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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

#431

Post by IslaDeEncanta »

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.

That number includes specialists and lab techs. It doesn't include hospital care (i.e. nurses).

You are just ignoring the profiteering done by the drug and insurance companies and the savings due to streamlining administration that a single payer system would bring.

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

#432

Post by FullMtlAlcoholc »

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.

Prisons for one.

You seem to misunderstand the role of governments though. Citizens and taxpayers are not shareholders seeking to maximize return on investment. The government exists to provide for national defense, rule of law, postal service, and domestic security. Private industry would have an incentive to not provide these services for free riders (the poor, those who dodge payment, etc.)

Private industry also ignores externalities in their pricing, which is why we have regulation. I quite like not having to pay for relatively clean air.

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

#433

Post by FullMtlAlcoholc »

refurb wrote: post #379
toomuchtodo wrote: post #361

Earlier quoted context omitted.

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.

Provide me with an example of a fully functioning free market completely devoid if any government regulation or involvement?

If one doesn't exist, I wouldn't like our system to move into that direction based upon wild speculation and pure theory. The implicit assumption in free market models is that people are rational agents, when all research shows that people are highly irrational.

Wouldn't you like see evidence of how a free market would function on the scale of the United States? Like a scientist, not like a religious zealot?

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

#434

Post by FullMtlAlcoholc »

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 in the American system that prevent reasonable pricing?

One major factor is the administrative cost for medical providers when dealing with insurance. That's why the cash price for medical services is often much cheaper

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

#435

Post by surfmike »

nikdaheratik wrote: post #385
surfmike wrote: post #61

Earlier quoted context omitted.

It sounds fanciful to say that we'll just use our existing Medi-cal budget but now it will cover everyone. If the government had so much bargaining power, then Medicare and Medi-cal would already have far smaller costs. We don't really see that. Also, who exactly, would we be negotiating with? I don't know that you can squeeze the budgets of hospitals in California by 50% and have everything carry on like normal.

Except that the lawmakers in Washington actually wrote the laws to forbid the government from negotiating for special rates for Medicare and Medicaid, unlike the UK or Canada. Which is why drugs there, for example, are so much cheaper than in the U.S.

Hmm, interesting. I know medicare reimbursement rates are still quite low compared to private insurance, so I wonder how that squares with a 'no negotiation' policy.

Edit: One study from Texas found that Medicare reimbursement rates were 70-80% below the private average. https://www.texmed.org/June16Journal/

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

#436

Post by dx034 »

luckydata wrote: post #268
maxerickson wrote: post #220

Earlier quoted context omitted.

Several of those countries implement universal coverage using a private insurance model.

All the best systems are single payer. Italy, France, Spain, the UK. The countries with private insurance like Germany are middle of the pack. Clearly single payer is the superior option.

Having lived in both countries, I wouldn't say that the UK system is in any way better than the German system. Rather the opposite.

In addition to that, the German system isn't really a private system. The premium and health coverage is set by law and the insurances are not-for-profit entities. There's the possibility to get private insurance for parts of the population, but you're not dependent on private companies.

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

#437

Post by dx034 »

__jal wrote: post #82
darkstar999 wrote: post #42

Earlier quoted context omitted.

Just curious why you would gladly pay more? Can you elaborate?

Can't speak for the poster, but I live in the Bay Area, and also would happily pay more in taxes for this to happen. That's because I think long-term, single-payer is the only sensible way to handle health care. We have (the US has) a truly screwed up healthcare system that (nearly) everyone acknowledges is inefficient, too expensive, wasteful and less effective than it could be. Looking at other countries, this is o…

It's certainly better than the current way, but single payer is not the only way. Look at Germany for example, where the government sets minimum coverage and the premium (in a band as a % of the salary which the state will pay if you don't earn enough), but coverage is then provided by not-for-profit entities. This allows some competition by eliminating inefficient providers while making sure that everyone receives the same treatment.

I think such a system would work much better for the US as it's easier for the state to build such a framework than to come up with health care for everyone. The NHS (UKs single payer health provider) is the biggest employer in the state, which gives you some indication on how complex it is to provide universal healthcare for everyone.

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

#438

Post by neltnerb »

piedpiper_ wrote: post #407
dariopy wrote: post #380

Earlier quoted context omitted.

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...

California has the highest income tax rate in the nation which directly impacts entrepreneurs starting a business (if they are successful and create wealth). Why would any sane person want to shave off an extra 13 cents for every dollar they make when they're already losing 40 cents per dollar from the federal government? This is why many entrepreneurs are choosing states with low or no income tax and leaving CA and…

I think you added the wrong link, which I had assumed was a reference to your claim that "many entrepreneurs are choosing states with low or no income tax". It appears to just be a link to Federal tax brackets. Do you have something to actually back up that claim?

I ask because it's very counterintuitive -- entrepreneurs are pretty much never showing much personal income for years since it's all in equity. And by the time they are making that much personal income, they're presumably just as well off as a normal employee with that income.

The only things I ever hear about that incentivize startups to move somewhere are the (a) ecosystem of support (b) availability of low cost facilities and (c) state tax credits or grant award opportunities, such as matching grants with federal SBIR grants.

I have literally never heard an entrepreneur suggest moving to a new state because of personal income taxes. If personal income is high enough that it's a problem, they're probably well enough off that they can afford it regardless of whether they're an entrepreneur or not.

Unless maybe you're talking about how progressive taxes in general do a bad job at the whole variable income thing. I hear lots of complaints about that with regard to personal income taxes from friends who are more contractor/consulting focused. But that's also not a California thing.

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

#439

Post by Daishiman »

mindcrime wrote: post #355
Daishiman wrote: post #248

Earlier quoted context omitted.

Some people will never have the means to pay for their own health care. Some jobs that have social value do not pay enough money to care for people. In your worldview, those people don't deserve to have health. I'll stick with civilized societies thankyouverymuch.

In your worldview, those people don't deserve to have health. No, that is not my worldview, not in the slightest.

Unless you can provide health care for those who are able to in a way that doesn't end up in coercing someone to give their share of resources towards that, then whatever you think may happen, will end up in some people not having access to care.

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

#440

Post by digitalzombie »

piedpiper_ wrote: post #407
dariopy wrote: post #380

Earlier quoted context omitted.

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...

California has the highest income tax rate in the nation which directly impacts entrepreneurs starting a business (if they are successful and create wealth). Why would any sane person want to shave off an extra 13 cents for every dollar they make when they're already losing 40 cents per dollar from the federal government? This is why many entrepreneurs are choosing states with low or no income tax and leaving CA and…

Your link doesn't prove anything it's just a federal tax.

The other reply posted a link and California does not have the highest income tax rate, it's 4th.

So from the get go your premise is false.

Also liberal or not you're stating an opinion of why hypothetical companies should do this and that, all the while we still have Silicon Valley and Hollywood in California. So in the face of reality you have not yet successfully prove or convincingly argue that high tax will drive away companies.

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