Because it creates collective action problems. Countries can exercise their sovereign powers to control commerce and the flow of people so as to reinforce their chosen social welfare systems. If they offer universal healthcare, for example, they can control immigration to manage the burden on their system (and keep out people who only move in when they get sick or to retire). U.S. states are precluded by the Constitution from doing that. Say Marylanders decide to pay higher taxes to support generous social services, and Virginians decide to stick to lower taxes and no service. There is nothing Maryland can do about free-loading Virginians who cross the border as soon as they get sick.[1] Likewise, say Virginia decides to reintroduce child labor, which gives Virginia a competitive advantage in producing cheap consumer goods. There is nothing Maryland can do to stop the flow of trinkets from Virginia undermining good Maryland companies whose prices are higher because they don't use child labor.
It's helpful to view the Constitution's Commerce Clause and Privileges and Immunities Clause as a two-pronged economic construct. One prong says that the U.S. is a totally free market internally for goods and labor. The other says that the federal government can intervene to address any collective problem actions that creates. To the extent that the provision of social services has knock-on economic effects (and it has major knock-on effects), it comports with the Constitution's design for those things to get kicked up to the Federal government.
[1] See: http://www.washingtonpost.com/wp-srv/national/longterm/supco....
One solution is to put a delay on eligibility. In your example, Maryland would provide free healthcare to anyone who has lived in Maryland as a permanent resident for 5+ years. Much like state universities. There's two different costs and in-state tuition is much cheaper. No more freeloading. Or less, anyway.
Whenever someone tells me, "It's too complicated!" I just think they're lazy. I usually don't say it though, to be polite. Instead I try to walk them through algorithmic thinking in a way that doesn't terrify them that I'll automate their jobs.
In your example of child labor, it's arguably better for everyone if Virginia can produce cheaper goods. (Please don't think I'm in any way arguing for child labor.) Maryland benefits from the cheaper goods as well, and is able to free resources for other pursuits that are economically advantageous for them. We already see this to a degree in places that have an abundance of a natural resource – it's cheaper and more efficient for them to export the resource than it is for other places that don't have the resource.
So is it arguably better for everyone or should there be protections for the children (who are presumably part of "everyone")?
I think if you immediately include a disclaimer about the children you probably don't believe there is much of an argument to be made.
If I look at it strictly in terms of child labor, there's nothing stopping those opposed to child labor from leaving Virginia and/or discriminating against products made there. Just as we can today with products produced by brands that we know use child labor.
My point is, in the hypothetical situation that a state did allow child labor – which I do not at all condone – people could choose not to buy products from that state, as people already do in not buying products from certain brands and countries that use child labor.
A US state can't do this on it's own because they can't force everyone to participate and they can't reject entrants from outside. In the Virginia/Maryland example Maryland would face an exodus of healthy and productive people who want lower taxes and an influx of sick people who want the free health care. It's not about "remaining equal in all other categories." It's that it wouldn't really work at all.
That's why you can't really have a system with massively different social services at the state level: the unbridled state to state migration.
On "unbridled state to state migration", I already covered that. Maryland would have to face the real cost of providing universal healthcare, and residents would have to decide whether it's still worth it to live there. Many sick people would decide that it's not, and choose to stay put in Virginia.
And if it truly wouldn't work, then it begs the question: Does it really work on the federal level? Why are costs skyrocketing and providers leaving exchanges?
The point is that they would have to face much more than the real costs of providing universal health care because they would have to provide care to a lot of people that never paid into the system due to migration.
People don't really oppose federalism, but national level politicians win elections by promising benefits to interest groups to justify their existence. Promising to sit on your hands will never win an election.
Insurance shouldn't be used for routine stuff, and people shouldn't be required to have it unless they want it.
If they're not forced to do this, then they won't and people are forced to stand by and watch as they fall ill and due which is bad for the economy and may already disease, even if you don't care about the moral aspects.
There's little benefit to seperating these things out and obvious downsides to them not being mandated.
And yet each year there are millions of people that receive medical services in excess of their insurance payments (including premiums, copays, etc).
So what was your point?
Anyway, I'm pretty sure they were saying that insurance didn't work, which is manifestly untrue. If they are complaining that it makes healthcare more expensive, well fine, but that is probably more about the principal agent problem than the administrative costs and profits of insurers.
And is it really affordable, even for the unhealthy?
Because we live in a society, and in a society people help one another.
I'm arguing against being forced to help others who I have no relationship with, live in far off places, hold different health standards than me, etc.
Believe me, if a family member of close friend needed help with medical expenses, I'd be the first to volunteer.
Instead, it hopes dogmatically that other moral values will be met as a side effect of following this one.
How is that any difference from defense, law enforcement, fire protection, or property rights standards?
