431–440 of 569 posts
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Anecdata but I personally know more than a few people who moved to Nevada to avoid California taxes, so yes.
And I personally know more than a few people who have moved from flyover states to California. Goes both ways.
I’m an MD who trained in NYC. I have also had emergency surgery in the NHS at one of their most prestigious hospitals in London and so I feel like I’ve seen the system a little bit from the inside. It was far cheaper for me than it would have been as a Brit in the USA, but the standard of care was lower. They didn’t have some technical and staffing resources late in the afternoon that would be a baseline in any of th…
Incentives are a complicated issue in healthcare. In Australia there is a 'two-tiered' system in the sense that there is a large public system funded federally and by states that provides access to anyone and everyone, and a private system where most people have private insurance and also pay additional fees. There is no insurance linked to employment.
Primary care can be accessed for free or depending on where you live, often involves paying a gap for each visit.
What doesn't happen is that all the best and most experienced doctors/nurses go and work in private. Almost all the doctors worth seeing work in the public system as well. Why? Well, it differs for each person but some combination of status, access to a professional network, collegiality, access infrastructure and expertise, job flexibility and the fact that it acts as a referral stream to 'take patients private'. The facilities in the public system are 'the best' becaue they still handle all the complicated and difficult care (Oncology, Transplants, Dialysis etc), despite what the private hospitals say in their brochures.
My point is that if you make some adjustments, bake in some infrastructure funding, and make smart use of non-financial incentives, you can avoid creating a two-tiered system and build enduring capacity and quality in a single payer system.
it will be interesting to watch NY (and/or CA) put something like this in place and observe from afar. i strongly feel that states should be much more aggressive running policy experiments if their constituents desire them, and at the national level we all get some benefit of seeing how things turn out in real time. all that said, assuming there is some tangible tax increase, NYC high earners are going to be knocking…
That's 60% marginal rates. Last year I paid 17% of my total income in taxes.
it will be interesting to watch NY (and/or CA) put something like this in place and observe from afar. i strongly feel that states should be much more aggressive running policy experiments if their constituents desire them, and at the national level we all get some benefit of seeing how things turn out in real time. all that said, assuming there is some tangible tax increase, NYC high earners are going to be knocking…
This is how it worked in canada. Saskatchewan decided they wanted single payer health care so they did it. About a decade later the federal gov made it national.
As someone who's lived in the Canadian health care system and the US system - it is absolutely lower quality than what average private employer healthcare plan provides in the US.
Even before covid, Quebec's healthcare system was in crisis with packed ERs having dozens of neglected patients on beds in the hallways for weeks... GP access is impossible with waiting lists 3 years long. ...and the nursing shortage was bad before - now because covid caused the government to order nurses to do forced overtime.
Americans have rose-colored glasses when they think about the quality of care in Canada. The truth is that Canadian healthcare is better for people that cannot afford healthcare. ...and American healthcare is far better for the average person that is employed with those benefits.
It's a simple tradeoff. Significantly higher taxes + healthcare for the poor (Canada) vs better healthcare for the average middle-class employed person (US).
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One of America's best ideas. Laboratories of democracy. Maybe it works.. maybe not. But the rest of us learn from whatever happens.
NY currently greatly restricts how health insurers can discriminate on price based on age to the point that age basically isn't a factor. But most states allow for a ~3x price difference based on age. The other state with a similar rule, Vermont, has a form of single payer insurance as well
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> isnt that the main reason the salaries are so high? It's because the NIH limits the amounts of medical residencies in the country, and to become a doctor with a license to practice, you must have completed residency somewhere. The amount of doctors in the US are kept at low numbers because of this.
I didn’t know that. Why does the NIH limit the number of residencies?
The AMA is actually doing a great job at this recently compared to the ABA, where there have been too many lawyers graduating recently for insane salaries except at the top.
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> isnt that the main reason the salaries are so high? It's because the NIH limits the amounts of medical residencies in the country, and to become a doctor with a license to practice, you must have completed residency somewhere. The amount of doctors in the US are kept at low numbers because of this.
I didn’t know that. Why does the NIH limit the number of residencies?
[0] https://www.npr.org/2018/03/09/592333771/severe-shortage-of-...
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I meant health insurance, but gonna just leave it lol
I figured, but with the "Most HN comment" meme and Poe's law providing context, it can be hard to be sure someone isn't suggesting something a bit more... extreme . :)
For reference, the idea is to optimize for public good. Banning insurance would drop fees dramatically because people would get less unnecessary work done. At the same time, hospitals and others would be willing to offer loans provided you could pay it off. This would drive down costs to the point even the poor can get some decent medical treatment. Any gaps can be made by non-profits, religious organizations and the like (similar to planned parenthood). Not perfect, but makes healthcare abundant and cheap.
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How would raising taxes on real estate not cause capital flight?
You can't move a house (or the land it sits on) out of state.
Capital flight lowers real estate tax revenues. This should be obvious, so maybe your comment was a joke?
it will be interesting to watch NY (and/or CA) put something like this in place and observe from afar. i strongly feel that states should be much more aggressive running policy experiments if their constituents desire them, and at the national level we all get some benefit of seeing how things turn out in real time. all that said, assuming there is some tangible tax increase, NYC high earners are going to be knocking…
It turns out that people don't often move over taxes, despite the claims of the anti-tax crowd, or NY and CA would have been emptied out long ago. Taxes are investment; we need to start calling them 'low-investment' and 'high-investment' states (but the liberal crowd is blind to the power of messaging and perception). People like the services and the community that investment creates, such a health care and arts.
Also, they can subtract their health insurance costs, and you are only talking about income taxes, while most taxes are either fixed rate for benefits (e.g., Social Security) or, for the wealthy, capital gains.