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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

#371

Post by xienze »

DrScump wrote: post #344
TheOsiris wrote: post #235

Earlier quoted context omitted.

I don't think anyone disagrees that single payer requires higher taxes than we currently pay. so given that, you're trying to tell me that a state with the highest taxes (much much higher than #2) in the nation, with the lowest housing affordability will attract more entrepreneurs than before? why? because the young and invincible will be choose cheaper healthcare over being able to live comfortably? I highly doubt i…

I don't think anyone disagrees that single payer requires higher taxes than we currently pay I disagree, in the sense that I don't take that as a given. Remember, all of the current inefficiencies in and profits for the carriers go away and are instead fed directly into the system of care. The first problem is, how could the government simply take over? Eminent Domain? Constitutional amendment?

> I disagree, in the sense that I don't take that as a given.

Well it depends who you're talking to. If you're poor, the impact on your income tax will be nothing. If you're like me, i.e. you have a fantastic employer plan with an annual premium amounting to ~4% of your annual salary, then you can bet your ass you'll be paying more in taxes and getting a worse product to boot.

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

#372

Post by SilasX »

chimeracoder wrote: post #356
SilasX wrote: post #303

Earlier quoted context omitted.

I added an edit that there is plenty of room between full current subsidy and 0% subsidy. You're doubling down on the strawman of adding new slots at 0% subsidy, and you're not considering the possibility that the requirements are too stringent to begin with. (Full bachelor's plus MD plus full residency.) Edit: Also, it wouldn't be "seeing the effects" of it until the number of med school applications = number of med…

There is no "full current subsidy" - the existing contributions from Medicare are already a partial subsidy. But this is kind of a meaningless debate after a point, because the number of unmatched residents is already an upper bound on the number of additional matches (you certainly wouldn't have more people interested when you increased the price to them). And even then, we wouldn't see a huge difference - the numbe…

>There is no "full current subsidy" - the existing contributions from Medicare are already a partial subsidy.

In the context, I meant "100% of current level"; I didn't mean to imply that it was "full" in that sense (and my point didn't depend on such).

>t this is kind of a meaningless debate after a point, because the number of unmatched residents is already an upper bound on the number of additional matches (you certainly wouldn't have more people interested when you increased the price to them)

You wouldn't have enough doctors if residents had to bear $1 extra in costs? That is implausible.

With respect, this exchange does not feel productive.

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

#373

Post by mullen »

ThomPete wrote: post #115
ClassyJacket wrote: post #77

Earlier quoted context omitted.

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.

Oh ya, Illegal immigrants totally pay their medicals bills after going to the emergency room.

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

#374

Post by acdha »

refurb wrote: post #261
acdha wrote: post #181

Earlier quoted context omitted.

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).”

That analysis ignores the income brackets. If I have the choice of living where the state income tax hit 8% at $50K vs. %9 at $200K, I'd gladly live in the state with the "higher" state income tax rate.

That wasn't the question, however, any more than the far more important question of what you get for those taxes.

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

#375

Post by Lazare »

alexqgb wrote: post #144
Lazare wrote: post #96

Earlier quoted context omitted.

Yep. Trying to solve this at the state level is a nice idea (and it certainly needs to be solved!), but it's actually harder to solve than at the federal level because you get all the same issues plus a few new ones, plus you can't actually change some key rules that are set at the federal level. If your proposed solution doesn't start with a plan to bring healthcare costs into line with the OECD average, then even i…

In general this true, but California is unique among American states in that its got an economy and a population bigger than most other nations in the OECD. That is to say, we've reached a scale where we absolutely can start thinking and acting like a nation state. That doesn't mean that smaller, poorer, and weaker states can simply copy what we do directly, one-by-one. But it does mean they can band together to see…

I live in New Zealand, population 4 million. If scale alone was critical, then Aetna (which covers about 23 million people in the US) would be squeezing really good pricing deals out of their suppliers, while NZ would be seeing really high costs. Nothing could be further from the truth.

(This is true, incidentally, because in large part NZ's low costs come from just buying less stuff. Fewer fancy drugs, fewer fancy machines, smaller and older hospitals, and lower salaries for doctors and nurses. Works great, but this is politically infeasible in the US, to say the least, which is probably why California isn't even dreaming about trying it.)

Yes, California has 38 million people or whatever, but other large groups of in the US can't get good deals (be that insurers like Aetna or Kaiser, or government programs like Medicare). They're not larger than Medicare, so that's out. Are they going to be greedier that Aetna? Really? Or is the famously dysfunctional and lobbyist dominated government in Sacremento going to make some hard choices and piss off the voters?

> But it does mean they can band together to see that a demonstrably good model gets implemented at the Federal level.

