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

nysenate.gov

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

#361

Post by mattmcknight »

criddell wrote: post #91
version_five wrote: post #74

Earlier quoted context omitted.

Would healthcare overall in e.g New York be equivalent though? In Canada, we have "free" healthcare but literally have no other option so it's the Soviet style mess you'd expect a government monopoly to be. But would this bar paid healthcare? Couldn't people still have health insurance and get private care? Is there something preventing that?

I’m a Canadian living and working in the US and I’d take the Canadian system any day of the week. I think it’s crazy that your access to healthcare is dependent on your employment.

It's not though. We have have ACA plans you get independent of employment and Medicaid for the unemployed.

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

#362

Post by frozenport »

space_fountain wrote: post #78
frozenport wrote: post #64

Earlier quoted context omitted.

>> but you get what you pay for. Americans are already paying more than most places for healthcare but not getting a good return.

Is this true even for individuals? I think one version of the problem might be that we pay too little for some peoples healthcare and too much for others, but do the people who pay the most still end up with worse results?

The same procedure costs magnitudes more in the USA. It is true for everybody.

An adjacent issue is that certain groups don't receive preventive care due to financial issues leading to increased long term costs.

But note, even in all cases we're paying way too much.

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

#363

Post by pkt_nspktr »

jmyeet wrote: post #348

Cue the Republican challenge arguing the state has exceeded its authority and this is a Federal issue (just like how Ajit Pai removed net neutrality saying it wasn't a Federal issue but then turned around and challenged California's net neutrality as being within the FCC's authority). As for the NY bill, I'll be interested to see what this looks like. There are many variations on single-payer. For example, the NHS in…

Data point of n=1: I think this effort by NY is exactly where the experiment of single-payer health care in the United States should occur, as per the 10th Amendment. According to Third Way[1], (which advocates for federal-level universal healthcare), three other states which have tried single-payer health care have ended up discontinuing their programs: Colorado, Massachusetts, and Vermont. Perhaps New York has identified where those states have failed and its proposal will address those shortcomings.

[1] https://www.thirdway.org/report/single-payer-health-care-a-t...

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

#364

Post by [deleted] »

charrondev wrote: post #322
jrodthree24 wrote: post #228

Earlier quoted context omitted.

Probably depends what you mean by high income. I think someone making 100k will not pay that much and that is considered high in a lot of places. But I am not sure that is considered high in NYC. High is probably more like 150k - 200k+ and that still wont be anywhere near 60%. I do get to ~40% when you add up federal, state and city. I don't think anyone is really looking at an actual 60%. Maybe 50% if you're making…

I’m in Quebec so I paid 29% on everything over 66k to federal and my provincial rates were 20% (over 50k), 26% (over 100k), and 29% (over 150k). We also have a 15% sales tax. I paid more than a 50% effective rate last year. This is the cost of our social safety net. It feels like too much too me and I’ll be relocating next year.

[deleted]

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

#365

Post by et2o »

inferiorhuman wrote: post #354
et2o wrote: post #285

I’m an MD who trained in NYC. I have also had emergency surgery in the NHS at one of their most prestigious hospitals in London and so I feel like I’ve seen the system a little bit from the inside. It was far cheaper for me than it would have been as a Brit in the USA, but the standard of care was lower. They didn’t have some technical and staffing resources late in the afternoon that would be a baseline in any of th…

As a not doctor I don't understand this: > It will likely strain these systems even further, as reimbursements from Medicaid/Medicaid are insufficient to run large health systems which depend on higher rates from private insurers Time ran an article a few years ago about hospital billing and whatnot. One of the things that they pointed out was that Medicare reimbursement rates were based on the actual cost to provide…

1. It’s just a fact that if all reimbursement was currently Medicare-level, the existing hospital systems in NYC would run a massive deficit and couldn’t provide the services they do now. They wouldn’t be in business barring massive reductions in staffing, hours, services, salaries, etc.

I don’t know what you read in the NYT but this is well-known in healthcare. Hospitals lose money on Medicaid/Medicare patients in general and make it up on private insurance (also in general) in order to hopefully pull in a surplus each year. Look up the idea of “payor mix.” Private insurance reimbursement varies widely but is typically a multiple of Medicare/Medicaid.

2. Yes - it is already happening. I think it would likely get worse. I don’t think single payer insurance is going to cause a renaissance of PCPs, especially if the overall reimbursement for that kind of service goes down. Probably the other direction. Maybe I’m wrong.

3. I’m not exactly sure what happened at UCSF with your ultrasound. Not familiar with SF really. But you can look up mean wait time for most elective procedures in the USA vs. Canada or USA vs. the UK. Or access to new therapies.

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

#366

Post by version_five »

codefreeordie wrote: post #135
KoftaBob wrote: post #90

Earlier quoted context omitted.

