comment: >
  
  It's a "tax increase".
  If they just called it something else like a "Medicare insurance premium" and could guarantee that the cost would be less than private insurance, what would be the problem?
context: It's the same tax increase whether it happens at the state or federal level. >
  
  Not necessarily. The federal government already runs the largest payer on the planet that has a billing system built into every provider operating in the country. CMS operating a universal healthcare system will be way cheaper than Vermont's effort with Green Mountain Care.
  For example, Vermont acts as the primary payer to about 182,000 Medicaid enrollees in the state. CMS covers 65 million people. >
  
  Don't forget the VA healthcare system with its more than 9 million U.S. veterans who are currently enrolled in the VA and eligible to receive health care. >
  
  ... and there's the funny thing about the US healthcare system. The US already has every kind of health care system in place today. By my rough reckoning the US payor landscape looks a bit like this:  
  
  Beveridge model - VA, DoD, IHS
  Bismarck model -> US group health market, Tricare, Medicare Advantage
  National health insurance model -> Medicare, 52+ versions of Medicaid/CHP  
  Uninsured model -> Uninsured 
  
  It's a touch unsurprising that the market is bananas when you have 52+ markets for health insurance, and then you carve up those markets even more with different models of care. >
  
  One thing you're not considering here is that if Blue states try to do this, it'll create an adverse selection pool. People who are likely to accumulate significant medical bills will move en masse to states with universal care, and healthy people who don't want to pay for universal care would be incentivised to move out of those states. For universal coverage to work, it needs to be nationwide. >
  
  Easy fix. Require them to have resided in the state for a fixed amount of time before being eligible. Nobody is going to live in expensive California for 5 years just to be eligible for benefits >
  
  This is only acceptable if you don’t lose coverage when you change states >
  
  That’s a great point. I didn’t think about that. >
  
  A major factor is budget concerns as state governments cannot run deficits in the same way that the federal government can. States are restricted in their ability to spend money in ways that the federal government is not. >
  
  The other thing is that a huge benefit of single-payer healthcare is the incredible position in price setting for drugs and medical procedures - effectively complete cost control. When done federally, its basically turning medical pricing over to the government. The problem with states doing it individually is that they don't have the same negotiating power as a national plan would. Now, it would be doable with the big four states - California, Texas, New York, and Florida - but just about any other state would struggle. Its just a higher price to pay at the state level in general due to the weakened ability to control costs. >
  
  The hive disadvantage is that the next time Republicans get into power they will be in charge of your healthcare. How you don't want additions, birth control, hrt or transiting in general, vasectomy, tubes tied, basically anything to do with family planning, or anything else the religious right is against. How anyone can go through the trunk years, including two where the GOP had the trifecta, and think "not o wish they had more control in my every day life." >
  
  Are you suggesting that the government should not offer any public services because maybe Republicans will control it when they're in power? >
  
  Never give the government power if your political enemies will also be able to wield that power >
  
  I think the other is just bemused by the idea that we shouldn't let the government provide universal healthcare at all because it might one day provide less than it did.
  Like, if we can get it to 80%, but we worry it might drop to 60%, that's still 60% more than 0%. >
  
  I think it's less about that and more about what medical procedures become legal or illegal based upon who is in power and whether or not you want government dictating what kind of medical treatment is available to you >
  
  That has nothing to do with government funded healthcare. In fact, the government already outlaws certain procedures based on conservative ideology. Just look at what's happening to trans people across the country. Doing good things isn't going to make them more able to do the bad things they're already doing >
  
  
  That has nothing to do with government funded healthcare.
  
