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California Considers Doubling Its Taxes

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Re: California Considers Doubling Its Taxes

#281

Post by mike00632 »

jamestimmins wrote: post #14

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.

Medical, the state's public option for lower income people is amazing, so I think your skepticism is misplaced

Re: California Considers Doubling Its Taxes

#282

Post by aaomidi »

pintxo wrote: post #202
sokoloff wrote: post #175

Earlier quoted context omitted.

> Germany has more ICU beds than the US. That would be shocking if true, which it does not appear to be. Germany has around 32K ICU beds. US has around 96K ICU beds. Germany has slightly more per-capita than the US. (387 vs 294 per million inhabitants) https://en.wikipedia.org/wiki/List_of_countries_by_hospital_...

your "slightly" is a 30% difference ...

30%. which is the difference between hospitals shutting down vs hospitals being able to treat patients normally during times like this.

Not sure what the original poster is talking about, but America's healthcare system is fucked. And it's not just fucked because it's expensive.

Re: California Considers Doubling Its Taxes

#283

Post by larkost »

Justin_K wrote: post #219
uberman wrote: post #170

California would increase taxes by $12,250 per household Let's take it at face value this is fact. For my healthcare plan I pay 6k a year on top of what the company pays (more that 20k). Then I pay copays on top of that. It seems perfectly plausible to me that I would come out ahead if the company and I switched from paying about 30k a year in healthcare costs to a single payer system with only 20k a year in costs to…

Also think about how providers won't accept lower rates, so your new discount plan will only give you access to bottom of the barrel providers willing to take any patient at any price.

You are forgetting that insurance companies are a middleman eating up some of the costs, both as profits and as costs. It is a slightly unfair comparison (Medicare has more older people who have large single-issue costs, so less admin work), but Medicare costs about 2% of its costs in administrative costs. Whereas private insurance usually is more like 12%-18%.

There are a lot of details in that to sort, and no-one expects a final single-payer system to wind up quite as good as Medicare is... but there is a lot of fat to trim off the private insurance system.

And note please: we are only talking about admin fees (salaries and the like for people working there), this has nothing to do with the actual costs of care. If anything this is unfair against Medicare, since they are ruthless in negotiating their actual costs (something private insurance is not really incentivized to do at all).

Re: California Considers Doubling Its Taxes

#284

Post by devmunchies »

jjav wrote: post #211
devmunchies wrote: post #51

Earlier quoted context omitted.

I hope Kaiser Permanente lobbies this or we can opt out. I've lived in many states and my exp with Kaiser in California is among the best. I don't see the state (especially bloated California) doing better. (I pay out of pocket via a side business, not from my current employer.)

Kaiser posted $3B in profits in a quarter. All that money is overhead that can be removed from the costs if health care didn't have to funnel through a private company taking profits from it. https://www.fiercehealthcare.com/hospitals/kaiser-permanente...

Yeah but from an operational POV you should factor in competition, efficiency, etc into overhead and profits. I don’t believe the state would be as concerned about keeping out bloat, so it would accrue a different kind of overhead.

Re: California Considers Doubling Its Taxes

#285

Post by omgwtfbyobbq »

commandlinefan wrote: post #121
omgwtfbyobbq wrote: post #92

Earlier quoted context omitted.

They tried to try it, but there were too many hurdles so they abandoned it. California could be the same, but there are benefits it has the Vermont didn't, as well as a significantly larger number of people to negotiate on behalf of. >As with any attempt to dismantle one American health-care system and replace it with another, Green Mountain Care was always going to be a long game. For starters, it would not be until…

> so they abandoned it Did they repeal the tax increase?

There wasn't a tax increase to repeal.

https://en.wikipedia.org/wiki/Vermont_health_care_reform

Re: California Considers Doubling Its Taxes

#286

Post by nomendos »

Maarten88 wrote: post #196
nomendos wrote: post #162

I am US Citizen living in CA, while also have lived (and am citizen) of other 3 countries, Canada as one prior to US. To remind all, Michael Moore's Sicko documentary is huge misrepresentation of how good socialized HC is, while it did point huge issues with the current privatized/greed-based private US HC with crooked HC+insurance industry. So as not all is BW, from my experience with Canadian HC, socialization of t…

> socialization of the health-care system shall produce the following [...] It should also produce better health outcomes for the people living there. Maybe you have a well-paid job and good insurance plan, and can enjoy good healthcare now, but that is not the case for many others and can change for you if you are unlucky. Even a very poor country like Cuba has higher life expectancy than the US. Most developed coun…

We can moralize 2nd but fundament is always numbers.

