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California Considers Doubling Its Taxes

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221–230 of 363 posts

Re: California Considers Doubling Its Taxes

#221
post #34

Earlier quoted context omitted.

Why do you believe single-payer is a bad idea? The model works very well in most European countries.

I suppose you are joking. NHS in the UK has 6M folks on waiting lists for things like cataract surgery, knee replacements etc. The wait time is in range of 18 weeks for many and for 300K+ > 52 weeks. Private providers in the US will see you MUCH more quickly than one year (!!). Some place like Europe are not really single systems. They do work well though in a lot of ways. They will have statutory mandated and the pr…

> NHS in the UK has 6M folks on waiting lists for things like cataract surgery, knee replacements etc. The wait time is in range of 18 weeks for many and for 300K+ > 52 weeks.

The obvious question here (and I legitimately don't know the answer) is if there are a bunch of people who want knee surgery in the US but can't afford it, and so demand at the offered price is lower.

Fewer people being able to afford a procedure would generally mean less demand and shorter wait times, but its not clear that that's a preferred outcome at a population level.

Re: California Considers Doubling Its Taxes

#222

California has a golden goose in the wealthy megacorporations and billionaires who live there. Every tax that California adds risks killing that golden goose. Tesla has already left as highly publicized, but others are too. Apple is building a billion-dollar campus in Austin, Texas. Oracle has moved its headquarters to Texas.

> Apple is building a billion-dollar campus in Austin, Texas That they're already seriously regretting doing now that the promises of the remote economy are starting to be truly realized and the pandemic shows no end in sight. Billion dollar campuses are worth $0 in a fully remote economy. Turn them all into high quality public housing and move on. The office is dead.

In which case, if I'm a business, why am I in California again? Why pay their taxes? Time to move out (if that's true).

Re: California Considers Doubling Its Taxes

#223

As a taxpayer I don't actually have a problem with this. However, as a California resident who has seen this state's inability to think through regulations effectively or solve housing problems, I'm incredibly skeptical of California's ability to implement single payer healthcare effectively. I would likely leave the state because I assume California would fail to deliver, and taxes would get raised for nothing.

Exactly - no doctor who has his crap together is going to accept the government's insurance. Medicare has the same problem. My mother many times can't find a decent doctor that accepts Medicare and when she does, they take so few appointments it takes weeks to get seen whenever an issue pops up.

> Exactly - no doctor who has his crap together is going to accept the government's insurance.

Isn't the whole point of a single payer system putting and end to this madness? You no longer need to worry about a doctor accepting your insurance, because there's only one insurance, and everybody accepts it. (You can still buy additional insurances if you're worried about a medical disaster, but that's a separate concern.)

Re: California Considers Doubling Its Taxes

#225
post #93

> to fund a first-in-the-nation single-payer health-care system. This is key here. So instead of paying this out to a private insurance company I pay it in taxes, there by my actual change is net zero, in most cases. I have a feeling most reactions might be headline driven here. I think it’s worth doing the math on how much it costs you in healthcare coverage before really judging a book by its cover here. If my comp…

Yeah, the headline could easily be flipped with the subheading and most people's reaction would be drastically different. Overall I think a single-payer system is for the best. Having healthcare tied to your job creates another anchor to keep people tied to large, stable companies instead of taking risks with startups or small businesses. The main downside is that companies have started doing tiered healthcare costs…

> Having income tax based on your weight or smoking status is probably a non-starter

Australia has very high taxes on cigarettes mainly because they want to keep their (universal) healthcare costs down. They could do the same thing to sugary snacks as well, even the conservatives would get onboard if it was to save money on healthcare expenditures.

Re: California Considers Doubling Its Taxes

#226

Earlier quoted context omitted.

It’s the preexisting injury part that jacked up the prices. They aren’t allowed to deny enrollment or charge significantly higher premiums if some was has cancer or something. And that totally makes sense morally, but that causes the risk burden to be offset on the aggregate of the subscribers resulting in higher premiums for everyone. It would be kind of similar to forcing auto insurance carriers to afford coverage…

I've NEVER seen an employee denied (or asked) about their medical conditions ever. The enrollment paperwork to the carrier is like basic address / name / effective date for coverage. That is it.