  The above poster didn't say it correctly (legal vs illegal), but the point is correct. If the government is the sole provider of healthcare payments, if they say they won't pay for something, it is essentially banned. This isn't hypothetical either. The Hyde Ammendment is a law right now that prohibits the federal government from paying for abortions. M4A plus Hyde = no abortions. Nationwide. Now apply that to anything else the religious right doesn't like. 
  If you don't trust Trump and McConnel to decide what is and isn't healthcare, you should oppose M4A. A public option gives healthcare to people who need it, without forcing anyone onto a government run plan. >
  
  
  If the government is the sole provider of healthcare payments, if they say they won't pay for something, it is essentially banned
  
  That's not how public healthcare works at all, nor is it at all what is being proposed. >
  
  So Massachusetts has Romneycare, which is a hybrid system that is what the ACA is based on. Under Massachusetts, law all residents of the state have to be fully covered with health insurance. How it ends up working is that most residents receive health care through their employers. Those whom are not offered health care through their job or make under a certain amount are eligible to sign up for mass health, which is the safety net system that covers all of those without insurance. Mass health is basically a combination of medicaid and chip with the program extended through state funding to cover the underinsured. >
  
  NJ implemented a similar system during the pandemic. >
  
  ummm, APM is the best short to medium term solution and is a success, Even in Vermont
  
  Statewide, the VTAPM achieved statistically significant reductions in cumulative gross ($782.58 PBPY;
  -6.8 percent) and net ($748.74 PBPY; -6.5 percent) total Medicare Parts A and B spending (see Exhibit
  ES.3). When including first three quarters of PY3 (2020), we observed significant reductions in gross
  spending ($921.34 PBPY; 8.7 percent) and net spending ($876.62; 8.2 percent). >
  
  Vermont tried Single Payer legislation kinda like M4A and it failed, Taxes were to high 
  But Vermont, and Maryland have instead used the current system to atleast reduce healthcare spending in the state through All Payor Model where costs are controled through rate setting
  
  An all-payer model agreement is a system where a service or treatment costs the same for every patient under the same provider, no matter what insurance
  
  
  Hospitals used rate adjustments to remain within their budgets. Hospitals regularly monitored their volume and adjusted their rates during the year to meet budget targets. 
  the number of
  hospitals with rate adjustments above 5 percent was largest in the last quarter. This pattern is
  expected if hospitals adjusted their revenues at the end of the year to meet their budget targets. 
  frequent rate adjustments could negatively affect uninsured patients who
  pay for their services out-of-pocket. Although patients with insurance had limited cost-sharing
  liability, individual patients who were uninsured might face different out-of-pocket costs
  depending on when they received services. 
  Inpatient revenues decreased as a share of hospital revenues, while
  outpatient revenues increased after starting the  All-Payer Model.
  This shift from inpatient to
  outpatient services is consistent with hospital efforts to move unneeded care out of the inpatient
  setting to lower-cost, outpatient settings. These changes, however, may reflect broader national trends led by market costs rather than a direct response to the All-Payer Model
  Maryland Medicare admissions with major or extreme severity of illness declined by 13.2
  percent relative to the comparison group. This decline suggests hospitals may have
  responded to global budgets by controlling the intensity of resource use during an
  admission for the sickest beneficiaries. This may not have been the case for commercial
  plan members as the percentage of commercial admissions with an intensive care unit
  (ICU) stay declined 6.8 percent less in Maryland than in the comparison group. >
  
  I think the biggest factor is actually negotiating power over prices.
  As long as it’s one state, or five or twenty, they will have to operate under the current system of private insurance and pharmaceutical companies. Pharmaceutical companies and other medical providers will, as they do now, negotiate prices well in excess of what is paid by countries with nationalized health programs. You need to nationalize to change the actual economic forces that create $60 charges for two Tylenol and the whole negotiated price nonsense where providers have to literally haggle with the insurance company. >
  
  This is one small but crucial piece of a large and complex problem. >
  
  The logistical headache this would create would be astounding. Going from state to state isn't like driving from one side of Europe to the other; you don't need a passport, you're not encountering separate courts and systems of law, you don't need visas. You can pick up and just move one day, no questions asked. Simply file a form with the post office that says you're moving, and the rest of the state's documentation can come later. 
  Imagine a world where California implemented a policy for UHC, but they were alone in doing so. And hypothetically, let's say you have a couple in Missouri who've just discovered they are pregnant. They could move to California and establish a full 6 months of residency, just to get Cali to foot the bill for the delivery and hospital stay, then fuck off back to Missouri. They are the only ones in this scenario who come out on top: the California government would be subsidizing the healthcare of essentially residents of another state, would not collect enough taxes from that couple over the course of their residency to even out the cost, and ultimately go heavy into the red as a result of just one procedure. The nurses & doctors in the now-state-run hospitals would almost certainly get overworked and underpaid...so no change there except they now get more overworked and less paid. Missouri hospitals lose out on the revenue from the birth, and so on.
  Now, does this mean that UHC is a bad idea, or an untenable one? NO. It's still by far the most humane way to treat your citizens' health, and pays dividends into the future. But it does mean that any state which leads the charge on this is dooming itself to massive financial struggles, not to mention the loss of the for-profit healthcare companies who generate tax revenue for setting up shop there. It's a prisoner's dilemma: he who goes first takes on all the water, and even though that might make future states more interested in following suit, more likely they'll just nuke their own state budget and face major unrest over it. >
  
