Healthy California Act: proposal to make findings about single-payer healthcare • Hacker News Board

Re: Healthy California Act: proposal to make findings about single-payer healthcare

#221

Post by hkmurakami » Thu, Mar 09, 2017, 1:36 AM UTC

pvelagal wrote: post #179

TheSageMage wrote: post #57

Earlier quoted context omitted.

I'm very new to the single-payer idea, but Vermont rates 49th for population in the US, California ranks 1st. I thought one of the strengths of a single-payer system was to leverage the power of large numbers to help drive costs down. Would this not make it more viable?

I have an common sense observation and questions. Apple, Microsoft etc you name it, all get their hardware products manufactured in china & Asian countries mainly to drive down costs (People blame CEOs but really ? do they have a choice ? Will wall street show mercy on them ? It is easy to forget that US consumers are the primary beneficiaries, and Wall street is happy - means - 401ks, IRAs of regular US citizens gro…

Your conflating cost based pricing and market based pricing.

None of the players above (including apple) engage in cost based pricing. They all charge the price that maximizes their profits, not the price that sells the most units while breaking even.

Re: Healthy California Act: proposal to make findings about single-payer healthcare

#222

Post by some-guy » Thu, Mar 09, 2017, 1:36 AM UTC

FT_intern wrote: post #126

amluto wrote: post #68

Earlier quoted context omitted.

By giving them healthcare? There aren't actually a large number of illegal immigrants sitting around contributing nothing to the CA economy.

I did a quick search and an estimated 11 million illegal immigrants pay an estimated $11.6 billion in taxes, so $1,000 per person. It's a huge net loss. Not to mention the fallout from stolen SSNs and creating demand for stolen SSNs

When I worked a minimum wage job after high school full time I paid zero in taxes, and I'm a citizen.

Re: Healthy California Act: proposal to make findings about single-payer healthcare

#223

Post by stale2002 » Thu, Mar 09, 2017, 1:36 AM UTC

mmanfrin wrote: post #64

gavman wrote: post #32

Vermont tried this a few years ago, they had to cancel it since in the end it wasn't financially feasible [1]. CA is already dealing with severe budget issues [2][3], so while it sounds nice in theory I'm hesitant to believe the finances actually work out. [1] http://www.politico.com/story/2014/12/single-payer-vermont-1... [2] http://www.latimes.com/projects/la-me-pension-crisis-davis-d... [3] http://www.cnbc.com/201…

[2] is about CalPERS, which is separate from the budget of the State. There may be a current budget shortfall, but CalPERS is fine (it is the largest non-country pension fund in the world; and comes in the top 10 when listed among countries). [3] mentions that tax revenues will fall because of the end of temporary tax increases; those increases are likely to be renewed. Categorizing these as 'severe budget issues' is…

Uhh, no thanks. I'd rather be able to decide for myself what healthcare I buy, instead of being forced into a substandard single payer system.

Ok, fine, create a public option. But don't force me to buy it. Let me buy my own healthcare.

Re: Healthy California Act: proposal to make findings about single-payer healthcare

#224

Post by mahyarm » Thu, Mar 09, 2017, 1:37 AM UTC

stvswn wrote: post #122

mahyarm wrote: post #110

Earlier quoted context omitted.

Your workplace probably pays $500/month for your health insurance. If the employer has to stop paying that and you pay $500/month in taxes instead, it will be about break even anyway. Or even less, since I more forsee a %1-%2 tax increase vs. the current %4-6+ tax that is health insurance.

I think you're assuming that there won't be over-the-top optional healthcare that we'd all (as in, people w/ good insurance at the moment) have to buy in order to meet the same quality we currently have.

Just going by my experience in Canada, most people don't buy too much extra. You still have to get dental & vision although, but the costs for that are minor. Many don't buy any health insurance at all.

Re: Healthy California Act: proposal to make findings about single-payer healthcare

#225

Post by stanleydrew » Thu, Mar 09, 2017, 1:37 AM UTC

mindcrime wrote: post #175

so should the government force those people to spend their earned income on healthcare for others? Absolutely not. Pretty much any question that starts with "should the government force ..." can be answered "no". You earned your income, it's yours and it should be up to you how to spend it. Using force / aggression (aka the government forcing you to do something) is a violation of your most fundamental rights, and st…

> the truth is that nobody is in a better position to determine how your income should be spent than you

This may be unpopular to say, but this is pretty demonstrably false.

Perhaps you've not heard of the free rider problem?