And don't say 'but charity', we already know charity is massively insufficient.
You're assuming that if the government didn't mandate health insurance, nobody would step in to help those people, which I don't believe is true. Lots of different groups – religious, businesses, municipalities, etc. – could fill that role. Individuals could even give directly to strangers in need through something like https://donorsee.com/.
https://www.youtube.com/watch?v=mwzBJF5Q7Vw#t=3m29s
This is Dan Ariely describing "The public goods game" and the instability of 'cheating'. Cheating in scare quotes because the conclusion stands -- in fact is enhanced -- even when the 'defect' choice is regarded as a choice that members of society are free to take (in fact that is the case he discusses).
No, the assumption is that if government mandated dollars stopped coming in, voluntary contributions wouldn't make up the difference. And that seems pretty obvious to anyone who pays attention to the political dialogue. Look at the Republicans who believe Obamacare is too costly. Their sole goal is to have less of their own dollars subsidize the sick.
Besides healthcare costs are lower in countries where the government intervenes more than ours does disproving the point.
Also, source for your second assertion?
The OECD publishes copious statistics on healthcare expenditures, access, quality, and outcomes: http://www.oecd.org/health/health-data.htm
It's well established, just google it.
That's a very strong assumption, and I see no reason to believe its true.
Now before you go and doomsay about all sorts of discrimination happening based on race, gender, sexuality, etc., I'd argue that lots of institutions wouldn't discriminate on those factors. Case in point: most of the major tech companies. And if one did, would you really want to be associated with them and/or have them paying for your healthcare?
The ones that have recently faced age discrimination suits, criticism for the lack of diversity in their employees, and a whole range of reports of terrible conditions in their manufacturing plants? For some bizarre reason, I'm sceptical.
>And if one did, would you really want to be associated with them and/or have them paying for your healthcare
When compared to dying or living with severe health problems, absolutely. This entire thing is about unexpected healthcare costs, I may not have the ability to shop around for the most ethical choice.
I understand what you're saying with "the ability to discriminate is important," but free discrimination has led to the trampling of human rights repeatedly in history.
It's good to know that you're against your tax money being used for the most expensive military in the world.
Over the course of time, everyone falls into both categories; this idea that there are healthy people is silly, everyone's health fails eventually and often randomly. Healthy is a temporary state. Everyone should contribute so everyone is covered when they become the unhealthy, as they all will.
Better to pay a little bit all of the time than to pay nothing and be unable to afford a giant medical bill that hits you all at once. This is why everyone should pay all of the time, then there's enough money to cover the every changing subset of people, which will eventually include you, who are sick.
That some people in society look at the circumstances of their birth and post-hoc reason that they don't want universal healthcare because it wouldn't have benefitted them is not the point really.
Incorrect, everyone gets sick to the same eventual degree: death. You will require medical care.
> or I simply want to take a chance that I'll remain healthy
No one remains healthy, period, everyone gets sick, everyone.
You could be the healthiest person in the world and get punched by someone who gives you an expensive disease through blood contact; you could randomly get cancer at any age no matter how healthy you think you are. So this notion that you think you should pay less is based on a naive understanding of how health actually works; you cannot predict the future. You could be disabled tomorrow through no fault of your own. As such, the system must be designed to consider that everyone will be sick at some point and most people will be healthy most of the time, everyone pays and the sick are covered, problem solved for everyone. Social medicine works better than any other approach, this is a fact proven around the world. Those objecting to it are doing so on ideological grounds, not on rational ones.
How do you justify those whose property isn't on fire paying for firefighters?
If I don't want to protect against my house burning down, why should I pay for it? And before you go and say, "because your neighbor's house could burn down too", they could choose to pay for firefighters and have them come out to douse my house in defense of their own.
Good to see you support others taking on your risk. This is the essence of universal healthcare.
The same (very good) reason we don't allow that is the reason we don't allow this: a lot of individual decisions have social costs.
We do allow them to choose that: you don't have to have car insurance, not even if you own a car.
We don't, however, allow them to drive on public roads without liability insurance or (in some jurisdictions, like CA) posting a liability bond.
Financial responsibility is something to be enforced by courts, not mandated by congress.
The medical bills for any one of the surviving parties dwarf the net assets of the deceased.
Who pays the remainder?
And who's to say the extended family or community wouldn't step up to cover their expenses?
This really goes to prove my initial point in all of this: Why can't we get to a place where you can live somewhere more aligned with your utopian vision, and I can likewise live somewhere more aligned with mine? Why must either of us force our vision on the other?
Except, of course, the wealthy.
Who gets the money printed by the Federal Reserve first? Banks, where wealthy bankers then loan the money to others who are wealthy enough to be accepted for the loans. By the time the money reaches the poor and needy, inflation has already taken hold.
