We don't have universal healthcare for a variety of reasons, most of which highly educated agree with. Many people don't seem to understand that federalism is slower and the idea is to see what works. The problem is that healthcare reform is not being appropriately worked on at the state level - primarily due to huge interventions at the federal level that prevent experimentation.
Anyway, there are tons of high paying jobs outside of NY and SF - people choose to live there because the like the culture and the cities -- that's why the rent is high.
When you really start looking at US healthcare you find most of the problems are associated with bureaucracy and a tiny fraction of people dominating healthcare costs. Which is why it's impossible to fix healthcare at the state level or you have the vary sick flocking to states where healthcare has been 'fixed'.
PS: The US government pays more per person for healthcare than any country with universal healthcare. Instead, the free market's focus on passing the buck adds more overhead than any 'free market' efficiency gains. 'Medical Billing' is practically the definition of dead weight. Random inspection of 5% of clames will rapidly catch outright fraud, instead we get the worst of both worlds with plenty of fraud AND overhead costs.
Vermont is going to go single payer and MA already has Obamacare - neither of which imho are good models, but I don't see people flocking to them for health care.
Most of the educated do not agree with the reasons we don't have universal healthcare. Most of the proponents of federalism don't understand economics well enough to realize the huge conflict between federalist policies and economic reality.
there are so many things wrong with this that it's painful, but most of all: people do not agree because they share a certain level of intelligence; they agree because they share a certain culture.
Rent is high in New York and Silicon Valley because the markets are warped by regulatory corruption and the extreme illiquidity of the market. Right now, local incomes can support those levels (just barely) but that can change, and when it does, urban decay will set in. Urban decay starts at least a decade before prices start to drop, because people hoard real estate rather than selling it when the market softens.
The problem with real estate markets is that there's extreme demand inelasticity, which means that declining conditions (reduced effective supply) actually cause aggregate prices to go up, in the same way that a hurricane in the Gulf drives up gas prices even though it's not a good thing.
The idea that high rents come from "desirability" is hopelessly naive. Very rich people can live whereever they want, so the difference between a $50-million apartment vs. a $10-million one is driven by those factors: how old the building is, how many third-world despots and celebrities live there there, whether it has a view of The Park. For the rest of us, the rent we pay is dictated by scarcity conditions rooted in regulatory corruption and the slow reaction of new housing construction to economic forces (i.e. that 10 jobs can be created faster than 10 houses)-- not "desirability". Real estate agents want you to believe that the reason The Rent Is Too Damn High is that New York is such an awesome place to live, but economics don't bear them out. Supply-side disruptions and failures push up prices much more than actual value increases or income improvements.
Regarding high-paying jobs outside of those locations, they exist but there aren't as many as there should or could be. The near-impossibility of getting funding for a new technology business away from the coasts is a real problem. Venture capital is ugly and I'd really like to see us, as a society, come up with something better, but it's the only option for a lot of companies in the global marketplace.
As for universal healthcare, we would have had it in 1948 if the Dixiecrat racists (who were afraid that a universal plan would require them to desegregate the hospitals) hadn't threatened to destroy Truman by stonewalling everything he did. Universal healthcare plans have problems-- Canada's system is far from perfect, and the UK's NHS has some serious flaws-- but all of those plans are leagues better than the horrendously shitty system that we have in the U.S.
You make an extremely good point. NYC and SF rents would not be nearly as high if there were more supply, and there isn't more supply because the housing market is so over-regulated. Manhattan is cramped, but outside a few places in the UES and Financial District, it's filled with block after block of low/mid-rise construction, mostly 80+ years old. The reason is that it's extremely difficult to tear down this crap and build new high rises because of regulations.
Also because of our property-tax regime. Tearing down a depreciated/ing low-rise to put up a fresh new high-rise will cause a reassessment of your property value, and because the building is new you'll get hit with a massive tax increase based on your property value shooting up.
The problem being that real-estate property values are only liquidated on selling a building, so you just end up passing the tax on to renters.
A tax on land-value or space usage tends to work better for allowing high-value construction to be done rather than continual depreciation of a whole city.
Anyway, there are tons of high paying jobs outside of NY and SF - people choose to live there because the like the culture and the cities -- that's why the rent is high.