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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

#321

Post by cam_l »

gautamnarula wrote: post #243
stale2002 wrote: post #223

Earlier quoted context omitted.

Uhh, no thanks. I'd rather be able to decide for myself what healthcare I buy, instead of being forced into a substandard single payer system. Ok, fine, create a public option. But don't force me to buy it. Let me buy my own healthcare.

This is what Australia does, I think. Single payer public option, but you can choose to buy private health care as well (though you still pay taxes for the public option regardless). I'm curious to hear from any Australians about how this system works for them.

You actually pay more taxes if you do not choose the private option. Though private insurance is generally more expensive. Over the years since it was introduced, there was an exodus of sorts from public to private due to this incentive. It has recently started to turn as insurance companies have been drawing more profit than the value they provide.

It helps that the standard of care in Australia, for significant or life-threatening health situations at least, is generally as good if not better in the public system. For everything else, insurance or otherwise, the only way to get quality healthcare is money and contacts.

As a system of encouraging higher spends on healthcare, private insurance works.. The only issue is none of the profits of that system goes towards better healthcare. It is just more damn rent.

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

#322

Post by SilasX »

jahewson wrote: post #140
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…

What are the factors? Number one is that doctors in the US are paid too much. Why is this? Because health insurance is purchased by employers, not individuals, so most people don't see or care how much it costs. This also explains number two - the price gouging by pharmaceutical companies and hospitals. People will try to say it's because of malpractice insurance or because the US invents all the drugs (they don't) a…

Mostly agree but I think you misrepresent this argument:

>People will try to say it's because of malpractice insurance or because the US invents all the drugs (they don't)

It's not that the US invents all the drugs, but that US customers bear a disproportionate share of the drug development costs because drug makers (whichever country they originate in) can actually charge above marginal price in the US, compared to the monopsonist discount that other countries can secure.

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

#323

Post by hackuser »

piedpiper_ wrote: post #314
hackuser wrote: post #215

Earlier quoted context omitted.

Government is "forcing" very few people. Most people participate in society voluntarily. For example, government doesn't force me to obey the law; I do it voluntarily. They don't force me to pay my bills, not shoot my neighbor, and pay my taxes. I do all that voluntarily. EDIT: I don't follow Hacker News' rules and norms because I'm afraid of being banned, but because I respect the other people here, respect that the…

> For example, government doesn't force me to obey the law; I do it voluntarily. They don't force me to pay my bills, not shoot my neighbor, and pay my taxes. I do all that voluntarily. Yes you don't do those things because you will be sent to prison. Is it going to be Ok to send Bobby to prison because he didn't want to cover Suzi's medical bill?

> you don't do those things because you will be sent to prison

No, I don't do them because I don't want to, and because I respect group decisions. I want to pay my bills; I don't want to rip off other people. I don't shoot my neighbor because I'm not a sociopath and like normal, healthy people I very much don't want to do it. I pay my taxes because we took a vote and I respect that and want to do my share. etc.

You can get away with a lot and not go to jail. That's not what determines most people's behavior.

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

#324

Post by r00fus »

ars wrote: post #186
IslaDeEncanta wrote: post #158

Earlier quoted context omitted.

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.

The pharma and medical instrument pricing racket is unbelievable. Took a look at the cost for our last delivery - of the $36k+ cost billed, facilities, equipment and medication were way over the billed rate of the doctors/nurses/anesthesiologists.

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

#325

Post by white-flame »

hackuser wrote: post #215
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…

Government is "forcing" very few people. Most people participate in society voluntarily. For example, government doesn't force me to obey the law; I do it voluntarily. They don't force me to pay my bills, not shoot my neighbor, and pay my taxes. I do all that voluntarily. EDIT: I don't follow Hacker News' rules and norms because I'm afraid of being banned, but because I respect the other people here, respect that the…

> For example, government doesn't force me to obey the law; I do it voluntarily. They don't force me to pay my bills, not shoot my neighbor, and pay my taxes. I do all that voluntarily.

That sounds like the IRS's shtick about income taxes being "voluntary". From a technical perspective, these decisions are under duress, under threat of legal repercussion, even if you find that choice agreeable and would act in the same way without the law involved.

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

#326

Post by ffk »

stale2002 wrote: post #223
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…

Uhh, no thanks. I'd rather be able to decide for myself what healthcare I buy, instead of being forced into a substandard single payer system. Ok, fine, create a public option. But don't force me to buy it. Let me buy my own healthcare.

How do you know it will be substandard?

From my travels to New Zealand, I'd argue their single-payer health care experience is overall better than here. You can buy private insurance there which supplements the public system and lets you visit private hospitals outside of the public systems, but you don't need it for emergencies or standard GP checkups. Most people don't bother since the public system is good.

And from a tax perspective, according to the BBC, the US effectively taxes an average income single person at 22.7% while NZ taxes at 16.4% [1]. For the top bracket, in US it is 39.6% while in NZ it is 33% [2][3]. I'd argue they are getting a much better deal than us. And don't forget the US numbers are before health insurance is paid.

So, it is definitely possible to get a good system. I think one of our major problems as a country is that we lack transparency which undermines trust and makes it easier to corrupt the system. You can't run a good health care system without transparency and accountability, regardless of whether it is a public or private system.

Cheers!

[1] http://www.bbc.com/news/magazine-26327114 [2] https://www.irs.gov/pub/irs-pdf/i1040gi.pdf [3] http://www.ird.govt.nz/how-to/taxrates-codes/rates/itaxsalar...

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

#328

Post by r00fus »

__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.

You're free to leave anytime. Why haven't you? If you have, then your opinion is moot.

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

#329

Post by seanmcdirmid »

intopieces wrote: post #228
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…

>I'm sure as shit happy to pay more in taxes for a universal single single-payer. As someone who just climbed out of being a contractor and into a full time position, I concur. Raise my taxes for this. Please do it, and do it soon.

Not to mention that detaching health insurance from employment is sure to create a lot more fluid labor market (contracting would be easier, part time work becomes more viable, etc....).

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

#330

Post by guelo »

stale2002 wrote: post #223
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…

Uhh, no thanks. I'd rather be able to decide for myself what healthcare I buy, instead of being forced into a substandard single payer system. Ok, fine, create a public option. But don't force me to buy it. Let me buy my own healthcare.

Most people are provided healthcare through work and are not given an option of what healthcare to buy.
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