Cost of universal health care in California bigger than state's budget • Hacker News Board

Re: Cost of universal health care in California bigger than state's budget

#41

Post by dragonwriter » Tue, May 23, 2017, 6:59 AM UTC

jlarocco wrote: post #10

sologoub wrote: post #5

TLDR; $400 billion total, $200 billion is currently spent on subsidies and medi-cal, $150 billion is already spent by employers. The state would need to "find" ~$50 billion or ~$1,300 per resident more to fully fund this. Personally, this seems like a relative bargain and some modest extra taxes should offset the difference. Article reads pretty poorly and sensationalist. Not to mention that the missing amount is les…

Yeah, the headline is sensationalist. With the current spending factored in, it's really not that bad. A big enough tax on fast food could probably cover it, with the added bonus of decreasing the amount needed. If that doesn't work, then there are a lot of programs they can cut that are less important than healthcare.

> A big enough tax on fast food could probably cover it, with the added bonus of decreasing the amount needed.

Probably not; it would take a huge chunk of US fast food revenue, and probably more than California's.

https://www.franchisehelp.com/industry-reports/fast-food-ind...

> If that doesn't work, then there are a lot of programs they can cut that are less important than healthcare.

The amount that would need to be cut is pretty much all the non-healthcare spending in the state budget (including the spending that directly produces revenue, yet it requires that the revenue come in anyway.)

Re: Cost of universal health care in California bigger than state's budget

#42

Post by pasbesoin » Tue, May 23, 2017, 6:59 AM UTC

mtgx wrote: post #33

sologoub wrote: post #5

TLDR; $400 billion total, $200 billion is currently spent on subsidies and medi-cal, $150 billion is already spent by employers. The state would need to "find" ~$50 billion or ~$1,300 per resident more to fully fund this. Personally, this seems like a relative bargain and some modest extra taxes should offset the difference. Article reads pretty poorly and sensationalist. Not to mention that the missing amount is les…

Indeed. An alternative view on this: > The state would pay for almost all of its residents’ medical expenses — inpatient, outpatient, emergency services, dental, vision, mental health, and nursing home care — under the plan, and Californians would not have any premiums, copays, or deductibles. > That’s an incredible deal for just 15% of GDP, which again is lower than the US as a whole already spends on health care. h…

I like seeing dental included (per the parent comment). Increasingly discovered to be the genesis of numerous systemic problems (e.g. cardiovascular, for one) when not cared for. A really big opportunity for the kind of up front, preventative maintenance that saves big money / expense, down the road.

Dental care needs to be wrapped into the fold of overall healthcare. Its exclusion creates far more trouble than just bad teeth.

Re: Cost of universal health care in California bigger than state's budget

#43

Post by laurencerowe » Tue, May 23, 2017, 7:00 AM UTC

mtgx wrote: post #33

sologoub wrote: post #5

TLDR; $400 billion total, $200 billion is currently spent on subsidies and medi-cal, $150 billion is already spent by employers. The state would need to "find" ~$50 billion or ~$1,300 per resident more to fully fund this. Personally, this seems like a relative bargain and some modest extra taxes should offset the difference. Article reads pretty poorly and sensationalist. Not to mention that the missing amount is les…

Indeed. An alternative view on this: > The state would pay for almost all of its residents’ medical expenses — inpatient, outpatient, emergency services, dental, vision, mental health, and nursing home care — under the plan, and Californians would not have any premiums, copays, or deductibles. > That’s an incredible deal for just 15% of GDP, which again is lower than the US as a whole already spends on health care. h…

Single payer would be a great improvement on the current nightmare of American healthcare, but let's not kid ourselves that this is an incredible deal. The UK spent 8.5% of GDP on healthcare in 2013 (life expectancy in the UK is marginally higher than in California.) Most European countries spend around 11%.

Re: Cost of universal health care in California bigger than state's budget

#44

Post by dragonwriter » Tue, May 23, 2017, 7:00 AM UTC

ryanx435 wrote: post #30

jernfrost wrote: post #22

Really weird talking about how expensive this is. Whether you pay through it out of pocket or through taxes what difference does it make? Why do Americans think there is somethink inherently more difficult with paying taxes than paying other expenses. Weird how these people talk about health care as unaffordable but somehow there are always money for wasting trillions in wars like Iraq and Vietnam.

You should look into how much the federal and state governments pay to Medicare and Medicaid and other medical programs than compare it to the budget for the various military expenditures. Also, although iraq and Vietnam were failures on the surface, I challenge you to put a dollar value on the pax Americana that American military spending has enabled in the last 70 years, a dollar value on the various technologies d…

> I challenge you to put a dollar value on the pax Americana

It's been near constant actual war with an entirely constant internal war footing and national security state limiting basic freedoms justified by the war footing. There is no pax Americana.

Re: Cost of universal health care in California bigger than state's budget

#45

Post by ryanx435 » Tue, May 23, 2017, 7:03 AM UTC

threeseed wrote: post #37

ryanx435 wrote: post #30

Earlier quoted context omitted.

You should look into how much the federal and state governments pay to Medicare and Medicaid and other medical programs than compare it to the budget for the various military expenditures. Also, although iraq and Vietnam were failures on the surface, I challenge you to put a dollar value on the pax Americana that American military spending has enabled in the last 70 years, a dollar value on the various technologies d…

No one is disputing that the US needs a military. What everyone is questioning (and rightly so) is whether the levels of investment are warranted. Especially when the US has such a pitiful social safety net compared to other Western countries. And let's be serious here. The rest of the world has done more to save the world from fascism and communism than the US has. And entrepreneurship has done far more for innovati…

The other western nations can afford to spend more on their safety net because of the military strength of america and the protection it provides against foreign invaders.

