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

#61

Post by csuwldcat » Tue, May 23, 2017, 9:00 AM UTC

fpgaminer wrote: post #53

carsongross wrote: post #9

Few know this: The United States currently spends more money per capita on socialized medicine than any other country except Norway: https://en.wikipedia.org/wiki/List_of_countries_by_total_hea... In fact, the US spends more on socialized medicine than Japan, the UK and Finland spend in total , private and public spending. The US healthcare system is totally out of control. Nothing will fix it until there is a collap…

My friend has dual U.S.-Swedish citizenship. It's crazy to think, but a few times now he's actually flown out to Sweden to have a medical procedure performed, because it's _cheaper_ to get an international round-trip ticket to Sweden then it would be to just have the procedure done in the U.S. (where he lives). And it's never been anything big; just outpatient type stuff. The U.S. healthcare system _is_ totally out o…

He should have just flown to Oklahoma instead: http://reason.com/blog/2017/01/27/what-happens-when-doctors-...

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

#62

Post by csuwldcat » Tue, May 23, 2017, 9:25 AM UTC

ncallaway wrote: post #7

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.

Right, it adds an insane cost. You then need to raise that same amount of money. However, when you consider that people are no longer paying for health insurance there's a large pool of money available. CA needs somewhere between $50-100B to fund this project. The population of CA is around 39M ( https://www.google.com/publicdata/explore?ds=kf7tgg1uo9ude_&... ). That means, you need about $2,564/person/year. Or about…

You forgot to account for two significant factors: that 40% of Californians pay no state income tax, and that California dramatically skews toward higher brackets paying for the state's expenditures - the top 1% already pay an absurdly massive 48% of state income tax.

Per person numbers like the ones you included are basically meaningless, given they bear almost no reflection of the actual fiscal implementation and unique issues it would create.

Alexander Tyler nailed the broader issue of 'democracy' long ago:

“A democracy cannot exist as a permanent form of government. It can only exist until the voters discover that they can vote themselves money from the public treasure. From that moment on the majority always votes for the candidates promising the most money from the public treasury, with the result that a democracy always collapses over loose fiscal policy followed by a dictatorship."

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

#63

Post by Turing_Machine » Tue, May 23, 2017, 12:13 PM UTC

flukus wrote: post #29

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.

> 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. Is that worse than corporate intrusion? Does your health insurance not factor these things in already?

"Is that worse than corporate intrusion?"

Yes. You sometimes have a choice about which corporation you deal with. You don't get a choice when it comes to the government.

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

#64

Post by Turing_Machine » Tue, May 23, 2017, 12:30 PM UTC

flukus wrote: post #60

ryanx435 wrote: post #45

Earlier quoted context omitted.

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…

> 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. Where to start? The US did most of the work in beating Japan but they also got a lot of help from Russia toward the end. Once Japan had lost Manchuria to the…

"Once Japan had lost Manchuria to the Russians they gave up on a conditional surrender, they had nothing to bargain for."

Most people think that nuking Hiroshima and Nagasaki was what made Japan surrender unconditionally, not the loss of Manchuria.

"But more importantly on the Eastern front, the tide had already turned before lend lease to Russia made any difference."

I'm sorry, that is simply not correct. The Lend-Lease pipeline was in full operation by early 1942, well before the tide turned at the Battle of Stalingrad in early 1943. In fact, the Germans moved on Stalingrad specifically to disrupt the Persian Corridor portion of the Lend Lease operation.

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

#65

Post by brownbat » Tue, May 23, 2017, 12:30 PM UTC

curun1r wrote: post #57

therealmarv wrote: post #36

Earlier quoted context omitted.

Wow, I'm surprised. So doctors/hospitals are extremely expensive in USA? What is spend monthly very roughly on health care in USA (if you're have one)? I'm originally from Germany and I always assumed we pay more for health care generally.

One aspect that makes care in the US cost more is our culture of being highly litigious. We seem to believe that if doctors make honest mistakes, it entitles the patient or their heirs to a large settlement. So doctors/hospitals need expensive malpractice insurance and that cost gets bundled in with the cost of care. To add to that, settlements encompass both medical costs and compensation for pain and suffering, whi…

Allow me to play devil's advocate...

Medical negligence is the third leading cause of death in the United States. We have an epidemic of "honest mistakes" like scalpels left in patients after surgeries,[0] often leading to deaths, or amputations of the wrong limb[1] leading to enormous harms to the patient. Something as innocent as 'forgetting to wash your hands' has outsized consequences in this industry, forgiving 'honest mistakes' is not a safe standard.

It's also not generally true that plaintiffs in tort cases receive exorbitant damages, this is a popular myth because there are a few outlandish examples. The most popular examples, such as the "Stella awards," are completely made up.[1][2]

States that have capped medical malpractice have seen no difference in medical costs, and it has not been found to be a significant contribution to costs in the industry.[3] Meanwhile, capping costs hurts patients - some mistakes end up costing millions in additional medical costs throughout an injured patient's life, and most importantly for getting improved care over time, it lightens incentives for billion dollar hospitals to actually correct underlying procedures that make harms more likely.

