The following is an explanation I gave for why it would be so hard for a US state to do single-payer even though comparably sized countries elsewhere can do it:
I am pulling these numbers out of air, just to give an idea of the flows I am talking about.
Let’s say we have a hypothetical state (“Bannack”) that gets back roughly what it sends to Washington. Bannack’s citizenry pays $7b a year in taxes, $2b to state and local governments, and $b to the federal government. The federal government turns around and spends $2.5b on health care in health care in Bannack, while Bannack is spending $.5b. Health care in the state in a given year costs $3b. They simply can’t do that with a $2b budget. They can’t raise taxes by $2.5b because the people just won’t pay it because that would be on top of all that money they’re sending to Washington. They’ll get some money by taxing businesses the money they’re no longer spending on health care, but anything more would be a tax hike and the same problems apply.
The best they can do is ask the federal government to say “We want that $2.5b in cash.” I think if they could get that, they could make it work. But the $2.5b is for one year and is going to fluctuate. And some states send in a lot more than they get out of Washington, and vice-versa. So it’s a real hornet’s nest of headaches. You can come up with a block grant formula, but that’s going to be difficult and going to be political. It’s much easier for DC to say “We’ll pay for this and we’ll pay for that. We’ll give you block grants for Medicaid but no way for Medicare and of course the VA system is different.”
Now, if Bannack were a country, it would be a lot simpler and they could do it even if they are not an especially large nation. They’re risk pool would still be a lot larger than many insurance companies’.
I didn’t put enough focus on how much other programs, like Medicare and the VA, complicate things. If you can’t fold them into your single-payer, you’re losing a lot of potential bargaining leverage.
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Prevailing theory assumes that people enforce norms in order to pressure others to act in ways that they approve. Yet there are numerous examples of “unpopular norms” in which people compel each other to do things that they privately disapprove. While peer sanctioning suggests a ready explanation for why people conform to unpopular norms, it is harder to understand why they would enforce a norm they privately oppose. The authors argue that people enforce unpopular norms to show that they have complied out of genuine conviction and not because of social pressure. They use laboratory experiments to demonstrate this “false enforcement” in the context of a wine tasting and an academic text evaluation. Both studies find that participants who conformed to a norm due to social pressure then falsely enforced the norm by publicly criticizing a lone deviant. A third study shows that enforcement of a norm effectively signals the enforcer’s genuine support for the norm. These results
demonstrate the potential for a vicious cycle in which perceived pressures to conform to and falsely enforce an unpopular norm re-inforce one another.
Several recent studies have investigated the consequences of racial intermarriage for marital stability. None of these studies properly control for first-order racial differences in divorce risk, therefore failing to appropriately identify the effect of intermarriage. Our article builds on an earlier generation of studies to develop a model that appropriately identifies the consequences of crossing racial boundaries in matrimony. We analyze the 1995 and 2002 National Survey of Family Growth using a parametr
If there is one thing in that statement which I would take issue with, it is Mallon’s overly optimistic belief that the new policy is “well-meaning”.
That’s because anyone who has spent any time in an Irish hospital over the last few years will have seen the smoking ban enforced in draconian and nasty ways which are simply punitive and judgmental.
Even those who have been fortunate enough to stay away from hospitals in that time can see the results of such bans.
Drive by the Mater on any rainy day, for instance, and you will see patients huddled together in their dressing gowns, exposed to the elements as they take a break from the drudgery of hospital life. This, apparently, is healthier than allowing the patients an enclosed area – which they used to have – where they could smoke without bothering anyone else and, perhaps, not get soaked to the bone at the same time.
People smoke in hospitals for a variety of reasons, and one which is never considered by the authorities is that it is actually good for their head.
Certainly, when my father spent a few years in and out of James’s hospital with the terminal, non-smoking related disease which would ultimately kill him, he measured the days by increments of when he’d go out for a smoke. It broke the endless monotony of living on a ward and, like many other long-term patients, he was determined to not become a ‘lifer’, one of those lost, institutionalised souls who simply lie in bed all day staring at the ceiling.
One might be forgiven for believing that this is more about sin and repentance than concern for the welfare of the sinners.
“Now, matters are such that German universities, especially the small universities, are engaged in a most ridiculous competition for enrollments…The interest in fees–and one should openly admit it–is affected by appointments in the neighboring fields that ‘draw crowds.’ And quite apart from this, the number of students enrolled is a test of qualification, which may be grasped in terms of numbers, whereas the qualification for scholarship is imponderable and, precisely with audacious innovators, often debatable… Almost everybody thus is affected by the suggestion of the immeasurable blessing and value of large enrollments…
It is a fact that whether or not the students flock to a teacher is determined in large measure, larger than one would believe possible, by purely external things: temperament and even the inflection of his voice. After rather extensive experience and sober reflection, I have a deep distrust of courses that draw crowds, however unavoidable they may be.”
-Max Weber, Science as a Vocation (1922)
Republicans reset robbing Peter to pay Paul, but are okay with robbing Peter City to pay Paul County.
Democrats resent the hell of out of robbing Peter City to pay Paul County, but are okay with robbing Peter to pay Paul.
It’s not easy, however, to actually disentangle these transfers from one another.
But the coaching business is booming, with affluent parents being the best customers. If the payoff is really so small, why has the market judged coaching to be so successful?
Most obviously, parents who pay for expensive coaching courses ignore the role of self-selection: the students who seem to profit from a coaching course tend to be those who, if the course had not been available, would have worked hard on their own to prepare for the test.
Then parents confuse the effects of coaching with the effect of the basic preparation that students can do on their own. No student should walk into the SAT cold. It makes sense for students to practice some sample items, easily available from school guidance offices and online, and to review their algebra textbook if it has been a few years since they have taken algebra. But once a few hours have been spent on these routine steps, most of the juice has been squeezed out of preparation for the SAT. Combine self-selection artifacts with the role of basic preparation, and you have the reason that independent studies using control groups show such small average gains from formal coaching.
Source: Abolish the SAT, Charles Murray