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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

#181

Post by acdha »

__realtime wrote: post #118
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.

https://taxfoundation.org/state-and-local-sales-tax-rates-20...

“The five states with the highest average combined state and local sales tax rates are Tennessee (9.46 percent), Arkansas (9.30 percent), Louisiana (9.0 percent), Alabama (8.97 percent), and Washington (8.90 percent).”

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

#182

Post by cmdrfred »

FullMtlAlcoholc wrote: post #139
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…

> CA is already dealing with severe budget issues [2][3], False. California has a budget surplus of nearly $3 billion and will be able to weather a mild recession without major budget cuts or tax increases for the next 4 years.

Jerry Brown says there is a projected 1.6 billion dollar deficit. Where did you get your numbers from?

http://www.latimes.com/politics/la-pol-sac-jerry-brown-budge...

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

#183

Post by charles-salvia »

mindcrime wrote: post #175

so should the government force those people to spend their earned income on healthcare for others? Absolutely not. Pretty much any question that starts with "should the government force ..." can be answered "no". You earned your income, it's yours and it should be up to you how to spend it. Using force / aggression (aka the government forcing you to do something) is a violation of your most fundamental rights, and st…

I understand that's the conservative/libertarian position - however the government forces you to pay taxes to support infrastructure and other things. Are you against that as well?

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

#184

Post by chimeracoder »

neltnerb wrote: post #152
jbhatab wrote: post #121

Earlier quoted context omitted.

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 frea…

> 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.

Sure, but empirically, seniors are far happier with privatized Medicare plans than they are with publicly-administered Medicare plans. Original Medicare has the lowest satisfaction rates of all major Medicare plans - far lower than the lowest of the privately-managed plans.

Medicaid is run at the state level, but the same applies there as well - privately managed Medicaid plans are gaining popularity because they deliver better medical results at lower prices.

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

USPS is a mixed bag, but it isn't a straightforward comparison, because the USPS is statutorily protected from competition. For example, by law, all private carriers are required to charge at least twice what USPS charges for a first-class letter - so when you say it's "amazing for the price", we're already dealing with a warped perception of what mail delivery costs.

Most of the other examples you list don't address OP's question ("Do we have examples of the government running a service better than the private sector"), because there hasn't been a private sector for those in modern history for us to compare them with.

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

#185

Post by CalChris »

pmoriarty wrote: post #89
TheSageMage wrote: post #57

Earlier quoted context omitted.

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?

Vermont is one of the poorest states in the nation as well, while California's economy is one of the biggest in the world.

Vermont is 32nd in per capita GDP. Poorest would be Mississippi, dead last. California is indeed a massive economy and we're ranked 10th in per capita GDP.

https://en.wikipedia.org/wiki/List_of_U.S._states_by_GDP_per...

One point about our size. When CA does something at the state level a lot of other states follow along. Minnesota can't dictate to manufacturers but CA can.

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

#186

Post by ars »

IslaDeEncanta wrote: post #158
ars wrote: post #112

Earlier quoted context omitted.

> 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.

> Physician pay (last I checked) only makes up about 20%

Does that number include specialists? Nurses? Lab technicians?

If not, why are you excluding them?

You basically have 4 expenses: Durable Equipment, Medication, Salary, Facilities.

I suspect that Salary is the largest one, and the hardest to reduce.

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

#187

Post by darkstar999 »

antimatter wrote: post #109
darkstar999 wrote: post #49

Earlier quoted context omitted.

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

Why are others entitled to his money?

You are arguing against the fundamentals of taxation.

Why are others entitled to his money (for healthcare)? Because we decided that we are all good people and take care of each other.

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

#188

Post by neltnerb »

gator-io wrote: post #164

I simultaneously believe in universal coverage as a moral imperative, but also the efficiency of markets over government AND basic income as a necessity as automation displaces millions of workers. So, why not combine concepts - start off with basic income that has to be spent on health care insurance. Start with enough for coverage against major issues, but people can spend more for more coverage. Universal coverage…

I'm pretty confident that if you get rid of individual mandates while not disqualifying sick people or enforcing benefit caps, premiums will skyrocket. I'm not sure there's really a middle ground here, it's just unavoidable actuary math.

So if it is, as you say, a moral imperative, what are your choices?

Maybe the EBI will need to be ridiculously high to actually provide the coverage you agree is a moral imperative to provide. But that doesn't really solve the problem, it just ends up meaning that sick people don't have that EBI to cover stuff everyone else can pay for with it. Like food and housing.

I'm open to hearing other ideas on how to do it, but I think that you'd have to vary the EBI based on how expensive health care is for the individual getting it, if your goal is to meet the universal coverage moral imperative. And that's very different from what EBI is supposed to be. I don't think it will solve the problem that you're describing.

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

#189

Post by nolepointer »

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 do you deal with illegal immigrants?

You deport them? Doesn't seem like a big problem.

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