  
  Going from state to state isn't like driving from one side of Europe to the other; you don't need a passport, you're not encountering separate courts and systems of law, you don't need visas. You can pick up and just move one day, no questions asked.
  
  Most of Europe already has free movement with no visas. The Schengen Area has a population far larger than the United States. >
  
  If you're from the UK and use the NHS as your primary means of healthcare and are hit by a bus in Germany, who foots the bill? The NHS? >
  
  Ah! I appreciate the information.
  Now, if we apply it to the United States, such a thing might be 1:1 applicable if we were more strict on state residency and enforcement of it - which, to be clear, I'm not in support of. I'd rather it be federal and be done with it. >
  
  You can't have state residency requirements.
  Shapiro v. Thompson (1969) and Sáenz v. Roe (1999) have already determined state residency requirements for welfare benefits to be unconstitutional impediments to US citizens right to travel to other states. >
  
  So then federal is the only way to do it? >
  
  Most of the Medical in the US is Scheduled.  Its calling a doctor and getting accepted.  
  
  There was almost 1 billion Doctor Office visits in the US and 1.3 Billion scheduled surgeries in the US compared to the 139 million ER Visits
  
  Over half of the ER VIsits are insured patients visiting the ER instead of waiting for a Doctors visit 
  According to UnitedHealth Group research, two-thirds of hospital ER visits annually by privately insured individuals in the United States – 18 million out of 27 million – are avoidable.
  An avoidable hospital ED visit is a trip to the emergency room that is primary care treatable – and not an actual emergency. The most common are bronchitis, cough, dizziness, f­lu, headache, low back pain, nausea, sore throat, strep throat and upper respiratory infection. >
  
  States don't have enough money to finance public healthcare.  Even wealthy states like California that post positive budgets in the hundreds of millions just don't have the money to pay for everyone's healthcare.
  The only way to make it cheap and fair for everyone is to have the federal government do it. >
  
  that’s why the people pay for the healthcare through taxes >
  
  An individual state doesn't make enough in taxes to pay for healthcare and also provide other basic services its people need, such as firefighting, road repair, schools, libraries, etc.
  The only U.S organization that can afford to drop that much taxpayer money on healthcare is the federal government. >
  
  What you are saying is that if individual state increases taxes to the level of federal taxes, then they can pay for it. >
  
  Why burden an individual state's taxpayers with additional taxes when the federal government already has the resources? That would be a silly thing to do. >
  
  "Why" is a different question. It is important to understand it is possible, and what are pros and cons of that. Saying "it's impossible" is false and does not allow to perform pros-cons analysis. >
  
  This would have been a lot more plausible and was floated as an idea before the SALT caps were put in. Now for a state to do it there would be a high degree of double taxation.
  Any move for state funded universal healthcare would have to be coupled to a SALT cap repeal at the federal level. >
  
  Altering SALT caps rules to create exception and allow to deduct in-state healthcare taxes from the federal taxes could be a way to federally fund UHC without federally implementing UHC. >
  
  I'd +1 to that, much more paletable than a full repeal of the cap. >
  
  MD poured a bunch of money into the market a few years ago. My premiums on the market went from 1100 to 700. I didn’t qualify for reduced amounts. I am now on Medicare. MD tries and that was even under a rep gov. The way it is Aetna doesn’t offer marketplace because they can’t make quite as many millions. At the time it was BC and Kaiser >
  
  A few reasons come to mind:
  
