Why can't California and New York make their own medicare for all?

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.

Same with Washington and I think Oregon too. They call it by different names.
- Are they closer to a public option than NY? NY really isn't a public option.
- Washington's Apple Health is great. Easy and accessible. The state could definitely expand that to everyone.
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")
- 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.
- There is something of a welfare cliff for medicaid, but aren't there also means tested subsidies/discounts on the health insurance market for when you make more than that but are still poor?
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.
- 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.
- I'm certain that none of this is correct
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
Funny story, if it cuts off at a certain income level, it’s not for all.
I can’t imagine making a survivable go of it in New York for 28k/year.
- This is probably a red vs blue thing too. There are plenty of rural conservative parts of NY with much lower cost of living than NYC

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?

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
I'd love to see people like Newsome, Kotek, Ferguson, and Hochul grow some balls and start co-opting Trumps rhetoric on these trade deficits but with federal taxes instead. Currently most blue states pay more to the federal government than they receive and those dollars that they do receive are just returning the very tax revenue they sent out but with Trump's ridiculous conditions tacked on. He currently has his base of useful idiots talking about how uninhibited islands like the Mcdonald Islands are "ripping us off" so they should strike while the iron is hot and threaten to seize federal tax revenue generated from the workers and industries in their respective states just the same. If Trump is going to gut every federal office and program that actually impacts people's lives, what are we even sending them money for?
As far as the first part of your response: Hmm, that's interesting.
As far as the, "Bruh, do you not remember.."
Yes, I remember how Obamacare was passed.
Do you you remember how it seemed like a public option should pass- it had a ton of support- people were rallying behind it.
And then DroopyDog Senator Lieberman had that touted "meeting with Obama" and the public option was scuttled.
From the moment that happened, I thought, "Lieberman's the fall guy. The democrats don't want the public option, and Obama isn't any different from everyone else before him." (think Flint, think Guantanamo, think Bank bailouts, think Bank Bailouts again). If Obama had wanted it, he could have done it. I mean, look at Trump. He didn't.
At the time I was furious with Lieberman and Obama- now, just Obama.
https://www.latimes.com/archives/la-xpm-2009-dec-15-la-naw-health-senate16-2009dec16-story.html
- If Obama had wanted it, he could have done it.
  Lord.

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

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

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.

You need healthcare for all your life, not just when retiring. Why wouldn't you want to live and work in the state with healthcare if it actually works out cheaper for you and less risky? It's a completely false economy to live in the other state with no healthcare but have to pay high insurance rates and have high deductibles?
- The elderly have much higher per-capita healthcare consumption than do people during other points in their life.
  One element of the ACA was capping insurance premiums for seniors at an 3:1 ratio, where seniors couldn't be charged more than 3 times the premiums of people at other ages in life.
- The elderly population has greater healthcare spending per cap than the 20-30 year old population. Getting old sucks.
Maybe that could be a plus. Make a large death tax. People die off in your state, and fund the next set of people coming and and more?

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.

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

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.

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.
- 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.
- Yeah but we’re clearly no longer using the Constitution
The conservatives justices (if you buy into the whole conservative/liberal justices thing) would 100% be eager to up hold a state healthcare law if it meant getting to strike down Wickard v. Filburn and allocating more power to the states.
But thanks for being at least one person in this thread who appreciates that Medicare and Medicaid are not synonyms.
That was then, this is now. The Nazis don't respect the law, nor court decisions, and do whatever the fuck they want. The law no longer exists, and states can do anything they want. If the serial killing insurance companies want to sue over interstate commerce, then the states can simply prohibit them from doing business in the state - problem solved.
Besides, who cares if they sue? Ignore them, ignore the decisions (unless its a win), and do what serves the PEOPLE, not the corporations. Then raise the state corprate taxes to 100% of revenues.
Fuck the corporations, fuck the Sociopathic Oligarchs who own them, and any MAGA Nazi traitor that supports them. They are the enemy, and we have no obligation to do anything that serves their interests in the slightest way.

They can. Cali at least has a partial plan.

Hell even a city could.

Hawaii already does.

I'm looking for a public-option health care in Hawaii. Haven't found yet. Do you have a link? If I find I'll post a link
- https://medical.mybenefits.hawaii.gov/

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

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

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.