This bill doesn't ban private insurance, it does however have this rule: "Private insurance that duplicates benefits offered under New York Health could not be offered to New York residents." So in other words, private insurances can only be offered if they provide benefits that surpass whatever the public option has. I imagine that private insurances will logically offer more benefits regardless, otherwise why would…

that will mean, though, that it will be impossible to get insurance to actually cover the things that the public system "covers" if you wait 35,600 years for your turn

Don't know why you were modded down (well I do but I don't want to start a fight), this is exactly how it works in Canada. I know people who have been told to wait years for tests or consultations. Those who can afford it go to the US.

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

#367

Post by oneoff786 »

buescher wrote: post #267
oneoff786 wrote: post #226

Earlier quoted context omitted.

Isn’t this sort of guaranteed to fail? High earners already have great insurance from employers. There’s not likely to be a mechanism to get those benefits back as dollars like you would expect in a national scale steady state system.

Somehow they have private insurance in Europe too. Germany has universal health care and you are well advised to get private insurance if you make enough that the state will allow you to buy it. The threshold is a salary of about $68K/year in US dollars.

That’s not what I’m saying. The norm is that a fairly substantial part of your comp in the US is healthcare provided by your employer. If this suddenly becomes worthless (or rather much less valuable because there’s a single payer system in parallel) but your salary stays the same while your taxes go up, you will lose out big time.

It could work just fine if everyone did it. But seems very hard to do just Ny.

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

#368

Post by paulmd »

prepend wrote: post #287
jonathankoren wrote: post #189

Earlier quoted context omitted.

By that logic, no one pays taxes except consumers.

I mean you’re sort of right. There’s no such thing as a free lunch. So stuff is all ultimately paid by the consumer since that’s the end of the line. There’s really no way to increase taxes without impacting consumers. Unless you try to limit rents, but then you have other problems with people not wanting to invest in apartment buildings.

That assertion depends on an efficient market though, and that is provably not true - the existence of corporate profits demonstrates this, because in an efficient market everyone makes 0 profit, and any rent-seeking will cause every single one of your customers to flee to a competitor who doesn't rent-seek. Everyone has to price as aggressively as possible given the costs, or lose customers to someone who does, and that means zero profit above the actual cost of production/service.

In a world where corporations make profits, some competitors choose to eat the taxes and retain customers, while others may increase prices and lose some customers, and some customers may eat the increased price and remain even though they're getting a worse deal than before. This is the concept of "consumer surplus" vs "producer surplus", and taxes are cutting into those surpluses differently depending on the specifics of each market participant.

All of this has been debated endlessly by economists, in terms of just how much of corporate taxes get passed along to consumers and so on. And the answer seems to be "not zero, and not 100% either", and everything beyond that is up for debate. So no, not "everything is ultimately paid by the consumer", that is the 100% answer and that's pretty clearly wrong in a market where producer-surplus exists.

In reality, real-estate and rents are probably one of the least-efficient markets imaginable. The frictional costs to buying and selling property, and finding a new tenant who might be a problem/deadbeat/etc, or spending a bunch of time apartment-shopping, picking up your life and packing your stuff, and moving, are immense, and all parties involved are highly emotionally invested as well. Landlords are trying to make a long-term calculation about whether the property is going to appreciate - even if they are losing money today, if they expect to make capital gains in the long term it could be worth it. And all parties are operating with minimal information. Out of all the markets in the world, real-estate and rental living spaces are probably one of the least efficient possible.

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

#369

Post by barry-cotter »

AnIdiotOnTheNet wrote: post #220
listless wrote: post #164

Earlier quoted context omitted.

I’m a landlord and yes it is. My taxes doubled last year because of the stupid housing bubble and so we had to raise rent as well. Gotta make a profit here for this investment to be worthwhile.

Maybe if people didn't buy property they don't live in as an investment then things like the stupid housing bubble might not happen in the first place. Personally I think owning a residence you don't actually live in should just straight up be illegal, but I'm admittedly pretty radical about parts of the system that seem to exist solely to make the rich richer.

> Maybe if people didn't buy property they don't live in as an investment then things like the stupid housing bubble might not happen in the first place.

Sure would be awful for a rental market to exist. Without rental there’d be only be home owners and homeless and that is clearly a better world.

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

#370

Post by paulmd »

kmonsen wrote: post #239
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.

> 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.

adverse selection is the usual objection raised. If you can live in Montana while you're healthy, and move to New York when you're sick, then New York effectively becomes the dumping ground for the nation's sick and ends up picking up a hugely disproportionate amount of the tab without the revenue base to make it up.

That said, since coastal states make up a disproportionate amount of the economic activity anyway... they may be able to power through it, especially if they can all get onboard with it at the same time. It's not like de-facto cash transfers to the poorer "heartland" states are a new thing in the US.

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