  States can't spend as much money as the federal government -- many can't go into debt and are forced to balance the budget. Spending would vary in volatile years, and probably most so in the first few years as things adjust. (Going into debt is worthwhile if the early costs will provide greater savings/growth in the future, which a healthy and secure workforce definitely does).
  Part of the advantage of a federal single-payer system is using such a massive customer base as leverage with pharmaceutical companies and medical service providers to negotiate prices. That's how costs are reduced. Most states are too small to pull that off on their own.
  A lot of the laws/regulations that would helpthe single-payer system work might not be legally feasible at the state level, e.g. any impact on interstate commerce would run afoul of Congress' privileged position.
  Even what laws and regulations states are allowed to enforce would vary between states, and could just make health care more expensive as companies need to hire an army of paper pushers to navigate the complex legal jungle.
  
  It's sort of an all-of-us-or-none-of-us situation. An elegant, nationwide system will definitely work. A smaller, state-specific system would be significantly more difficult to pull off, if at all. And a shared system between a coalition of states would probably get sued out of existence by corporations, or even the federal government. Of course, Congress could even pass a law forbidding it. >
  
  Your point 1, the inverse is essentially "we want this to be paid for by deficit spending" which is untennably large at the federal level. >
  
  
  Your point 1, the inverse is essentially "we want this to be paid for by deficit spending" which is untennably large at the federal level.
  
  That's not what I said. It's prudent to read the full context of my statement. Again:
  
  Going into debt is worthwhile if the early costs will provide greater savings/growth in the future, which a healthy and secure workforce definitely does
  
  It wouldn't be fully financed by deficit spending for an indefinite period. The problem, as with all federal policies, is that health care spending would not be consistent year after year, so it's necessary to have the safety net that is deficit spending for years when tax revenue is lower than usual, or health care spending is higher than usual (e.g. during a pandemic). This is how literally all federal governments work around the globe (as well as corporations). But it is not how most states work.
  So, for example, you wouldn't say "don't maintain a military because during war time it would cause deficits." Obviously, you'd rather go into deficit spending than surrender to an invader -- the survival of the country is worth paying interest on debt later. Similarly, affordable and accessible health care is worth incurring debt from time to time, because a healthy and happy work force in the future will grow the economy (and thus, tax revenue) more than the interest on the debt incurred. It's a return on an investment. 
  Incidentally, this is why the debt fear mongering of the 90's hasn't been realized yet despite the national debt being sextupled over the last 23 years: the economy and tax revenue is growing fast enough to keep up with the rise in interest payments on the debt. If and when interest payments grow at so a rapid rate that the economy/tax revenue no longer keeps up, then it's a problem. 
  Though it's unclear where that point is. For perspective: Japan's national debt is currently 225% the size of its economy, compared to the USA's current 124%. After World War II, the USA was at 120%, but as we know, boom times came as a result of all that federal spending, and the surge in economic growth shrank the percentage to 46% by 1964, even though the national debt had increased by a third. In 1965, the USA enacted a single-payer health care system: Medicare! And what happened? Debt as a percentage of GDP continued to shrink: it was 32% by 1980, even though the debt had quadrupled since 1946.
  Unfortunately, Reaganomics reversed the trend. The last 40 years of steep tax cuts has taken its toll. >
  
  Just to clarify, Canada's provinces actually have more power and autonomy than American states do. >
  
  Oregon and Massachusetts have started such plans but what happens when you are out of state and need care. Not easily paid for. >
  
  I has something to do with the way the Federal gov funds the current non-universal public insurance programs (Medicare and Medicaid). For whatever reason states aren't allowed to use this money for a universal system so they would have to stand up a 3rd system on their own, which would be kinda hard. >
  
  Here in California if you don’t have private or commercial insurance, and or insurance from your employer, the federal governments Medicaid kicks in. Its called Medi-Cal. Each state has their own version of Medicaid. Medi-Cal is heavily funded here and each major county distributes it under a public health agency. But it’s only mostly for single mothers, people that are habitually sick, the low income residents, the elderly, and kids teenagers until they reach 18. It’s your most basic health insurance, aka medically necessary health care. If you have Medi-Cal you don’t have to pay for anything. The bill is picked up by the county and state. I know this cause I work for the county that distributes it. It’s not perfect but it’s something. >
  
