The economics of a state-based single payer system are brutal • as evidenced by the recent attempts in CO and VT.Amendment 69 in Colorado would have increased payroll taxes by 10%Vermont would have increased payroll taxes 11% • and income taxes 9%Colorado is more of a swing state • so it was thought to be a better test for other states. Almost 80% of voters rejected the measure • so it wasn’t just defeated, it was crushed.Vermont’s governor (Peter Shumlin) calculated the fiscal hurdle as an impossibility and simply abandoned the initiative before it even got to the ballot.It’s not just the fiscal burden, it’s the challenge of states to attract and retain talent, businesses and wealthy individuals to sustain the higher tax structure. Over time • two things work against each other to further erode the fiscal mechanics of state-based single-payer healthcare.Wealthy citizens leave (or modify their resident status) to avoid paying the higher state taxes necessary to support state-based single-payer healthcare.Citizens who need expensive healthcare (but often can’t afford it) from other states will relocate into a state with universal health coverage.In the end, our decades long battle with actuarial math has been epic • but it’s unwinnable. Moving that battle from the national to the state level doesn’t change the economics of the battle • just the geography.