And before ACA, the prospective employee would normally have to show evidence of continuous creditable coverage before being added to the new employer group plan. This is how pre-existing conditions were handled - if you had always had coverage, OK, but if you went uninsured for a while and then tried to re-join a group, tough luck.

Re: California Considers Doubling Its Taxes

#227

If this happens, I will most certainly leave the state. I mean this is ridiculous. These people have consistently shown that their ability to spend our tax dollars is literal dog shit. People and companies are leaving the state in droves. And their response is to literally double taxes?

The state tax and the health insurance payment are both line items on my paycheck deductions, right next to each other.

If the latter goes to zero and the former goes up, that's not actually doubling my deductions, despite the hyperbolic headline.

Re: California Considers Doubling Its Taxes

#228

Earlier quoted context omitted.

Some system to earn tax credits if you can prove that you lead a healthy lifestyle. Maybe verified by the doctors in the unified health system.

A sugar tax will accomplish a lot and is much easier.

Yeah I was going to say this. If you want smokers and the obese to partially fund their own healthcare, you can very easily slap taxes on cigarettes and soft drinks, earmark that money to go to insurance, and call it a day.

Re: California Considers Doubling Its Taxes

#229
post #34

I do not believe single-payer is a good idea, but then lots of people DO seem to think it is, and the state is probably the best level at which to conduct an experiment this way. As a Californian, I'll be happy to see the experiment conducted, sad that it happens in my state, and excited to be a guinea pig. My only hope if we do this is that the federal govt or other states do not leap quickly into this and give it a…

Why do you believe single-payer is a bad idea? The model works very well in most European countries.

Not OP, but I'll answer.

Switching to a single-payer will be too costly for any political party to tolerate. The US spends $3.8T on health care per year. That's $11,500 for every single person in the United States.

In order to fund (raise taxes) to a single-payer system that number will need to drop dramatically. We'll have to cut out middlemen, reduce bureaucracy, negotiate domestically, etc. That $11.5k needs to drop to about $6k to be on the upper quintile of health spending per capita compared to other, successful, single-payer systems. That brings the total from $3.8T down to $1.98T.

...but therein lies the problem. The health sector is 18% of the economy and employs 14% of all US workers. You can't quickly pull $1.8T out of a single sector of the economy. Would it stabilize to 9% of the economy and 7% of all US workers? What do all those people (7% of all workers) who previously worked in health care go do? Where does that $1.8T that we used to spent show up?

So it's a conundrum. You need to slowly reshape the industry over 10-20 years and carefully manage the outcomes or it's an economic and political disaster. However, the only way for that gradual plan to work is if you raise taxes to fund the $5T that it would take to maintain status quo. ...and good luck with that. The total net worth of all the billionaires in the US is $5T. There isn't a tax rate in the world that could raise that kind of revenue.

Vermont tried to implement a single-payer system, did their own analysis of what it would take, and decided not to move forward.[0]

So it's not that I oppose single-payer in theory, I just oppose it as policy in the US because I see it as a political impossibility that is in the way of realistic reform. To me it's chasing a perfect outcome when there are good outcomes available.

[0]:https://www.vox.com/2014/12/22/7427117/single-payer-vermont-...

Re: California Considers Doubling Its Taxes

#230
post #206

Earlier quoted context omitted.

This is my thought, as well. When your private insurance company stinks, you find a new insurer. When you're forced to pay the government for health insurance, you're stuck without options. Health insurance isn't one of the services that I trust the government to be able to run well. They don't have a particularly great track record where efficiency, customer service, and speed are concerned.

> This is my thought, as well. When your private insurance company stinks, you find a new insurer. You can't, because the health insurance is provided by your employes so you get whatever they give you. My health insurance (blue shield) is absolutely terrible (right now I need some medicine they refuse to let me have because it cuts into their profit margins) but there's nothing I can do about it. And that's after pa…

Sorry to hear that. My experience with government insurance has been with Medicare, Medicaid, and the VA, and to say I've been unimpressed is an understatement.

I guess I should be thankful my insurance is ~$1000/mo, and hasn't left me with the horror stories some seem to experience.

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