  Long answer short: most Democrats are beholden to the insurance industry, and refuse to buck that source of campaign finance. >
  
  As a Canadian please avoid this disaster , we have the worst system in the world , it’s slow , it is substandard and is run by a bunch of entitled know nothings . Your system isn’t the best but is 10000 percent better than ours >
  
  
  As a Canadian please avoid this disaster , we have the worst system in the world , it’s slow , it is substandard and is run by a bunch of entitled know nothings . Your system isn’t the best but is 10000 percent better than ours
  
  You are ignorant and grossly wrong.  The US system is the worst in the world by an unfathomable margin.  We spend the most in the world by a massive margin.  
  Times?  We are the second longest waits in the developed world.  
  Standards?  We have nearly 300 avoidable deaths per 100k, the highest in the developed world. 
  We have millions that cannot afford basic healthcare services.  We rank last in healthcare access and quality.  Our life expectancy at birth is the lowest in the developed world.  People have to ration insulin.
  If you think your system is bad, keep in mind that many Americans spend hundreds in premiums a month just for a glorified customer service rep to overrule their doctor and tell them to die a painful death or go bankrupt.  
  If you think your system is complicated or run by know-nothings, just try understanding the basics of the US system.
  You spend less and massively more.  
  The US healthcare system is such a disgrace that they'd improve by throwing a dart at the map and following the healthcare system of the closest developed country.  There isn't a worse way to fund healthcare yet found. >
  
  No combination of blue states could cover that nut. And there would be a flood of 'healthcare refugees' from other states that would crash the system. 
  Important to point out... the US is a federal system of government. Some blue states have pretty generous Medicaid systems that maintain eligibility into the low middle incomes. (Medicaid = health insurance for poor people; Medicare = health insurance for old people). 
  90% of Americans have some form of health insurance. It's not always good insurance... but Obamacare set standards for what needs to be covered. The pictures on Reddit of "$39,000 for a hangnail" are often misleading. >
  
  No, those memes are usually quite accurate - but they're just the opening bids of the drama between provider, insurer, pharmacist, and patient to see who gets the most ratfucked at the end of it. 
  Even healthcare professionals who deal with this on a daily basis can easily be overwhelmed by the bureaucratic barriers between a patient and necessary care. Because they're very, very profitable barriers. >
  
  Taxes.
  
  Who's Paying for Insurance right now
  
  Only 62.1% of the Working age population was working as of November 2022
  Of those Only 61% of the Employed had insurance through their job
  
  Not that many people currently pay for insurance and changing that is raising taxes >
  
  165 million people have givernment insurance through Medicare and Medicaid. Only approx 27 million have no insurance. The rest have employer paid  insurance programs  This means 8% don’t have easy access to health care. Obamacare was supposed to pay for this BUT it was Ill conceived was most givernment programs are. The reality is the fight is over who will pay for that 8%. When I didn’t  have insurance I paid $1800 a month for my wife and myself. Seems the affordable health bill was anything but. All Insured  should have skin in the game for the system to be able to work and try to lower costs. The lower costs are places on the back of the healthcare professionals. See how long that will last. >
  
  
  Seems the affordable health bill was anything but
  
  Lots of times we forget how employer health insurance works 
  
  Health Insurance is an employee benefit, that costs money
  
  In California the Average Employer paid $8,100 per employee for health insurance and the employee paid ~18% of that as a Paycheck Deduction ($1,459) 
  
  In California the Average Employer per Family Plans paid $20,000 per employee for health insurance and the employee paid ~27% of that as a Paycheck Deduction ($5,400)
  Those number stay the same regardless of Income
  
  Your employee benefit is that affordable health bill
  
  Of course the deal your company gets is also a bulk discount rate
  In 2017, of the 155 million people in Private Insurance, 93 Million of these people and growing are serviced through Self-funded health care, also known as Administrative Services Only 
  
  In 2022, A report shows that 17 percent of small firms and 80 percent of large organizations have self-funded insurance.  
  According to the Kaiser Family Foundation’s 2018 Employer Health Benefits Survey that examined medical coverage offered by employers, “sixty-one percent of covered workers are in a plan that is completely or partially self-funded.”
  