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

Re: Healthy California Act: proposal to make findings about single-payer healthcare

#226

Post by chimeracoder » Thu, Mar 09, 2017, 1:37 AM UTC

notliketherest wrote: post #134

rdmcfee wrote: post #72

A single payer system is a step in the right direction, however, there are deeper issues with the American healthcare system. The unit cost of healthcare is so much higher than in other developed countries. In British Columbia, physicians bill at total of around $31 CAD ($23 USD) for a standard office visit. They pay all their overhead out of this fee. Typically doctors keep 65% of their billings and the offices take…

It's the insurance companies dance with the healthcare providers. Over many decades, the insurance companies have negotiated payments much less than the quoted payment. In turn, the healthcare providers raise their rates in order to make sure they can still make money even with the discount they give insurance. When the time comes for the insurance companies to renegotiate, the same thing happens, and the healthcare…

> ver many decades, the insurance companies have negotiated payments much less than the quoted payment. In turn, the healthcare providers raise their rates in order to make sure they can still make money even with the discount they give insurance. When the time comes for the insurance companies to renegotiate, the same thing happens, and the healthcare providers raise their rates. This works fine for those of us who have insurance, but for non insured individuals, they have to pay the "actual" rate - which has been inflated because of the insurance company discount! This has been going on for many decades

This is close to correct, but a subtle correction:

Medicare and Medicaid set their reimbursement rates by fiat, and providers have essentially no ability to negotiate those. Except in critical access areas, Medicare actually reimburses much less than the marginal costs of care for its patients (7% in the aggregate). As a result, providers present very large bills to everyone else (privately insured and uninsured patients) to make up for this loss - you can't stay in business if you're literally making a loss on every patient! Uninsured patients see the large bill and assume they have to pay the entire amount (they don't!), and private insurers end up negotiating that down to some multiple of what Medicare pays.

A typical insurer will negotiate an agreement like, "we'll pay 350% of what Medicare pays for this category of services".

Re: Healthy California Act: proposal to make findings about single-payer healthcare

#227

Post by gnopgnip » Thu, Mar 09, 2017, 1:37 AM UTC

gavman wrote: post #95

mmanfrin wrote: post #64

Earlier quoted context omitted.

[2] is about CalPERS, which is separate from the budget of the State. There may be a current budget shortfall, but CalPERS is fine (it is the largest non-country pension fund in the world; and comes in the top 10 when listed among countries). [3] mentions that tax revenues will fall because of the end of temporary tax increases; those increases are likely to be renewed. Categorizing these as 'severe budget issues' is…

Thanks for the details regarding the budget, I didn't realize the pension budget shortfall was separate from the state budget. In that case stupid question: if CalPERS owes much more than it can afford to pay, where is the rest coming from? The LA Times article, in multiple places, talks about how much the shortage will cost the "taxpayers" (see quote below for example), how is this not related to the CA budget which…

They will either have to increase contributions or cut payments to future retirees.

Re: Healthy California Act: proposal to make findings about single-payer healthcare

#228

Post by intopieces » Thu, Mar 09, 2017, 1:37 AM UTC

mmanfrin wrote: post #64

gavman wrote: post #32

Vermont tried this a few years ago, they had to cancel it since in the end it wasn't financially feasible [1]. CA is already dealing with severe budget issues [2][3], so while it sounds nice in theory I'm hesitant to believe the finances actually work out. [1] http://www.politico.com/story/2014/12/single-payer-vermont-1... [2] http://www.latimes.com/projects/la-me-pension-crisis-davis-d... [3] http://www.cnbc.com/201…

[2] is about CalPERS, which is separate from the budget of the State. There may be a current budget shortfall, but CalPERS is fine (it is the largest non-country pension fund in the world; and comes in the top 10 when listed among countries). [3] mentions that tax revenues will fall because of the end of temporary tax increases; those increases are likely to be renewed. Categorizing these as 'severe budget issues' is…

>I'm sure as shit happy to pay more in taxes for a universal single single-payer.

As someone who just climbed out of being a contractor and into a full time position, I concur. Raise my taxes for this. Please do it, and do it soon.

Re: Healthy California Act: proposal to make findings about single-payer healthcare

#229

Post by nickff » Thu, Mar 09, 2017, 1:38 AM UTC

hprotagonist wrote: post #212

nickff wrote: post #208

The problems with your last argument are that almost nobody is actually a utilitarian, and utilitarianism is wrong.[1][2][3] edit: full disclosure; I am an ethical intuitionist.[4] [1] http://degreesofclarity.com/writing/utilitarianism/ [2] https://en.wikipedia.org/wiki/Trolley_problem [3] https://en.wikipedia.org/wiki/Utilitarianism#Criticisms [4] https://en.wikipedia.org/wiki/Ethical_intuitionism

But it sounds good to sell it to the "fiscal conservatives". I am not a utilitarian, but nobody likes to be hectored into doing things -- and it's easy for an argument from, e.g., personal morality to sound that way.

Have you ever convinced someone of something by using a utilitarian argument? I haven't.

I have become completely convinced that either nobody is a utilitarian (i.e. 'utilitarians' just frame their preferences as the utility-maximizing solution), or that there is no consistent way to evaluate utility.

Re: Healthy California Act: proposal to make findings about single-payer healthcare

#230

Post by Apocryphon » Thu, Mar 09, 2017, 1:38 AM UTC

nosuchthing wrote: post #157

unabridged wrote: post #117

Earlier quoted context omitted.

California could get rid of their budget issues instantly with a progressive property tax. How about an extra bracket for nonhomesteads starting at values over $1M?

That requires an effort to repeal Prop 13 asap.

Maybe the time to begin such an initiative is now. And maybe the tech industry, which has long suffered from the related housing crisis, should back such an initiative.