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

#241

Post by refurb » Thu, Mar 09, 2017, 1:41 AM UTC

nodamage wrote: post #149

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…

Insurance companies acting as profit-seeking middlemen between doctors and patients create a perverse incentive to drive up costs on both ends. It's a terrible feedback loop caused by treating health care (which is ultimately a cost center) as a for-profit enterprise. Every other modern country has managed to figure this out except the United States.

* It's a terrible feedback loop caused by treating health care (which is ultimately a cost center) as a for-profit enterprise.*

Ummm... you do realize that many other countries with universal coverage rely on private insurance, right?

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

#242

Post by nickff » Thu, Mar 09, 2017, 1:41 AM UTC

stale2002 wrote: post #232

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

The Trolley problem isn't really an example of utilitarianism being wrong. Quite the opposite, I use that example to convince people of how awesome Utilitarianism is, not as a contradiction. What, would you chose to kill 5 people, instead of one?

I gave that as an example of a controversial subject; many people prefer to let things be rather than interfere and kill one or more people. The organ donor example is much tougher.

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

#243

Post by gautamnarula » Thu, Mar 09, 2017, 1:42 AM UTC

stale2002 wrote: post #223

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…

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.

This is what Australia does, I think. Single payer public option, but you can choose to buy private health care as well (though you still pay taxes for the public option regardless). I'm curious to hear from any Australians about how this system works for them.

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

#244

Post by refurb » Thu, Mar 09, 2017, 1:42 AM UTC

acdha wrote: post #180

darkstar999 wrote: post #42

Earlier quoted context omitted.

Just curious why you would gladly pay more? Can you elaborate?

Just agreeing with what others have said: I'd prefer not to live in a world where bad luck means easily avoidable pain and suffering, or where many people live in semi-constant fear that a malicious or incompetent company will prevent them from getting vital care or create an acute financial crisis. If you only care about yourself, ask what would happen if you developed a serious illness or were in a bad accident: ve…

OK, so when this is rolled out and healthcare costs don't come down, but rather increase at the same rate, will you be happy to pay another 10-20% in taxes knowing the problem isn't solved?

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

#245

Post by Apocryphon » Thu, Mar 09, 2017, 1:42 AM UTC

tylersmith wrote: post #76

darkstar999 wrote: post #49

Earlier quoted context omitted.

> As a mid-30s person who earns a decent tech salary ... you can afford it. Moreso that others. You _are_ the wealth.

He can afford it. Others can't. Why should he pay for them just because they have a lower value?

To be blithe, it goes into the same ultimate goal of social welfare: to keep the not-well-off contented enough to prevent revolution. So he can either pay for programs to improve medical care in general, or he can pay for a militia to protect him should there be a class-based insurrection. That is the pragmatic principle behind taxation.

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

#246

Post by chimeracoder » Thu, Mar 09, 2017, 1:42 AM UTC

SilasX wrote: post #216

chimeracoder wrote: post #193

Earlier quoted context omitted.

> The amount of people able to become doctors is artificially limited. It is not artificially limited, and this is a common misconception that simply won't go away. The bottleneck is currently the number of people who can complete residency training. Residency programs are not self-sufficient, so most of them are funded by Medicare. That's not an artificial limit - that's a natural one (the sheer economics of the pro…

And (per previous discussion [1]) that doesn't explain it. If there is still excess demand for MD degrees, then there is still room for potential MDs to borrow any shortfall that residency subsidies won't cover. The argument is like saying that Hamilton showings are limited by how much the government will pay in subsidies for the tickets. No. The demand is enough to cover expansion. And even if it weren't there's sti…

> If there is still excess demand for MD degrees, then there is still room for potential MDs to borrow any shortfall that residency subsidies won't cover.

Because the amount of loan debt physicians have to take on is already massive, and very few want to increase that by an additional $112,000 (which is the amount Medicare provides). There are some, but empirically, not many.

The term of that loan is comparable to many mortgages, and there's enough uncertainty at this point in the expected payout that many qualified would-be doctors are incentivized to choose other professions instead, where they can make a pretty good living (and, possibly, a better one) much sooner and without the risk of taking out an additional series of six-figure loans on top of whatever may be outstanding from undergraduate education.

> The argument is like saying that Hamilton showings are limited by how much the government will subsidize ticket prices by.

Broadway ticket prices are a really bad analogy, because prices are intentionally sold below market-clearing rate for a whole slew of reasons that aren't directly comparable to the medical profession.

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

#247

Post by sdenton4 » Thu, Mar 09, 2017, 1:42 AM UTC

refurb wrote: post #209

tempestn wrote: post #137

Earlier quoted context omitted.

It seems like most of the complaints about healthcare now relate to unpredictable costs and complexity though. I'm not sure the simplicity and stress-reduction of a single-payer system really are appreciated. I'm Canadian, and our system is fair from perfect. That said, it's hard for me to comprehend the stories I regularly read about people's experiences in the American system, trying to decide on plans, sacrificing…

As a Canadian as well, I appreciate you being up front about the drawbacks of our system as well. I've heard so many American's say "oh, the Canadian system is so much better". Is it better in coverage? Obviously! However, when I ask if they'd be ok waiting over a year for joint replacement surgery, they get a weird look on their face. Or, if they have cancer, they aren't going to get to go to the best cancer center…

And yet. We have a system where the rich are OK and the poor can be destroyed by an encounter with the health care system.

A system where almost everyone is OK and the rich can pay for the best care available is far, far preferable.

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

#248

Post by Daishiman » Thu, Mar 09, 2017, 1:43 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…

Some people will never have the means to pay for their own health care. Some jobs that have social value do not pay enough money to care for people. In your worldview, those people don't deserve to have health.

I'll stick with civilized societies thankyouverymuch.

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

#249

Post by nikdaheratik » Thu, Mar 09, 2017, 1:43 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…

It is related to the budget, but not directly related since it is promises to fund pensions rather than something directly related to government services.

It could be funded by increasing contributions gradually until it reaches the correct funding level (either from cuts in other areas or taxes), by cutting the future amounts they distribute from the pensions, by raising the retirement rate of current workers which would give them time to make up the deficit, or a combination of these.

The problem is, these options all kind of stink politically, but they won't bankrupt the state by themselves.

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

#250

Post by bdamm » Thu, Mar 09, 2017, 1:43 AM UTC

api wrote: post #51

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…

I wonder how much taxing legal marijuana will help the state's budget issues?

Not likely to matter very much. Some local benefits but compared to income tax it's a rounding error.