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Healthy California Act: proposal to make findings about single-payer healthcare

leginfo.legislature.ca.gov

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Re: Healthy California Act: proposal to make findings about single-payer healthcare

#111

Post by johncolanduoni »

sbov wrote: post #65
old-gregg wrote: post #41

Earlier quoted context omitted.

Yes you can. As a 6th largest economy in the world [1] California can negotiate prices down by 50-60% to be comparable to Canada/UK. [2] Besides, the existing state program (medi-cal) already covers over 1/3 of CA residents [3]. So it looks like if we lower the cost by 60% we can get pretty close to normal healthcare situation using the existing budget. [1] https://en.wikipedia.org/wiki/Comparison_between_U.S._states…

The driver of the cost of insurance is the cost of care, and I haven't seen much, even in the form of rhetoric, paid this way. So, can they really? Part of the reason places like Canada and the UK can do this is they can threaten to run around the industry when they try to fleece their citizens. Ultimately CA may be unable to do anything to combat the costs of medical care because the laws that give pharmacies and th…

Why can't California do the same and refuse to cover medications unless the sellers cooperate on price?

Re: Healthy California Act: proposal to make findings about single-payer healthcare

#112

Post by ars »

old-gregg wrote: post #41
marcell wrote: post #27

I can't get over the cognitive dissonance of these two points: > (2) Californians, as individuals, employers, and taxpayers have experienced a rise in the cost of health care and health care coverage in recent years > (4) Individuals often find that they are deprived of affordable care and choice because of decisions by health benefit plans guided by the plan’s economic needs rather than consumers’ health care needs.…

Yes you can. As a 6th largest economy in the world [1] California can negotiate prices down by 50-60% to be comparable to Canada/UK. [2] Besides, the existing state program (medi-cal) already covers over 1/3 of CA residents [3]. So it looks like if we lower the cost by 60% we can get pretty close to normal healthcare situation using the existing budget. [1] https://en.wikipedia.org/wiki/Comparison_between_U.S._states…

> can negotiate prices down by 50-60%

You can only do that by paying Doctors less.

Good luck with that. If you did it anyway, good luck finding enough Doctors.

When people think "negotiate prices" they usually think of drugs, but Doctors is the real problem.

Medi-Cal (and Medicaid in general for all states) only works because the regular rates subsidize the under-market charity rates. That only works up to a point, then it doesn't.

That BTW is why hospitals never publish rates - they need the higher rates to subsidize the charity rates.

Until you change that, you will never have single payer, it's impossible to do.

Re: Healthy California Act: proposal to make findings about single-payer healthcare

#113

Post by tarr11 »

11thEarlOfMar wrote: post #75

If this would replace my private health insurance premiums with State taxes, I'd have about $21,600 to contribute for a family of 4, generally healthy humans. - Does it mean no such thing as 'in or out of network'? That alone cost me $10,000 in 2015, over an above the $21,600 premiums. - Will it be PPO or HMO-style? Some of us like Kaiser, some don't. - Will I be forced to change providers? A real sore spot from the…

As a CA small business owner, I'd be much happier to just pay a simple payroll tax per employee than have this multi-step octopus process around open enrollment periods, health insurance brokers, differing city regulations (like SF), multiple vendors, audits, etc.

Single payer would also make hiring and HR a lot simpler.

Re: Healthy California Act: proposal to make findings about single-payer healthcare

#114

Post by stvswn »

darkstar999 wrote: post #49
brutus1213 wrote: post #35

Earlier quoted context omitted.

This will likely be funded from income tax. As a mid-30s person who earns a decent tech salary and has zero hope of buying a house in the decent parts of the SF Bay area, I think this is another case of taking from the young to feed the old. We should totally do this single-payer thing and pay for it via a wealth tax (that takes the current price of your home into account). Lets make it tiny .. say 0.5% a year.

> As a mid-30s person who earns a decent tech salary ... you can afford it. Moreso that others. You _are_ the wealth.

I'm in my 30s as well -- I make a great tech salary and own small house that cost me a ton to buy. I pay a lot in taxes. I support a family of four off of my salary.

At the end of the day we basically live the same lifestyle that I grew up with, and my dad was a police officer, my mom a public high school teacher. Our house is smaller than the one I grew up with, the local public schools are about the same quality. I'm not complaining, because I'm staying in the Bay Area for a reason: I believe that my good tech salary can be an amazing tech salary if I build the right skills, climb the right ladders. I think it's a chance for upward mobility. But it's a tough call when I ponder what my life would be like if I took a slightly lesser paying job in a more reasonable area of the country.

So, anyway, my point is that you can make the case that "you can afford it, your fellow Californians deserve it," and I'll roll my eyes because no one makes decisions that way. If I had to pay 10% more each year in taxes, I'd definitely be out of here. The other options are just way better at that point.

So, there's a point where I'm simply going to move instead of pay. You can lecture me about what I ought to do all you like but I have a family to take care of, and our standard of living matters to me. Yes, we'd be fine with less money, but I want even more for my family and I really don't feel bad about it.

