I see successful government projects in many countries. Unfortunately in the US we have this belief that government projects are destined to fail, which means we don’t invest in them, so they often fail... self fulfilling prophecy if ever there was one.
Sorry, no, that excuse is toxic because it provides cover for bad government that doesn’t work. We’re talking about states like California and New York that don’t have a meaningful “right.” California’s attempt at universal healthcare managed to self-destruct with Democrats having the Governorship as well as super-majorities in the state legislature. Every now and then these states will elect a moderate Republican just to get a reprieve from the repeated waves of failure of public services, but those failures can’t be blamed on “the right.”
People in blue states should be madder about the fact that their public services are bad. That just means that people get less than what they pay for, and people in need do without. If it cost Europeans as much money to build subways as it does New York or SF they probably wouldn’t do it! And even when it doesn’t like (like California HSR) and is merely 5-10x more expensive than it should be, that just means 1/5 or 1/10th as many people get the service.
California would, in practice, need a variety of permissions from the feds to do approximately single-payer, which still wouldn't be actually single payer. Both the ACA and Medicaid would be major federal issues (in principal, it could opt out of Medicaid, but that would lose a lot of federal health care funding California is being taxed for). And it would still have the interface-to-other-systems problems single-payer is designed to avoid, because Medicare and VA would still exist and require coordination of benefits.
No European country would have similar problems, because they are independent nations.
Europe has free movement of people throughout the Schengen Area and a common currency plus European Central Bank. It's not quite federalism but there is nothing here to disqualify California from providing universal healthcare.
Citizens of members states can, for instance, travel through Germany and remain there indefinitely so long as they're financially independent or actively looking for work, but they are not automatically residents of Germany. The two situations, EU member states and California compared to its peer states, are obviously not comparable.
There are clear reasons why individual US states haven't been able to provide universal health care. It's not because the idea is unworkable at a national level; it's because you can't do it state-by-state.
(I oppose single-payer health care, for whatever that's worth to you. I just think the bar Rayiner set for this discussion is silly.)
I’m curious why you think Canada couldn’t provide single payer health care. (For the record, I support a Canadian style system.)
The biggest challenge I see is that people might rush to California to claim the benefits. It’s not clear that’s a real problem (and it’s not the problem Vermont and California actually ran aground on).
The Supreme Court’s precedent in this area is a shambles. But if California offered state-run universal insurance, I bet the Supreme Court would approve measures to keep people from moving to California after they got sick.
Adverse selection of people claiming residency benefits isn't the only issue I cited there, right? There are things countries can do to finance universal health care that states can't do.
> There are clear reasons why individual US states haven't been able to provide universal health care. It's not because the idea is unworkable at a national level; it's because you can't do it state-by-state.
How do you figure? This is exactly how Canada's single payer system came about: province-by-province. Saskatchewan was the first Province to offer single payer in 1947, followed by Alberta in 1951, etc. By 1961, all Provinces had some form of a single payer healthcare system. To this day, Canada's single-payer system is Provincial, not Federal.
Not now, but between 1947 and 1961 there absolutely was. That’s the point: it didn’t happen from the top-down at the Federal level, it happened province-by-province and there was a period of time when it was patchwork. It was fine for the Canadians, and it can be fine for Americans as well.
Also, if I’m understanding your argument correctly, it’s that States can’t do this because borders are open, but there’s nothing stopping a State from applying its public insurance only for established residents of the State. This is how State university systems operate; you don’t get in-state tuition at UC Berkeley unless you can establish residence. In theory, someone at the borders could move across State lines in order to do that, but that’s probably a rounding error in the UC budget.