[0] https://en.wikipedia.org/wiki/Retained_surgical_instruments

[1] http://www.hotcoffeethemovie.com/default.asp?pg=mcdonalds_ca...

[2] http://www.snopes.com/legal/lawsuits.asp

[3] http://www.decof.com/decof/wp-content/uploads/2015/12/five-m...

[4] More on handwashing as a challenge to health in hospitals: http://annals.org/aim/article/712481/compliance-handwashing-...

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

#66

Post by Turing_Machine » Tue, May 23, 2017, 12:33 PM UTC

euyyn wrote: post #56

ryanx435 wrote: post #55

Earlier quoted context omitted.

The peace in Europe today is a direct result of nato and the threat of invasion from the soviets during the 50s through early 90s. You gotta remember that the Americans occupied western Germany up until reunification (we still have huge military bases in germany) and provided finances to pretty much every european country during their reconstruction periods after the devastation of the world under thr conditions of a…

You misunderstand: the overall trend of deaths around the globe due to armed conflict. About Europe, I said I wouldn't argue because I don't have the knowledge to assess those claims. Just saying what is usually acknowledged by historians as the main cause.

"You misunderstand: the overall trend of deaths around the globe due to armed conflict."

WWI killed 38 million. WWII killed 60 million.

That doesn't look like a downward trend to me.

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

#67

Post by maxerickson » Tue, May 23, 2017, 12:46 PM UTC

therealmarv wrote: post #36

carsongross wrote: post #9

Few know this: The United States currently spends more money per capita on socialized medicine than any other country except Norway: https://en.wikipedia.org/wiki/List_of_countries_by_total_hea... In fact, the US spends more on socialized medicine than Japan, the UK and Finland spend in total , private and public spending. The US healthcare system is totally out of control. Nothing will fix it until there is a collap…

Wow, I'm surprised. So doctors/hospitals are extremely expensive in USA? What is spend monthly very roughly on health care in USA (if you're have one)? I'm originally from Germany and I always assumed we pay more for health care generally.

A young single person can get insurance for about $300 a month but it won't cover much until they have spent about $8000. This varies by state of course.

(the first couple simple doctor appointments would be $20 or something, there is some basic care built into the monthly payments)

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

#68

Post by GiorgioG » Tue, May 23, 2017, 12:48 PM UTC

As much as I'm a proponent for free markets & lower taxes, I want universal healthcare in the US. When big pharma companies & hospital systems are forced to negotiate with the government for rates, costs will go down. My 5 year old's type 1 diabetes quarterly supplies are billed at $6,000 per shipment. Looking at what's in the box, I'm hard pressed to guess there's more than $100 of material costs. The technology has been around forever, and yet these companies continue to extort these exorbitant prices because nobody had said 'Enough!' Same story with a friend's Gleevec. $14,000 per month. It's time to put cost controls in place. If universal care is how that's achieved, then so be it.

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

#69

Post by wtbob » Tue, May 23, 2017, 1:25 PM UTC

threeseed wrote: post #35

wtbob wrote: post #21

Earlier quoted context omitted.

> 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. They also, of course, decrease other costs due to the deaths of the beneficiaries. Is that a net win or a net loss, financially speaking? And are you so sure of your analysis that you would use violence to take your fellow citizens' mon…

The scientists and public policy professionals who formulate these policies aren't doing this for a laugh. There are significant benefits to taxing things that make people sick. And these policies have been pioneered in other countries e.g. Australia first where they have been wildly successful in reducing overall health care cost.

I'm not arguing that they don't reduce health costs: I'm arguing that a) they increase other costs (e.g. old-age pensions, since people would live longer) and b) they are an unjust imposition of force in order to change private behaviour.

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

#70

Post by DanBC » Tue, May 23, 2017, 1:35 PM UTC

laurencerowe wrote: post #43

mtgx wrote: post #33

Earlier quoted context omitted.

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%.

http://visual.ons.gov.uk/how-does-uk-healthcare-spending-com...

> ONS’s new internationally-comparable “health accounts“1 show that the UK’s total healthcare spending in 2014 was £179 billion, or 9.9% of GDP.

> As a percentage of GDP, the UK spent less on healthcare than USA, Japan, France and Germany and a similar percentage to Canada. The USA spent the most on healthcare as a percentage of GDP at 16.6%.

And it's not all private insurance for the US. In 2014 the US government spent more than 8% GDP, compared to UKs just under 8%.

> Despite less than half of the USA’s total healthcare expenditure coming from government expenditure or compulsory insurance schemes, it still spends more per person on these financing schemes than the UK- £3,111 in the USA in 2014, compared with £2,210 in the UK. In the USA spending on privately-funded healthcare is over five times more per person than in the UK.

The US government spends more per person on healthcare than the UK, Canada, Italy, or the OECD average, and gets worse outcomes across a range of measures.