America defeated japan essentially by itself while providing enough food and supplied to keep the russian army alive while also providing the majority of the military strength to the western front, essentially being the primary factor in the defeat of fascism.

As for communism, it was the us vs ussr while Europe and China and japan rebuilt after the destruction of world War 2, again, the us provided the bulk of the force against communism.

Your statement about the rest of the world doing more to save the world from fascism and communism is blatantly false.

Re: Cost of universal health care in California bigger than state's budget

#46

Post by dragonwriter » Tue, May 23, 2017, 7:04 AM UTC

jernfrost wrote: post #24

a3n wrote: post #11

Separate from the cost debate, the bill is labeled a "job killer," I assume because of all the insurance and related jobs lost. Which would be bad for the people losing their jobs, but they're only employed because they work for an arguably unnecessary middle-man industry. There's no "right" to those jobs, and if we can find a way to deliver health care , as opposed to health insurance , to close to everyone, we shou…

How is this supposed to kill jobs? Total money spent should be no different. It just shifts from out of pocket to taxes.

It actually drops spending significantly; there's lots of friction in healthcare caused by the maze of different payers and their different requirements and processes.

But it's not a job killer; reducing the total cost drag from healthcare and the associated personal uncertainty resulting from the gaps in the status quo system ought to spur pretty much every other industry.

Re: Cost of universal health care in California bigger than state's budget

#47

Post by dragonwriter » Tue, May 23, 2017, 7:10 AM UTC

jernfrost wrote: post #25

chipperyman573 wrote: post #2

Isn't that a given? I mean, do people not realize that the money has to come from somewhere? Of course it's going to be insanely expensive to insure everybody. Edit: I'm not arguing against Single Payer, I'm just surprised that this is something so shocking an article was written (and then upvoted) about.

If you pay 200 dollars today per month for health insurance but instead have to pay 200 dollars in extra taxes tomorrow for health insurance, what difference does it make?

Quite a lot to people who are ideologically opposed to taxes and/or government spending irrespective of the cost-effectiveness of the programs they find compared to alternatives.

Which California—Democratic majority notwithstanding—is hardly short on.

And those are exactly the people this Sac Bee headline is aimed at.

Re: Cost of universal health care in California bigger than state's budget

#48

Post by ryanx435 » Tue, May 23, 2017, 7:11 AM UTC

dragonwriter wrote: post #44

ryanx435 wrote: post #30

Earlier quoted context omitted.

You should look into how much the federal and state governments pay to Medicare and Medicaid and other medical programs than compare it to the budget for the various military expenditures. Also, although iraq and Vietnam were failures on the surface, I challenge you to put a dollar value on the pax Americana that American military spending has enabled in the last 70 years, a dollar value on the various technologies d…

> I challenge you to put a dollar value on the pax Americana It's been near constant actual war with an entirely constant internal war footing and national security state limiting basic freedoms justified by the war footing. There is no pax Americana.

The number of people who have died in armed conflicts throughout the entirety of the globe as a percentage of the population is the lowest it has ever been in human history. The number of wars between nations is at the lowest rate in all of human history. Yes, wars occur and will continue to occur, but to assert that the last 70 years of human history is not in a relatively peaceful time is historically disengenious.

Edit to add: the last 70 years have been the first in human history where no major conflicts occured on the European continent. Same with the north American continent.

All of this has been under the blanket of American military dominance and the threat of mutually assured destruction.

Re: Cost of universal health care in California bigger than state's budget

#49

Post by fpgaminer » Tue, May 23, 2017, 7:16 AM UTC

jlarocco wrote: post #17

tuxracer wrote: post #14

Earlier quoted context omitted.

> A big enough tax on fast food could probably cover it Exactly this kind of statement is what worries some about universal healthcare. I highly support single payer, universal healthcare. But statements like this undermine the cause by feeding fuel to the idea universal healthcare will inherently lead to more government intrusion into your personal decisions.

Like it or not, it's already done with cigarettes, alcohol, marijuana, gasoline, and a ton of other stuff. These type of taxes are the only way I'm in favor of government healthcare programs. Cigarettes, alcohol, and junk food directly increase medical costs, and people who indulge (and over indulge) in those things should be partly responsible for those increased costs.

> Cigarettes, alcohol, and junk food directly increase medical costs

Actually, all those things you listed _decrease_ lifetime medical costs. From a purely economic sense, people who drink, smoke, and eat junk food are _ideal_. They're reasonably healthy during their most productive years, and then mortality rate spikes just before retirement (a time when most people are least productive).

So if the logic is that we tax things based solely on economic externalities, then we should encourage drinking, smoking, and obesity. We should subsidize all those activities.

Check Google for numbers that back this up; usually the analysis is done against the U.K. health care system/NHS.

Re: Cost of universal health care in California bigger than state's budget

#50

Post by flukus » Tue, May 23, 2017, 7:18 AM UTC

threeseed wrote: post #38

flukus wrote: post #6

Earlier quoted context omitted.

> Of course it's going to be insanely expensive to insure everybody. The entire rest of the western world would indicate that it's cheaper than the current system, better too.

Actually let's be clear here. The rest of the Western world does not have a pure single payer system. In fact almost all of them don't. What we have e.g. in Australia is a mixed system closer to Obamacare. If you don't pay for private health insurance you get public coverage (but you have to pay an increased tax).

The increased tax is our governments attempt to copy the American system.