What do you consider Medi-Cal to be? 🤨

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?

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

NY has a bill floating around for this but it’s never gone anywhere.

Source: https://www.nysna.org/campaigns-healthcare-all/single-payer-system-new-york-state

Yeah! Something like this. But with other states involved to reduce risk, normalize costs.

I imagine the answer is the same as to why we lack all of the other good things too: Rich people only care about themselves.

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.

https://masscare.org/
At a glance, looks like it would cover anyone working 20 hrs/wk in MA

Because they don't want to.

Full stop.

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.

Does this imply that a state funded health insurance for all will operate at a net loss?
- 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.
- In the same way that the USPS operates at a loss
- 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.

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.

My state rep. Has been pushing for this in Minnesota for quite awhile. https://mnhealthplan.org/

Didn't happen in the last session. Think it's unlikely to happen soon with things getting tighter in multiple ways now.

A few reasons:

States are not currency sovereigns in that they do not create and control their own currency. All the money the state uses come from revenues they collect in taxes, fees, sales, etc. This is not the case for a national government, which creates all the money it needs for whatever it wants to spend money on. This gives the national government a lot more spending power than any state could possibly have, regardless of the state's GDP.

More importantly, though,

All states except Vermont have statutory or (state) constitutional requirements to have a balanced budget every year. This means they cannot run a budget surplus or deficit. Any surplus has to be spent or returned to taxpayers and any deficit needs to be resolved that year. This makes it incredibly difficult to run large programs like a M4A over time. When the state runs into a budget shortfall, the M4A system would be the first on the chopping block.
Insurance companies fight HARD against anything that hurts their business. This is specifically why Obamacare (the ACA) didn't include a public option despite Obama campaigning hard for a public option in the 2008 election. Insurance companies got their stooges in the Democratic Party to kill the public option when the ACA debates were going through Congress. They do the same in states when states try to do something about the healthcare industry. And if insurance companies publicly talk about a proposed bill causing them to raise rates or pull out of a market, that's a huge political stick to swing.

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.

Can you imagine the influx of people to those states?

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.

Because for all the big talk and anti-rich/anti-corporate talk that many Dem politicians preach--they aren't really willing to do anything other than talk about it in order to get votes.

Republicans aren't out to help you. Democrats aren't either. And most of Lemmy is too busy playing PokemonGO, to actually do anything close to a revolution that would change anything. They'll talk about it, upvote it, but they won't actually do it. lol

- Not sure what you mean. Can you explain?

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

Massachusetts also has a version of universal health care for those near the poverty line and requires companies with 10 (I think it’s 10) or more people to provide insurance. And requires everyone to have health insurance and helps them get it.

There are also bills currently live regarding true universal care for all. However, it’s extremely expensive and complicated to pay for, and I can’t imagine it will happen just yet. Maybe we can make some progress towards it though. The topic comes up frequently and has a massive amount of public support, so maybe some day.

But even the version we have now is at risk because it’s partially subsidized by federal funds and Trump is currently going after blue states and withdrawing funding. Even though blue states already get less federal money back because they subsidize red states.

Obamacare didn’t introduce true universal healthcare because insurance companies and republican politicians have been blocking, weakening, and trying to repeal it ever since it was introduced. You can see the same trend happening now with the efforts to wreck Medicaid going on. And then onward to social security and Medicare.

It’s important to remember that even when Democrats have control of say the house and the presidency, a republican majority senate can block everything still. And simple majorities are not always enough - sometimes 2/3 majorities are required to pass bills.

Are democrats perfect? Have they always done everything they could to make things better for people? Of course not. Mistakes have been made. There’s always room for improvement. Republican leaders and politicians are all about what big companies want though, and they distract people from this by pitting them against each other. White vs black/brown, democrat vs republican, American born vs immigrant/refugee, straight vs gay/trans, man vs woman. And all the while they continue to raise CEO salaries and rake in profits while not even paying people a living wage. There are some interesting graphs out there showing the increasing disparity of the 1%’s income compared to the rest of us. We shouldn’t be wasting our time hating each other, we should be uniting to rein in the big corporations. We are becoming the United Corporations of America, and we are the serfs providing cheap labor.