San Francisco has plenty of poor and will no doubt obtain many more with their new healthcare ruling.
>If this is what you think realize then that only the rich
> counties, cities and states will be able to provide any
> healthcare. Medicaid, for instance is a shared cost between
> the feds and the states. Most states could not afford it
> without "central" funds.
That is mainly because so much money (from income and payroll tax, etc.) is collected at the central level and trickled back down to the states. If federal income tax went down drastically and state income tax went up drastically, to essentially the same values the citizens are currently paying, the states could easily afford it, albeit some much more easily than others. South Dakota, for example, would be in even more serious trouble while California and New York would be richer than they are now.
People could then pick and choose where to live. If they wanted a low tax region, they'd go to the red states, if they wanted paid healthcare, they'd move to the blue states. Would we then see a major split between rich and poor states? I don't think it would be too bad, because there is always low wage work that needs doing and if no one was there to do it, something would have to give to attract it there.
A trickle up direction could also allow richer states to contribute to the poorer states as they were able, much like happened during Katrina. It may not be perfect, but aren't we seeing in very clear and stark terms that the centralized trickle down gov't monopoly is a disaster?
--tully