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California's single-payer bill dies

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Re: California's single-payer bill dies

#41

Post by jefurii »

notch656a wrote: post #26
lotsofpulp wrote: post #25

Earlier quoted context omitted.

Population wide benefits without population wide taxing power will never work. Net benefit recipients will move in and net benefit payers will move out. Which is why healthcare (including mental healthcare), and homelessness/housing require a federal solution. I assume any non federal politician campaigning on taxpayer funded healthcare is just posturing for votes, because the math is never going to work out on a sta…

>Population wide benefits without population wide taxing power will never work. Net benefit recipients will move in and net benefit payers will move out. Taxing some or all of the middle/upper class to pay for healthcare of those who aren't paying taxes, is exactly this. Also California's tax burden is nearly double that of the least burdensome states. Clearly there's something more at play here than merely the fear…

It's untrue to say that lower classes are not paying taxes. They can't access the array of techniques the wealthy use to avoid paying their fair share. Undocumented people in particular pay into the system by having social security and other taxes deducted from their wages even though they will never be able to access the services because of their status.

Re: California's single-payer bill dies

#42

Post by lotsofpulp »

notch656a wrote: post #26
lotsofpulp wrote: post #25

Earlier quoted context omitted.

Population wide benefits without population wide taxing power will never work. Net benefit recipients will move in and net benefit payers will move out. Which is why healthcare (including mental healthcare), and homelessness/housing require a federal solution. I assume any non federal politician campaigning on taxpayer funded healthcare is just posturing for votes, because the math is never going to work out on a sta…

>Population wide benefits without population wide taxing power will never work. Net benefit recipients will move in and net benefit payers will move out. Taxing some or all of the middle/upper class to pay for healthcare of those who aren't paying taxes, is exactly this. Also California's tax burden is nearly double that of the least burdensome states. Clearly there's something more at play here than merely the fear…

The US federal government spends $766B for Medicare + $571B for Medicaid, a sum of $1.337T out of a total $6.011T that will be spent in 2022. This does not even include the healthcare spending of Tricare and other federal government employees' healthcare, and it does not account for things like deductibles and copays and insurance premiums.

https://www.thebalance.com/u-s-federal-budget-breakdown-3305...

And that is only for old people, (very) poor people, and employees of the federal government.

Paying for every person's healthcare within a given jurisdiction would blow a massive hole in governments' budgets that I would bet even people willing to pay extra CA taxes would notice, which are currently probably only 10% to 15% extra compared to other locales. Granted this increase would be offset by not needing to pay insurance premiums or Medicare tax, but in turn, that would be offset by the additional deductible/copay expenses, plus people simply getting more healthcare because they no longer have to worry about the cost.

Note that Vermont tried and called it quits after a couple years for the same reasons:

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

For one more data point, I recall how much consternation the Affordable Care Act caused, and that one merely allowed poor people to access SOME part of healthcare. The outcry over increased health insurance premiums (a proxy for taxes) because people would now be paying to subsidize old people and sick people was and is massive.

Re: California's single-payer bill dies

#43

Post by lotsofpulp »

pessimizer wrote: post #31
lotsofpulp wrote: post #25

Earlier quoted context omitted.

Population wide benefits without population wide taxing power will never work. Net benefit recipients will move in and net benefit payers will move out. Which is why healthcare (including mental healthcare), and homelessness/housing require a federal solution. I assume any non federal politician campaigning on taxpayer funded healthcare is just posturing for votes, because the math is never going to work out on a sta…

> Net benefit recipients will move in and net benefit payers will move out. The numbers don't bear this out. What we see is a bunch of anti-welfare state conservatives taking credit for poor people being gentrified out of desirable high-tax areas.

Current internal migration numbers are not representative of what would happen if a locale were to take on taxpayer funded healthcare.

The magnitude of comprehensive healthcare expenses would make other state and local level expenses pale in comparison. Even Vermont called it quits after a couple years due to inability to sufficiently increase taxes:

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

California is in a better spot than Vermont, of course, but I would not gamble on it being that much more desirable than elsewhere that people with the ability to move would be willing to pay an easily double digit percentage increase in taxes.