  ASO is a self insurance arrangement whereby an employer provides health or disability benefits to employees using the company's own funds.
  
  Most companies then add on to contract with a third party health insurance company for assistance in claims adjudication and payment. Third party administrators (TPA's) provide access to preferred provider networks, prescription drug card programs, utilization review and the stop loss insurance market.
  Self-funded employers who contract a TPA receive a monthly report detailing medical claims and pharmacy costs. Knowing this information becomes instrumental in controlling costs by shifting buying patterns.  This is different from fully insured plans where the employer contracts an insurance company to cover the employees and dependents.
  Self-funding is attractive because it helps in maximizing the company's health insurance savings. The employer's health plan that is self-funded may be able to lower administrative costs associated with the provision of health benefits and eliminate the profit that an insurance company would make >
  
  And Self Insured need not follow ERISA regulations. So this also limits liability and spending. >
  
  Because they'll have to raise taxes. And if they did that how would they get re-elected. >
  
  They're extremely expensive and not as popular as Reddit thinks when it actually comes to drawing up an implementation. States need to be budget neutral so they can't just write some funny math and go "aw shucks" when it doesn't pan out like we've used for tax cuts and stuff in the past.
  Determining who pays for a grossly overpaid thing doesn't fix the thing, the costs have to be controlled which unfortunately are a matter of federal regulation in almost all cases. >
  
  Universal healthcare only polls well when you don't talk about having to pay for it. Any states that try and implement universal healthcare are going to need to pay for it with tax increases, which are unpopular even in very blue states. >
  
  Taxes aren't unpopular in CA. It's their version of a medieval "indulgence". >
  
  Because the first state to do so would be flooded by the chronically ill from other states. They’d go broke quickly. >
  
  I think this could potentially be partially counteracted with residency requirements, let's say 2-3 years or smthn, though I suspect it would still result in a minor influx of older people moving in
  IMO only a couple of states can pull off a statewide universal healthcare system: California, Texas, New York and Florida. These states are large enough that if they implemented residency requirements, the number of healthcare refugees would probably be a proportionally small number >
  
  There are SCOTUS cases saying this kind of residency requirements for state benefits is unconstitutional. 
  Shapiro v. Thompson: 
  
  In Shapiro v. Thompson' the Supreme Court held that State and
  District of Columbia residency requirements for welfare assistance are
  unconstitutional. Affirming the judgments of three United States Districts courts, the Court said that basing eligibility for welfare assistance
  on one year of residency discriminated against a class of people and
  impinged on their constitutional right to travel. 
  In an opinion expressing the view of six members of the court, Mr. Justice Brennan said the
  residency requirements divided needy families into two groups-(1)
  those who have resided in the state for more than one year and are
  eligible for welfare assistance, and (2) those who have resided in the
  state for less than one year and are ineligible.
  
  Sáenz v. Roe also reaffirmed this:
  
  Justice Stevens further held in Sáenz that it was irrelevant that the statute only minimally impaired the plaintiffs' right to travel. The plaintiffs were new to the state of California, but they had the right to be treated the same as long-time residents, especially given that their need for welfare benefits was unrelated to the amount of time they had spent in the state. Furthermore, wrote Stevens, there was no reason for the state to fear that citizens of other states would take advantage of California's relatively generous welfare benefits because the proceeds of each welfare check would be consumed while the plaintiffs remained within the state. This distinguishes them from a "readily portable benefit, such as a divorce or a college education", for which durational residency requirements had been upheld in cases such as Sosna v. Iowa and Vlandis v. Kline. >
  
  I can see 1 major reason: per-capita state taxes are *much* lower than per-capita federal taxes, and the funds collected by individual states are not enough to pay for UHC within those states.
  To pay for UHC in say New York state would mean to raise state taxes 200-250%. This is of course problematic for many reasons:
  
  Lobbying. All those BlueCross, Aetna and other dudes will lobby hundreds of millions for this to never happen in New York.
  State being far less competitive and companies taking their jobs elsewhere
  It will take time to persuade people that raised taxes on their wages will be cancelled out by the absence of insurance payments taken off of their paychecks.
  Not everyone is in the same boat. Someone who was not paying for health insurance for this or that reason now will be, and their income will be effectively cut in the short term, it will take a lot of propaganda (in good sense) to promote long term thinking about the problem.
  
