NY Senate Bill S5474 proposing a universal single payer health plan for NYers • Hacker News Board

Re: NY Senate Bill S5474 proposing a universal single payer health plan for NYers

#231

Post by omegaworks » Mon, May 09, 2022, 10:07 PM UTC

collegeburner wrote: post #192

toomuchtodo wrote: post #54

Earlier quoted context omitted.

Very broad strokes, doctors in the US are overpaid and conservatives legislated Medicare can't negotiate drug prices. Lots of room to drive down costs. Spending is high because of a dysfunctional system driven by profit instead of care. https://www.npr.org/sections/money/2019/03/12/702500408/are-... https://www.healthaffairs.org/doi/full/10.1377/hlthaff.2010.... https://www.bostonglobe.com/2021/10/25/opinion/let-medi…

We already have a shortage of doctors and it is very expensive to become a doctor. How will paying doctors less help this? We need to reduce requirements for becoming a doctor and have "tiers" so people who just do family doctor things only need to know family doctor things. Prescription drug spending is less than 20% of medicare. Negotiating prices might help but taking that 20% to 10% still leaves healthcare as a v…

We could forgive the school debt of existing doctors and pay the entire cost (with appropriate cost controls) of medical school for new doctors.

Re: NY Senate Bill S5474 proposing a universal single payer health plan for NYers

#232

Post by yazaddaruvala » Mon, May 09, 2022, 10:07 PM UTC

ceeplusplus wrote: post #183

mtalantikite wrote: post #77

Earlier quoted context omitted.

> If NY does this, the near zero chance of my moving there ever would go to absolute 0. Are they proposing kicking you off your insurance? From the bill: > SUMMARY OF SPECIFIC PROVISIONS: Every New York resident will be eligible to enroll, regardless of age, income, wealth, employment, or other status. There would be no network restrictions, deductibles, or co-pays. Coverage would be publicly funded. The benefits wil…

I read through the bill and there are no specifics written on how the entire thing is supposed to be funded, other than saying that payroll taxes will be increased to fund it. My guess is that once the numbers come out on how much tax would have to be paid that this bill would be dead.

Companies currently provide health insurance and pay per employee.

Per employee costs go up due to health care payroll taxes.

Per employee costs come down due to not paying for health insurance.

Overall, net-neutral cost to companies and simplifies health care payments for hospitals, clinics, etc so fewer employees to explain and collect payments so cost of care comes down. Seems like a win - win - win.

Re: NY Senate Bill S5474 proposing a universal single payer health plan for NYers

#233

Post by codefreeordie » Mon, May 09, 2022, 10:08 PM UTC

marricks wrote: post #217

codefreeordie wrote: post #131

Earlier quoted context omitted.

Actually, the median American has access to exceptional care. What is actually the case is that care available to the bottom quartile of Americans is below the care received on average in a top-tier universal care nation, and the US spends an absolute fortune delivering this quartile with substandard care. We also spend a bit more than average providing exceptional care to everyone else, except that we also spend a t…

Why do Americans always have to play a zero sum game with human lives. If a quarter of our country has the worst healthcare in the developed world that is unacceptable. Answers like this are just begging us to give up our humanity.

I have made no statements about how things should be. I have lots of opinions about how things should be, which I don't share on HN.

I was making statements about how things actually are, since no discussion about how to make the world we want is likely to be meaningful or useful if there is not a shared view of what is first.

Re: NY Senate Bill S5474 proposing a universal single payer health plan for NYers

#234

Post by DaveExeter » Mon, May 09, 2022, 10:08 PM UTC

akomtu wrote: post #76

lettergram wrote: post #41

Earlier quoted context omitted.

Probably because your company can negotiate and control the population characteristics (unlike the exchange). Or is self-insured, meaning they aren’t profit motivated. Insurance on average is always more expensive than not having insurance on average. The question is given that risk, how much of a premium can / will insurance companies take. Turns out they like high profits and low risk.

Are health insurance companies allowed to discriminate customers by their health status, that includes age? With a good deal of populace morbidly obese and not even bothering to exercise, it's expected that healthy 25 yo are going to pay crazy insurance payments. Corps, on the other hand, absolutely do discriminate by all sorts of characteristics and insurers know what they are signing up for. Offer health insurance…

> Offer health insurance tiers by age and BMI and watch premiums getting reasonable again

That's not the way health insurance works. The way it works it that the young and healthy are overcharged and that overcharge is given to the old and unhealthy.

