ppl who are unable to jump through them, for whatever historical/individual reasons. The natural logic that mindset produces is that coming together with your neighbors & coworkers to try and push against what's "realistic" is just a silly waste of time, because you could use that time more productively by working longer hours for your boss, or getting another job so that you can pay for those medical bills
My suspicion has always been that America is farther to the right than most people realize.
The government is maybe. When you poll people on individual issues, most Americans are comfortably left of center. That this isn't reflected in their government showcases a pinnacle of managed democracy and information warfare scarcely seen in other nominally democratic states.
Federal universal healthcare would be much better than 50 different systems with different quirks.
But until then state level uhc will be a good first step. They just have to make sure they can phase it out when we do get federal uhc.
Is Canada's system federal or are there differences depending on province?
In Canada, the administration of health care is under provincial jurisdiction. However, the federal government transfers a significant amount of money to the provinces for the purposes of health care, but those transfers are subject to the Canada Health Act.
TL;DR: Provincial, but the feds bribe the provinces to keep coverage more or less uniform across the country.
Politics is a thing on state-level just as it is nationally. Some states do have comparable systems - most notably Massachusetts
https://en.wikipedia.org/wiki/Massachusetts_health_care_reform
Here are a few major issues that are not easily resolved, and slow down the process of individual state adoption as opposed to a federal one (some of these issues also exist at the federal adoption level):
Those are some good points but regarding #1, wouldn't you require people to be a resident in said state (even require a certain amount of time until it's expanded in other states if you really want to) to avoid this kind of issue?
Residency laws help, but when you're talking about a condition that regularly costs tens of thousands of dollars a year in medication, 6 months, a year, or even 2 years won't do much in the long run for controlling costs.
I feel that if the person had the knowledge that they were in a bad condition before they changed residency then it wouldn't apply but I'm not knowledgeable on the subject.
Laws would need to be updated. Right now there is no application for residency. If you move to a state, and stay there long enough, you become a resident.
Chances are a universal healthcare law would take some time to go into effect, so people might move after it's passed but before it's in effect, so a law change on residency would need to go in effect first.
If you are an Alaskan Native/American Indian in Alaska, you can receive free healthcare at the Alaska Native Medical Center, or one of the regional Health Corps. around Alaska.
https://en.wikipedia.org/wiki/Alaska_Native_Tribal_Health_Consortium
Jared Polis just became governor of Colorado and that was one of his initiatives. We'll likely see your question answered shortly.