> Financial responsibility is something to be enforced by courts, not mandated by congress.
That's a matter of opinion.
No, that's the electoral system; it's been empirically studied and established democracies with more proportional representation have much higher satisfaction with government than those like the US with poor proportionality, even though many of them also have much greater levels of public social support.
Your 'solution' would be massively regressive - what if Texas decides to rescind Medicaid? Are those people who cant afford to move just SOL?
Medicaid is a voluntary state-run program with federal participation standards. Texas could withdraw from Medicaid if it chose to, now.
All states have chosen to participate since 1982, but they are not required to.
What if Florida decides to roll back gay marriage?
What if Alabama rescinds the Civil Rights Act?
Are those who can't afford to move supposed to just deal with it?
You're relying on the right people being in office/power making the right decisions in your opinion. But of course, at any point the wrong people can get into office and make the wrong decision in your opinion. For nearly half the country, that happened when Obama entered office, and then again when Trump entered office.
Oppressing others isn't something that should be allowed to happen, period; those people are simply wrong, the position is immoral and indefensible. These things belong at the federal level, states should not be allowed to say oppression is OK because a majority of our citizens want to oppress gays.
> That's a matter of opinion.
To be clear, I am not one who is in favor of rolling back gay marriage. But you cannot logically say
> Oppressing others isn't something that should be allowed to happen, period
while in the same breath calling for the oppression of those you disagree with. It's an inconsistent position using the same argument you're railing against.
I believe true tolerance is respecting that everyone can have their own opinion/worldview. We can certainly disagree and have a good discussion about it, but nobody should be forcing their opinion/worldview on others who don't agree.
And where in this thread has me or anyone forced our world view on you? Not allowing you to force your view on others isn't forcing our view on you. Frankly I don't think you understand what oppression or tolerance actually is.
If you read back through the hierarchy to my comment here[1], you'll see that I ask the hypothetical question, What if gay marriage were rolled back in the U.S.?, to make the point that currently you'd have to move out of the country to escape the law. I do not believe in rolling it back! I used it as an example of a law/idea where there's a difference of opinion among worldviews.
We're actually on the same page here, gnaritas. People should have equal rights, regardless of their race, gender, sexual identity, etc. Nobody should be forcing their worldview on others. But that's exactly what the federal government does by making decisions that affect everyone. Every decision they make is made from a specific worldview. It's impossible for them to make a decision that complies with every unique worldview out there.
yes you did with this comment...
> while in the same breath calling for the oppression of those you disagree with.
You accused me of calling for the oppression of those I disagree with, so please do show me where I did that.
> But that's exactly what the federal government does by making decisions that affect everyone.
No, when the thing they're doing is providing equal rights, that isn't forcing anyone's world view on anyone else. Those who don't want gays to have rights aren't being imposed upon, they're still free to think whatever they like and they're free not to be gay; they have not suffered at all even though the law is in conflict with their world view.
> Every decision they make is made from a specific worldview.
While that is true, that doesn't imply said decision is imposing that view on anyone. Stopping group A from oppressing group B is not imposing a worldview on group A.
> It's impossible for them to make a decision that complies with every unique worldview out there.
Of course, but it's not impossible for those decisions not to impose that view on anyone else. Protecting minority rights imposes nothing on anyone. If someone doesn't believe in gay marriage, the federal protection of it might be against their worldview, but nothing has been imposed upon them; they are not losing anything by someone else being treated equally.
You're failing to draw the necessary line between having different points of view, and having those points of view imposed upon you. Just because the feds do something at the federal level that may be the result of a world view in no way implies that thing they're doing imposes that view on anyone else.
Now certainly, many things they do "do" impose a worldview, but I'm only defending the protection of minority rights to have equal protection under the law, and that doesn't impose anything upon anyone.
Enough said. All our problems are caused by trying to fight against this simple fact.
Arguably that militates against treating it as insurance as opposed to a straight-up single payer system or Singapore style system (http://theweek.com/articles/684952/republicans-should-blow-e...), but it does mean you can't argue from the success of existing insurance markets.
Even now, there are places like https://surgerycenterok.com/ that prove high quality healthcare can be provided at affordable prices (they even list them on their website!).
It doesn't have to be that way. By decentralizing decision making down to a level closer to the individual (if not the individual), more people get what they want. For example, right now there's a federal mandate for health insurance. Not everyone agrees with this mandate, so why not at least push it down a level to the states? California can still have a mandate for health insurance, and Alabama can decide not to. And then, why not push it to the city/county level? If you don't agree with San Francisco's mandate for health insurance, simply move to Oakland. You don't even have to move states, let alone countries.
Why do so many oppose such a solution where everyone can much more easily find a place where they agree with the "social services" offered (or not)?