Do you want your state to try single-payer, like Colorado???? I DO. Absolutely.

[Jim Lane]

25. I have a question about single-state single-payer

Wouldn't it run into the problem of reverse cherry-picking?

Suppose a large number of healthy young adults living elsewhere select the cheapest possible Bronze plans under ACA or maybe even choose to pay the penalty for being uninsured. Then one of them gets a cancer diagnosis and another is in a bad accident, being discharged from the emergency room in stable condition but needing multiple surgeries. Depending on their employment situation and other factors, they might be able to move to Colorado to get the expensive medical care they now require. (If you're a welder in Florida paying for much of your medical care, taking a pay cut to be a sales clerk in Colorado might leave you with higher net income.)

The result is that the risk pool is distorted. The way it's supposed to work is that all those healthy people pay premiums and that money is used to provide care for the few who need it. If the healthy people are all outside Colorado, then they're not contributing to the fund that has to pay for the new arrival's chemotherapy.

Granted, not everyone facing big medical bills would be able to move. Nevertheless, if a significant number could and would move, the result would be to make single-payer look unfeasible.

I know that Canada moved to nationwide single-payer by starting in one province. I don't know whether this problem arose there or how it might have been addressed.