Re: California's single-payer bill dies

#44

Post by AnIdiotOnTheNet »

colechristensen wrote: post #11
bitwize wrote: post #6

Earlier quoted context omitted.

The American people want it. Powerful business lobbies ensure it gets blocked. Things like that are why the USA is not a democracy but a corporate oligarchy.

I’m an American person, I don’t want it. Just look towards how the VA or operated and how many problems people have it and tell me you want to force that experience on everyone. People want healthcare to be magically free, that’s not how it’ll be. People who now pay almost no taxes and choose not to buy health insurance because they can’t afford it and their other life choices will suddenly be taxed quite a lot for “…

> People who now pay almost no taxes and choose not to buy health insurance because they can’t afford it

I guess that's one way to phrase "are completely priced out of something guaranteed as a human right in pretty much every civilized country". A good friend of mine is in this situation, and I have a very low tolerance for the attitude of the "fuck poor people because I don't like taxes" crowd.

Re: California's single-payer bill dies

#45

Post by colechristensen »

pessimizer wrote: post #35
colechristensen wrote: post #18

Earlier quoted context omitted.

“responsibility to provide health care coverage for all” can mean lots of different things to survey respondents, and does not imply single payer, which is but one way of implementing this. I would also probably respond “yes” to this question, but there are indeed other solutions.

Not when you include the word "provide" . If you change it to "make accessible" or something else, something other than single-payer is possible. Government provision of health care coverage for all === single-payer.

Do you think people answering this question for this survey spent an incredible amount of time dissecting each word for the very specific implications of it's meaning?

Or did they think "government provide medicine, yay!"

People can really easily be manipulated by how surveys are presented and word patterns used. Survey results are weak arguments for how many people actually would agree with a certain outcome once they thoroughly understood it, especially when the only link between the outcome you're defending is a line about the specific implications about the word "provide".

Re: California's single-payer bill dies

#46

Post by actually_a_dog »

colechristensen wrote: post #37
actually_a_dog wrote: post #28

Earlier quoted context omitted.

I'm sorry, but that still does not make sense to me. The US (meaning really, the American people) is expected both to innovate and subsidize the world? Come on, now. If the US develops it, why shouldn't the US benefit the most? If prices keep going the way they have over the past 40 years, we're not going to be able to afford all these fancy treatments and drugs, anyway. Imagine a corporation developing a product, th…

Welcome to macroeconomics, free trade, globalization, and simple business strategy, topics which can't be adequately conveyed in a forum comment. Almost every product you buy benefits from the lower costs of labor and everything else in foreign economies in one way or another. The flip side is you generally have to lower your own prices to sell in those economies as well. You could try to keep prices constant globall…

This is not a sustainable phenomenon, though. Americans can't continue to pay an increasing portion of their income to healthcare while exporting the benefits to everyone else. That's simply absurd.

It's all right here: https://www.washingtonpost.com/business/2020/02/24/this-char...

You can't keep squeezing people for more and more and expect to get anywhere in a sustainable fashion. This is the road to collapse. What does macroeconomics say about that?

Re: California's single-payer bill dies

#47

Post by s1artibartfast »

actually_a_dog wrote: post #21
AniseAbyss wrote: post #5

Earlier quoted context omitted.

Extreme, but I have to admit I'm getting the popcorn ready for the next Presidential election. But if the American people literally don't want affordable healthcare that is their choice.

Bizarrely, 90% of Americans only favor Medicare for All if it means not abolishing private insurance: https://thehill.com/hilltv/what-americas-thinking/428958-pol... Yet, 94% of Medicare recipients "report being very satisfied or satisfied with the quality of their medical care": https://www.kff.org/report-section/medicare-covered-older-ad... At the same time, 19 out of 22 studies in a systematic review concluded tha…

>Yet, 94% of Medicare recipients "report being very satisfied or satisfied with the quality of their medical care

I think the part you are missing is that 83% of Medicare recipients have supplemental insurance to cover their medical needs. The recipients know specifically the scope of Medicare and what they would loose.

https://www.kff.org/medicare/issue-brief/a-snapshot-of-sourc...