To remind ~150K earners pay ~50% of CA taxes.

Let that sit in your mind 1st, then ask yourself if ~1/2 of those flee to where it is better for them, the effect is and can only be either or both; worsening of health care and/or further raising the taxes. This is known effect that happens. Major HighTech companies are disincentivized and are already taking difficult decision. The question is when the avalanche effect happens? If it happens or if it is gradual race to the socialist bottom, then you can moralize 'til the cows come home, but guess what they won't be coming back.

Silicon Valley CAN become Detroit and it is already on initial phases of the path in that direction, although still far. Capacity of derangement of the CA government is not yet reached and ~70% Blue is not making any constructive dialogue to balance things here.

I am high earner and for a while I can bear still ok health care here and then I could enjoy early retirement (i.e. freedom 55) with this new socialized HC while it is still "ok". After a while I guarantee it will go worse and even I will be forced to re-evaluate and possibly move.

Re: California Considers Doubling Its Taxes

#287

Post by yongjik »

Justin_K wrote: post #244
yongjik wrote: post #223

Earlier quoted context omitted.

> 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…

Do you think an entire industry is going to let a dysfunctional, bureaucratic government to dictate what their rates are? There will always be a market for better care to the highest bidder.

Way to load your question, as if the entire US health insurance industry is not already dysfunctional and bureaucratic ...

But to answer your question, sure, there will be always a market for the select few for whom money isn't a concern. The difference is that, under a single-payer system, you don't have to worry about it: just find a doctor at Yelp, or let the ambulance drive to the nearest hospital, and your doctor and your hospital is covered. You will intentionally have to go out of your way to find your boutique doctor who doesn't accept "dysfunctional government insurance."

This is very important, because when your kid is bleeding inside an ambulance your concern shouldn't be "Wait but does this hospital accept my insurance?" You have a bigger problem to worry about.

Re: California Considers Doubling Its Taxes

#288

Post by jjav »

jimbob45 wrote: post #242
jjav wrote: post #206

Earlier quoted context omitted.

> 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…

>You can't, because the health insurance is provided by your employees so you get whatever they give you. That's not true, is it? You could decline coverage and then go purchase a policy of your own elsewhere. Yes, that might be expensive but the original claim was "Y'all actually have one of the best systems in the world, it's just way too expensive." and that still tracks. Even better, you could purchase a policy t…

> That's not true, is it? You could decline coverage and then go purchase a policy of your own elsewhere.

What other choices exist, there's only a few giant insurers anyway.

> Even better, you could purchase a policy through the Obamacare exchanges.

I have no direct experience, would love to be wrong, but what I've heard is that even the top-tier plans are extremely limited in what they cover and where they are accepted so it's even worse than company-provided plans.

Re: California Considers Doubling Its Taxes

#289

Post by larkost »

john_moscow wrote: post #116

So, we are not building new hospitals, not creating new ICU beds, not investing into more medical programs at universities (or making them more affordable), not cracking down on opaque pricing and exponentially growing hospital administration. Instead we are introducing another bureaucratic layer to manage access to an extremely limited resource that has not been keeping up with the increasing population. What could…

This would not be creating another bureaucratic layer. It would be replacing the portion of the system that is currently a private bureaucratic layer (insurance companies), and replacing it by expanding (and modifying) the existing governmental bureaucratic layer.

If you don't like the switch from private bureaucrats to public bureaucrats then please state that and make your argument why. Don't pretend the private ones don't exist.

Re: California Considers Doubling Its Taxes

#290

Post by jjav »

salawat wrote: post #259
jjav wrote: post #206

Earlier quoted context omitted.

> 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…

Blue Shield is notorious for not paying out enough of premiums for care. If you're having issues though, figure out who your PBM. (Pharmacy Benefits Manager) is that Blue Shield is contracting the pharmacy adjudication out to. Basically, get in contact with them, try and get an override, or get them to explain why you are not covered. If it isn't in the formulary your employer opted into, you're hosed; but there is u…

Thanks for the tips, it is very exhausting to fight these.

> Also remember: You can pay out of pocket, but you'll be at the whims of that pharmacy. They'll generally help you work through coupons.

I did ask, but it was nearly $1K/week so can't afford that.

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