Healthy California Act: proposal to make findings about single-payer healthcare • Hacker News Board

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

#151

Post by narrator » Thu, Mar 09, 2017, 1:12 AM UTC

rdmcfee wrote: post #72

A single payer system is a step in the right direction, however, there are deeper issues with the American healthcare system. The unit cost of healthcare is so much higher than in other developed countries. In British Columbia, physicians bill at total of around $31 CAD ($23 USD) for a standard office visit. They pay all their overhead out of this fee. Typically doctors keep 65% of their billings and the offices take…

For one, doctors educational costs are astronomical in the U.S compared to other countries. The amount of people able to become doctors is artificially limited. Drug prices are unregulated. The cost of developing drugs is high and has been getting higher.

Hospitals have little price transparency and the cost of same procedures at different hospitals is wildly different. The same bag of saline can cost 10x more at one hospital vs another. In markets where there is price transparency, like Lasik surgery or other elective procedures, the prices are far more sane.

One thing that spending double as a percent of GDP on health care and getting worse outcomes proves is that THE SOLUTION TO THE PROBLEM IS NOT TO SPEND MORE MONEY. Unfortunately, this is the only thing American politics knows how to do as more money means more money for every special interest with their hand out.

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

#152

Post by neltnerb » Thu, Mar 09, 2017, 1:12 AM UTC

jbhatab wrote: post #121

df3 wrote: post #5

A well-executed single-payer system would make California even more attractive for entrepreneurship and increase labor mobility for everyone. Life would be much easier if we could start companies or switch jobs without worrying about healthcare.

Here's the only thing I'm confused about. Do we have examples of the government running a service better than the private sector? I'm not 100% on this, but it seems all of the best aspects of American services come from competition and letting capitalism thrive. Would love a counter opinion.

Off the top of my head, and certainly some are up for debate. But consider how well these systems worked prior to government intervention.

You may think medicare, for instance, is run horribly -- but I'm pretty confident that seniors are far happier with it than they were pawning off their possessions to get medical treatment prior to it being created.

- Medicaid

- Medicare

- The USPS (which, let's be honest, is freaking amazing for the price)

- Social security

- Basic research

- The military (remember our private security contractors and how much more horrible they were?)

- The fire department

- The police (can you imagine how horrible a private police force would be?)

And on the flip side, consider how atrocious private prisons are compared to federally operated ones.

I'm sure there are many, many others...

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

#153

Post by alexqgb » Thu, Mar 09, 2017, 1:12 AM UTC

jbhatab wrote: post #121

df3 wrote: post #5

A well-executed single-payer system would make California even more attractive for entrepreneurship and increase labor mobility for everyone. Life would be much easier if we could start companies or switch jobs without worrying about healthcare.

Here's the only thing I'm confused about. Do we have examples of the government running a service better than the private sector? I'm not 100% on this, but it seems all of the best aspects of American services come from competition and letting capitalism thrive. Would love a counter opinion.

Many. Start with highways, aviation safety, and prisons. Oh, and the history of private fire departments is a carnival of horrors. I mean, the list goes on (and on, and on).

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

#154

Post by cft » Thu, Mar 09, 2017, 1:13 AM UTC

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 legislature is much more financially reckless than Vermont's

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

#155

Post by davewritescode » Thu, Mar 09, 2017, 1:13 AM UTC

jbhatab wrote: post #128

rdmcfee wrote: post #72

A single payer system is a step in the right direction, however, there are deeper issues with the American healthcare system. The unit cost of healthcare is so much higher than in other developed countries. In British Columbia, physicians bill at total of around $31 CAD ($23 USD) for a standard office visit. They pay all their overhead out of this fee. Typically doctors keep 65% of their billings and the offices take…

Why is single payer better? Genuinely curious. I just don't have any solid proof of the American Government doing a better job than the private industry enabled by competition.

It's hard to quantify 'better' but there are some major advantages to a single payer systems in terms of efficiencies. For example, a single standard for billing is in itself a major win.

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

#156

Post by cortesoft » Thu, Mar 09, 2017, 1:14 AM UTC

bawana wrote: post #60

if health care prices were mandated to be public (like calorie counts on food) then we would all be better off

Knowing health care prices doesn't help much, though. If you break your leg, you aren't going to go to a bunch of different hospitals, compare prices, and choose the best value option. If you are in a car accident and unconscious, the paramedic isn't going to figure out where you can get the best deal.

Medical decisions are a TERRIBLE candidate for a free market. You are never in a position to be a rational actor in them.

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

#157

Post by nosuchthing » Thu, Mar 09, 2017, 1:14 AM UTC

unabridged wrote: post #117

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?

That requires an effort to repeal Prop 13 asap.

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

#158

Post by IslaDeEncanta » Thu, Mar 09, 2017, 1:15 AM UTC

ars wrote: post #112

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…

> 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, t…

Physician pay (last I checked) only makes up about 20%, including the costs of them practicing. They see about half of it in the end. There is even more spent on administration, which makes up about 25% of spending. Compare that 25% to the 9% in Canada and it becomes pretty obvious where you can save money.

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

#159

Post by theflyingkiwi42 » Thu, Mar 09, 2017, 1:15 AM UTC

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…

Have your contractor friends check out NASE. I used to have amazing health coverage through them for about $150 (pre-Obamacare).

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

#160

Post by feld » Thu, Mar 09, 2017, 1:15 AM UTC

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…

Because they didn't add provisions to control pharma and hospital gouging. Let them run free and they'll suck you dry.