  There are also a medium-sized issue: medical tourism.
  Naturally people from neighboring states would want to take advantage of the situation, especially those with complex medical conditions. Healthcare expenses almost follow Pareto principle with 20% of patients accounting for 80% of costs.
  There might be ways to prevent that, requirements to be a resident for longer than 6 months time to get coverage for pre-existing conditions... but stories might get nasty... and no one likes that. >
  
  I can become a resident of any state with a $12/month PO Box and a closet I rent from someone for $100/month that I can claim as my “residence.”
  I don’t think Europeans realize how easily people can move states here. >
  
  The reason is because the democratic party are a right wing corporate party who serve the interests of big business, not the people. >
  
  Because Healthcare Tourism will become a thing and that’s about it.
  Also, Germany, Austria and Canada all exist under the same system. >
  
  Bernie Sanders, champion of UHC, has failed to implement it in his adopted far-left state of Vermont. If Bernie can't get it done maybe it's not as popular as he says it is. >
  
  
  Bernie Sanders, champion of UHC, has failed to implement it in his adopted far-left state of Vermont. 
  
  Bernie Sanders is a United States senator and not a member of the Vermont state government. Your comment is like saying "Joe Biden has failed to implement universal healthcare in his adopted state of Delaware." Makes no sense. >
  
  But you think he could have influence over his state because of his”popularity”. He’s just another givernment shill getting rich while saying one thing and doing another. He’s as corrupt as they come. >
  
  For the same reason that the left tends to say that personal responsibility and choices can’t fix our carbon emissions and help with climate change.
  They don’t tend to want to drive and EV, use solar panels and live a more carbon neutral lifestyle, they want to force others to.
  On the state to state level it is because higher taxes are needed, and higher taxes cause problems with getting elected again. >
  
  Cost. There’s no way any state could afford to fund it, the United States government itself can’t afford to fund it. Estimates are all over the place but most agree it would cost somewhere in the range of 34 trillion dollars over the next ten years. 
  That’s $34,000,000,000,000. >
  
  
  the United States government itself can’t afford to fund it
  
  Bullshit. The United States is the wealthiest nation in the history of the world, and 33 of the top 34 developed nations have figured it out. >
  
  They also don’t have a population of 325 million people. 25% of all collected taxes currently go towards just paying down the interest on our nation’s debt. On paper we might look like the wealthiest nation, but we’re in horrible shape lol.
  In 2022 the United States collected $4.9t in revenue. The estimated cost (and it’s likely even higher) of healthcare-for-all over 10 years is $34t. >
  
  Citations needed. If your argument depends on those numbers, you need to say where they come from... Especially that "25%" bullshit. >
  
  It isn’t bullshit, it’s the sad reality of our limitless spending (from both parties). It isn’t even a D or R issue…
  In 2022 the United States paid $853 billion dollars just in interest on our $31 trillion debt total. We paid more than our entire yearly military’s defense budget…just in interest. In 2023 we will be at $1.2 trillion just in interest - when the government only collects $4.9t annually. That’s around 25% of our entire GDP - just paying interest, not reducing 1 cent from our total outstanding debt. 
  And you’ve got crazies on the Left saying we should fund Medicare for All. It isn’t possible. Not unless you want to pay 4-5x more in taxes than we do right now… >
  
  Again, where are these numbers coming from? >
  
  Without federal controls on insurance, medication and health care price gouging universal care is too expensive. >
  
  it's pretty simple.  the large corporations run that party also.  it's the reason why there's still only two parties.  it's so much easier for them to control two parties set up to hold the value voters at bay.  
  big corporations, like what the health care industry is made of, are for profit entities.  u think pharmaceutical companies, want to make less money?  hospitals?  you think insurance companies want to fold or give up most their profits?  no one with money or power is just going to give it to you cuz it's morally right.  businesses aren't built with moral compasses....
  this is how hard it is.  obama had to sweep an election, win 60% of the senate.  a gazillion house seats.  just to pass one tiny legislation that say an insurance company can't kick you off of their plan when you get sick and need them to pay for stuff.  yes there are a ton of other things in the bill.  but it's still, to this day, criticized and used as an issue in campaigns.  who do you think is behind that?  a bunch of citizens?  or a bunch of companies that now have to follow through on what an insurance company is.  
  now think of some state trying to take on these big guns? >
  