Re: California's single-payer bill dies

#48

Post by actually_a_dog »

Axsuul wrote: post #38
actually_a_dog wrote: post #28

Earlier quoted context omitted.

I'm sorry, but that still does not make sense to me. The US (meaning really, the American people) is expected both to innovate and subsidize the world? Come on, now. If the US develops it, why shouldn't the US benefit the most? If prices keep going the way they have over the past 40 years, we're not going to be able to afford all these fancy treatments and drugs, anyway. Imagine a corporation developing a product, th…

The analogy that the people in the US are “employees” of pharm companies is the wrong analogy. There is no obligation here. Companies price discriminate all the time. It’s capitalism. I run a SaaS and offer lower pricing to businesses from lower cost countries. But it doesn’t mean I’m subsidizing costs thanks to richer countries. It’s so I’m not leaving money on the table.

Have you ever stopped to consider for even one second that maybe capitalism is the problem? That maybe there should be an obligation? As I said in my other comment, you can't keep squeezing people for more and more and more and expect it to be sustainable. What good are fancy new drugs and treatments when nobody can afford them, even with insurance?

Re: California's single-payer bill dies

#49

Post by colechristensen »

AnIdiotOnTheNet wrote: post #44
colechristensen wrote: post #11

Earlier quoted context omitted.

I’m an American person, I don’t want it. Just look towards how the VA or operated and how many problems people have it and tell me you want to force that experience on everyone. People want healthcare to be magically free, that’s not how it’ll be. People who now pay almost no taxes and choose not to buy health insurance because they can’t afford it and their other life choices will suddenly be taxed quite a lot for “…

> People who now pay almost no taxes and choose not to buy health insurance because they can’t afford it I guess that's one way to phrase "are completely priced out of something guaranteed as a human right in pretty much every civilized country". A good friend of mine is in this situation, and I have a very low tolerance for the attitude of the "fuck poor people because I don't like taxes" crowd.

It's market forces at work. When most people in a certain situation neglect a cost so they can afford everything else in their lives, everything else has a tendency to raise prices to eat up all of their income anyway.

It comes down to most people paying a lot of money for rent and not being able to afford other things like healthcare. Well rent is that high because enough people neglected to pay for healthcare that the competition for space made rent go up.

I live in a place where low income people have a whole lot of access though the state to get low or zero cost health insurance which is very good. My taxes pay for that and I have no problem with it.

A lot of the states that don't have such nice programs are largely run by parties strongly favored by the low income population so I'm not really sure this is my fault now.

People don't want these solutions, especially the political parties of the people who would benefit the most from single payer. If tried it will lose elections.

The things which could win elections are pragmatic measures to address the biggest cost excesses in medicine individually, but people are pretty dumb and tend not to rally for a large number of incremental improvements instead pretending that one big solution will definitely solve their problems and not just add new, different, and perhaps bigger ones.

Re: California's single-payer bill dies

#50

Post by s1artibartfast »

colechristensen wrote: post #20
toomuchtodo wrote: post #17

Earlier quoted context omitted.

No, the data showing Americans spend more on healthcare than every other OECD country with worse outcomes does that. https://www.harvardmagazine.com/2020/05/feature-forum-costli... https://www.kff.org/health-costs/issue-brief/americans-chall... https://insights.som.yale.edu/insights/why-is-healthcare-so-... Not even the wealthy get better healthcare with their dollars. https://astralcodexten.substack.com/p/highlights…

How many drugs, medical devices, etc. were developed in the US and are being sold to all of those OECD countries at a significant discount? If that pricing was forced on Americans as well, where would the now missing money come from? Is it a bunch of corporate fatcats getting rich or is the richest country in the world subsidizing the healthcare of the rest of the world? (I mean, probably both, but is your intention…

As a point of clarification, The issue is not limited to US based companies and development.

Many global healthcare developers also see a disproportionate part of their revenue coming from the US market/sales.

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