Re: NY Senate Bill S5474 proposing a universal single payer health plan for NYers

#235

Post by bdzr » Mon, May 09, 2022, 10:08 PM UTC

mtalantikite wrote: post #77

goatcode wrote: post #46

Coming from a country that has this, there should be caution: it gets more affordable, but you get what you pay for. In my country of origin, you get a partially-paid-for ride to the emergency room, where you pay for things like casts, non-ward rooms, dental care out of pocket. There is no prescription coverage. There is no optometry coverage. I would wait significant chunks of a year for procedures and diagnostics.…

> If NY does this, the near zero chance of my moving there ever would go to absolute 0. Are they proposing kicking you off your insurance? From the bill: > SUMMARY OF SPECIFIC PROVISIONS: Every New York resident will be eligible to enroll, regardless of age, income, wealth, employment, or other status. There would be no network restrictions, deductibles, or co-pays. Coverage would be publicly funded. The benefits wil…

Network restrictions are dumb, but copays and deductibles serve a purpose. Healthcare isn't unlimited, and free services leads to long wait times because people don't reduce demand (e.g. going to the doctor for a stubbed toe). Certain specialities already have enormous wait times. You're in NY, try seeing a neurologist for a non-emergency. Given that an enormous amount of first appointments are "come back in a month if this is still bothering you" - copays need to exist. Patients have to have "skin in the game" as Andrew Yang would say.

Re: NY Senate Bill S5474 proposing a universal single payer health plan for NYers

#236

Post by ABCLAW » Mon, May 09, 2022, 10:09 PM UTC

hervature wrote: post #194

beebmam wrote: post #96

Earlier quoted context omitted.

That's 60% marginal rates. Last year I paid 17% of my total income in taxes.

I don't want to be rude, but if you paid 17%, that's basically the minimum income tax rate (10+4+3) for NYC. That's pretty far form the OP's "NYC high earners". Of course, if you got credits, that's orthogonal as normally those credits cost more than they are worth. For instance, the child credit is far from the cast of raising a child.

If you're a "high earner" there are a panoply of services that allow you to structure your income, wealth appreciation, or other forms of wealth generation in tax-optimized vehicles.

The tax universes at 200k/yr and 500k/yr-2m/yr income look very different.

Re: NY Senate Bill S5474 proposing a universal single payer health plan for NYers

#237

Post by exabrial » Mon, May 09, 2022, 10:09 PM UTC

I really want the government deciding what it considers "covered". Didn't get your Vaccine? Too bad, Democrats voted they won't cover your health care costs of a hospital visit. Unprotected Sex? Too bad, Republicans decided they won't cover your Plan B the next day. Your health choices are your business. Both sides have an agenda they will leverage and hold you hostage with.

Leave the government out of healthcare. They can't get make a functional driver license system, or a post office that doesn't dump billions of tons of C02 into the atmosphere delivering spam while being open between 11a-4pm, or run an airline security service like the TSA that actually stops threats and doesn't take away your Grandma's nail trimmers.

Re: NY Senate Bill S5474 proposing a universal single payer health plan for NYers

#238

Post by ceeplusplus » Mon, May 09, 2022, 10:09 PM UTC

yazaddaruvala wrote: post #232

ceeplusplus wrote: post #183

Earlier quoted context omitted.

I read through the bill and there are no specifics written on how the entire thing is supposed to be funded, other than saying that payroll taxes will be increased to fund it. My guess is that once the numbers come out on how much tax would have to be paid that this bill would be dead.

Companies currently provide health insurance and pay per employee. Per employee costs go up due to health care payroll taxes. Per employee costs come down due to not paying for health insurance. Overall, net-neutral cost to companies and simplifies health care payments for hospitals, clinics, etc so fewer employees to explain and collect payments so cost of care comes down. Seems like a win - win - win.

Health insurance is a constant cost per employee, effectively decreasing in percentage of income as income goes up. Payroll taxes scale up as your income goes up. So no, it's not net-neutral as it's highly redistributive. If single payer were implemented as a flat tax, then it would be net-neutral.

Re: NY Senate Bill S5474 proposing a universal single payer health plan for NYers

#239

Post by kmonsen » Mon, May 09, 2022, 10:09 PM UTC

aserdf wrote: post #30

it will be interesting to watch NY (and/or CA) put something like this in place and observe from afar. i strongly feel that states should be much more aggressive running policy experiments if their constituents desire them, and at the national level we all get some benefit of seeing how things turn out in real time. all that said, assuming there is some tangible tax increase, NYC high earners are going to be knocking…

This came up in the VOX in the weeds on healthcare policy some time ago. Their conclusion from the people that had looked into it is that it is sort of impossible for states to do this. Can't really remember the reasons.

There was another state that was trying something like this, I believe it was Vermont.

Re: NY Senate Bill S5474 proposing a universal single payer health plan for NYers

#240

Post by majormajor » Mon, May 09, 2022, 10:10 PM UTC

goatcode wrote: post #46

Coming from a country that has this, there should be caution: it gets more affordable, but you get what you pay for. In my country of origin, you get a partially-paid-for ride to the emergency room, where you pay for things like casts, non-ward rooms, dental care out of pocket. There is no prescription coverage. There is no optometry coverage. I would wait significant chunks of a year for procedures and diagnostics.…

The US spends more per capita than other countries on healthcare.

But that doesn't mean the US would have to pay less per capita in a single-payer system.

So we could keep getting what we pay for in terms of capacity, etc, if we want. You would expect a wealthy country to be able to pay a premium to get a premium.