  Because despite what they tell you, Democrats don't want universal healthcare either. The private healthcare industry is extremely profitable. Any politician who sticks their neck out to kill that golden goose is going to be pilloried by the party. >
  
  A public option for healthcare had 59 votes. So that doesn't track >
  
  Ain't it funny how that works? Almost like they all talk to each other and can organize little stunts like this. "Oooh, so close. Keep voting for us, you'll get it next time kid!" - Said the Carny working the ring toss. >
  
  Lieberman was an independent - he tanked the public option. >
  
  Because the most Democratic Blue state in America is a centrist -but-right-leaning state everywhere else. :-( >
  
  This is the real answer. They don't do it because they don't want to. >
  
  The startup funding needed is a pretty high bill and chances are the first few years would look like a state was wasting money at first before seeing universal healthcare become cheaper. The American public doesn't like waiting too long for results, plus because of how the current healthcare system in each state and the US have been working, there would probably be a decent amount of "backlog" or people that have put off getting medical help deciding to start getting the help they need. >
  
  I support single payor, in order to standardize prizing. This would be much more effective at the federal level.
  For profit insurance companies are not the best system. Not knowing the price of medical care in advance is just ridiculous. >
  
  One of the biggest roadblocks to any singular or small collection of states implementing state sponsored healthcare is that in the US it is unconstitutional (read as: legally impossible) to withhold welfare benefits on the basis of residency. 
  This is known as "the right to travel" and can be broken down into three prongs:
  
  
  
  the right to enter one state and leave another
  
  
  the right to be treated as a welcome visitor rather than a hostile stranger
  
  
  the right to be treated equally to native-born citizens
  
  
  
  Providing state funded healthcare to long-time citizens but not recent immigrants from other states would be unconstitutional because of that third prong.
  Shapiro v. Thompson (1969) 
  
  In Shapiro v. Thompson' the Supreme Court held that State and District of Columbia residency requirements for welfare assistance are unconstitutional. Affirming the judgments of three United States Districts courts, the Court said that basing eligibility for welfare assistance on one year of residency discriminated against a class of people and impinged on their constitutional right to travel.
  In an opinion expressing the view of six members of the court, Mr. Justice Brennan said the residency requirements divided needy families into two groups-(1) those who have resided in the state for more than one year and are eligible for welfare assistance, and (2) those who have resided in the state for less than one year and are ineligible.
  
  Sáenz v. Roe (1999)
  
  Justice Stevens further held in Sáenz that it was irrelevant that the statute only minimally impaired the plaintiffs' right to travel. The plaintiffs were new to the state of California, but they had the right to be treated the same as long-time residents, especially given that their need for welfare benefits was unrelated to the amount of time they had spent in the state. Furthermore, wrote Stevens, there was no reason for the state to fear that citizens of other states would take advantage of California's relatively generous welfare benefits because the proceeds of each welfare check would be consumed while the plaintiffs remained within the state. This distinguishes them from a "readily portable benefit, such as a divorce or a college education", for which durational residency requirements had been upheld in cases such as Sosna v. Iowa and Vlandis v. Kline.
  
  If California passed state healthcare then they would be providing healthcare not only for Californians but for all Americans capable and willing to travel to California, and they could not deny them based on residency requirements because the SCOTUS has seen that as an impairment on US citizens's right to travel and be treated equally with their long-time counterparts in all states. This would undoubtedly bankrupt the systems of any number of singular blue states that tried it. >
  
  Because Democrats (with money) are in on the scam to defraud Americans. The two party system we have is basically political trickery. >
  
  Because there are only two parties, and one doesn't like funding healthcare and the other doesn't like empowering states.