Re: Healthy California Act: proposal to make findings about single-payer healthcare

#115

Post by ThomPete »

ClassyJacket wrote: post #77
ThomPete wrote: post #48

Here is the problem. How do you deal with illegal immigrants? At least in the current system there are ways for them to get treated, but in a single payer system? Single-payer works great in countries were everyone have a ssn. Not sure its feasible in the US as much as i think it would be great.

How does this stop illegal immigrants getting treated the same way they do now?

You can pay out of pocket. The second you get into free healtcare you need to suddenly track things on federal and state level to make sure budgets are kept. I am a fan of single payer but its a very different beast and i am not sure its possible in a US context.

Re: Healthy California Act: proposal to make findings about single-payer healthcare

#116

Post by davidw »

TheSageMage wrote: post #57
gavman wrote: post #32

Vermont tried this a few years ago, they had to cancel it since in the end it wasn't financially feasible [1]. CA is already dealing with severe budget issues [2][3], so while it sounds nice in theory I'm hesitant to believe the finances actually work out. [1] http://www.politico.com/story/2014/12/single-payer-vermont-1... [2] http://www.latimes.com/projects/la-me-pension-crisis-davis-d... [3] http://www.cnbc.com/201…

I'm very new to the single-payer idea, but Vermont rates 49th for population in the US, California ranks 1st. I thought one of the strengths of a single-payer system was to leverage the power of large numbers to help drive costs down. Would this not make it more viable?

Also: lots of doctors probably enjoy living in California, and couldn't easily move elsewhere, whereas Vermont is pretty small and one could pretty easily move to NH or upstate NY or somewhere else close by.

Re: Healthy California Act: proposal to make findings about single-payer healthcare

#117

Post by unabridged »

gavman wrote: post #32

Vermont tried this a few years ago, they had to cancel it since in the end it wasn't financially feasible [1]. CA is already dealing with severe budget issues [2][3], so while it sounds nice in theory I'm hesitant to believe the finances actually work out. [1] http://www.politico.com/story/2014/12/single-payer-vermont-1... [2] http://www.latimes.com/projects/la-me-pension-crisis-davis-d... [3] http://www.cnbc.com/201…

California could get rid of their budget issues instantly with a progressive property tax. How about an extra bracket for nonhomesteads starting at values over $1M?

Re: Healthy California Act: proposal to make findings about single-payer healthcare

#118

Post by __realtime »

wjossey wrote: post #30

I'm excited to see this show up on hacker news. As a Santa Monica resident, I'd gladly pay more in taxes for universal coverage. The only way that we are going to achieve federal universal coverage is via states paving the way. Just as "Romney care" was a predecessor to the ACA, so can healthy California pave the way for the US to join the rest of the modern world with guaranteed access.

Glad you have that luxury, CA has some of the highest taxes anywhere and I would definitely be opposed to more.

Re: Healthy California Act: proposal to make findings about single-payer healthcare

#119

Post by ng12 »

mmanfrin wrote: post #64
gavman wrote: post #32

Vermont tried this a few years ago, they had to cancel it since in the end it wasn't financially feasible [1]. CA is already dealing with severe budget issues [2][3], so while it sounds nice in theory I'm hesitant to believe the finances actually work out. [1] http://www.politico.com/story/2014/12/single-payer-vermont-1... [2] http://www.latimes.com/projects/la-me-pension-crisis-davis-d... [3] http://www.cnbc.com/201…

[2] is about CalPERS, which is separate from the budget of the State. There may be a current budget shortfall, but CalPERS is fine (it is the largest non-country pension fund in the world; and comes in the top 10 when listed among countries). [3] mentions that tax revenues will fall because of the end of temporary tax increases; those increases are likely to be renewed. Categorizing these as 'severe budget issues' is…

> it is the largest non-country pension fund in the world; and comes in the top 10 when listed among countries

Yes, and that's the problem. It's funding is at 73% and dropping -- that 27% is an astronomical deficit.

Numbers here: https://www.calpers.ca.gov/page/newsroom/calpers-news/2017/a...

Re: Healthy California Act: proposal to make findings about single-payer healthcare

#120

Post by mmanfrin »

chaostheory wrote: post #92
mmanfrin wrote: post #64

Earlier quoted context omitted.

[2] is about CalPERS, which is separate from the budget of the State. There may be a current budget shortfall, but CalPERS is fine (it is the largest non-country pension fund in the world; and comes in the top 10 when listed among countries). [3] mentions that tax revenues will fall because of the end of temporary tax increases; those increases are likely to be renewed. Categorizing these as 'severe budget issues' is…

> is about CalPERS, which is separate from the budget of the State. There may be a current budget shortfall, but CalPERS is fine It's 'separate' from the state budget, but doesn't California still ultimately pay for pensions? How is this fine when there's a huge difference between the projected costs and the actual costs? Doesn't 70% of CA tax revenue go towards paying pension obligations? Current CA pension debt is…

  Doesn't 70% of CA tax revenue go towards paying pension obligations
Not even close. The article linked by the comment I replied to states that CA will chip in $5.4bil -- last years budget was $122bil.

Maybe you got the 70% figure from where CalPERS gets its funding? Currently yearly contribution is ~70% from the state, but there was a bill passed that is shifting some of the requirement on to those who will benefit from it.

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