I'm a very strong proponent of federalism and the states as laboratories of democracy and all that. But... What California is proposing to do is not really new or untested. It's an expansion of a system that already exists in the US, and closely replicates systems from other countries. Yes, it works great if costs are low, and will bankrupt the state if costs are high. Costs are currently high. How do you square that circle?

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

#376

Post by charles-salvia »

mindcrime wrote: post #353
charles-salvia wrote: post #183

Earlier quoted context omitted.

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?

I understand that's the conservative/libertarian position FWIW, conflating conservatism and libertarianism is a mistake. There's some incidental overlap, just like there is between libertarianism and liberalism, but that's pretty much the extent of it. Are you against that as well? Yes, of course. Basically, if the word "force" is involved, it's wrong. Come up with a way to collectively fund infrastructure that's vol…

Right now, I can't think of a good way to have everyone voluntarily fund infrastructure. No nation-state has ever functioned without the threat of state-imposed force. It's not a pleasant reality, but nobody really knows how to do better at the moment. The only known alternative is scaling back civilization to pre-city-state conditions. But perhaps you have some suggestions on how to actually do this.

Regardless, this idea you have - that governmental "force", or any kind of institutional force that suppresses your individual will, is some kind of ultimate evil - seems very misguided. The laws of biology and physics will override your will and force you to degenerate and die. Micro-organisms will force you to cough up blood and die. Wild animals will force you to give up your flesh and die. Collective human institutions are the only things that have successfully imbued individual humans with an order of magnitude more power and more rights than our primitive ancestral conditions would allow. Many of these human institutions are also abusive, however there doesn't seem to be an alternative to forming collective human institutions that require forced large-scale group efforts if we want to actually not die of malaria all the time.

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

#377

Post by CalChris »

r00fus wrote: post #342
CalChris wrote: post #291

Earlier quoted context omitted.

Per capita GDP matters more in determining whether Vermont or California can better afford this. In fact, CA can better afford this than Vermont. By comparison, Mississippi cannot afford this. They're basically supported by states like California; their economy is trivial and they're propped up by defense spending.

Why? Disagree with your reasoning, it's not about per-capita, it's about absolute numbers in the risk pool and ability for a large actor like CA to better negotiate prices down. Why do you think Apple gets better prices than, e.g. Logitech for component parts? Because they order massively more, up-front, and with strict timetables for delivery.

Costs are still per capita. We will only be able to negotiate so much and we'd be negotiating with providers rather the insurance companies.

To be very clear, I think CA can afford this and I think we should do it.

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

#378

Post by zaroth »

neltnerb wrote: post #131
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.

Completely agree. The trick is making sure it's well-executed so that other states can use it as a template. Once one state proves that single-payer can be done well, I suspect it will cascade inevitably. With 100% seriousness, if the ACA is repealed I will likely be choosing between Massachusetts (where Romneycare would hopefully take priority again) or another country. It's too risky to do otherwise. My extended an…

California had guaranteed issue before the ACA. Any small business with at least 2 employees could get it. Premiums were reasonable as the "rating adjustment factor" was capped on these plans. A one time 6 month waiting period on pre-existing conditions is waived if you have prior credible coverage without more than a 62 day gap in coverage.

For example, a husband and wife working together in a sole proprietorship, would qualify.

I'm not sure the current state since ACA passed, but I depended on CA guaranteed issue myself for several years before ACA and it provided access to high quality expensive insurance (~$500 / person / month) with unlimited annual benefits, as well as somewhat cheaper HMO plans (~$350-400 / person / month).

Google 'AB 1672'.

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

#379

Post by refurb »

toomuchtodo wrote: post #361
refurb wrote: post #282

Earlier quoted context omitted.

I'm not arguing one is better than the other. Just that both system are run by humans so I wouldn't say you'd have less corruption or waste in one or the other.

I can vote out government representatives; I cannot vote out unregulated companies doing damage in a marketplace. Government provided services provide the opportunity for total transparency; this is not the case in the private sector. EDIT: @refurb: You're confusing a free market with what the United States has. A free market it ain't (especially regarding healthcare).

In a free market you can chose to go with another company.

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

#380

Post by dariopy »

TheOsiris wrote: post #235
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.

I don't think anyone disagrees that single payer requires higher taxes than we currently pay. so given that, you're trying to tell me that a state with the highest taxes (much much higher than #2) in the nation, with the lowest housing affordability will attract more entrepreneurs than before? why? because the young and invincible will be choose cheaper healthcare over being able to live comfortably? I highly doubt i…

CA #1? What are you talking about? The state with the highest tax burden is NY. CA doesn't even make it to the top 10.

https://wallethub.com/edu/states-with-highest-lowest-tax-bur...

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