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

#281

Post by [deleted] » Thu, Mar 09, 2017, 1:52 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…

[deleted]

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

#282

Post by refurb » Thu, Mar 09, 2017, 1:52 AM UTC

enraged_camel wrote: post #277

refurb wrote: post #231

Earlier quoted context omitted.

After all, it was them that gave us Enron, Deepwater Horizon, and most recently, the subprime mortgage crisis, which brought the entire world economy to its knees. That's a pretty poor argument if you line it up against gov't waste, incompetence and corruption.

Can you provide any arguments (or, even better, empirical evidence) as to why the government has more waste, incompetence and corruption than the private sector?

I'm not arguing one is better than the other. Just that both system are run by humans so I wouldn't say you'd have less corruption or waste in one or the other.

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

#283

Post by marak830 » Thu, Mar 09, 2017, 1:52 AM UTC

gautamnarula wrote: post #243

stale2002 wrote: post #223

Earlier quoted context omitted.

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.

I use to work pretty well for me. Note I haven't been there in 4 years.

When I left if you earnt over (iirc) 40k per year, you had to purchase private health insurance. Im happy with that.

I did have to goto hospital a few times, I shattered my elbow joint and required 3 surgeries to repair it in total.

The cost was under 5k in total if I remember correctly. I went to public hospital first, but for something like this they recommended private(which I had at the time) - that way there was less waiting, 2 days later I was having my first surgery.

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

#284

Post by ihaveajob » Thu, Mar 09, 2017, 1:52 AM UTC

TheOsiris wrote: post #235

df3 wrote: post #5

A well-executed single-payer system would make California even more attractive for entrepreneurship and increase labor mobility for everyone. Life would be much easier if we could start companies or switch jobs without worrying about healthcare.

I don't think anyone disagrees that single payer requires higher taxes than we currently pay. so given that, you're trying to tell me that a state with the highest taxes (much much higher than #2) in the nation, with the lowest housing affordability will attract more entrepreneurs than before? why? because the young and invincible will be choose cheaper healthcare over being able to live comfortably? I highly doubt i…

I can't speak for everyone else, but the two reasons that were holding me back as an employee of a large corporation instead of starting my own company were employer-provided healthcare and visa restrictions at the moment. This measure would have eliminated one of those major constraints.

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

#285

Post by mcbruiser » Thu, Mar 09, 2017, 1:53 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. I

Great, you can opt in to that, but don't force everyone else who doesn't agree with you to subsidize everyone else's poor decisions

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

#286

Post by chimeracoder » Thu, Mar 09, 2017, 1:53 AM UTC

SilasX wrote: post #269

chimeracoder wrote: post #246

Earlier quoted context omitted.

> 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 ma…

>Because the amount of loan debt physicians have to take on is already massive, and very few would want to increase that by an additional $112,000 (which is the amount Medicare provides). Sure, you think it's expensive, but the demand is still there, people are willing to work for (net of costs) less than they currently are. That supports the claim that the service is priced above the market clearing level. (Edit: an…

> Sure, you think it's expensive, but the demand is still there, people are willing to work for (net of costs) less than they currently are. That supports the claim that the service is priced above the market clearing level.

* There are more people who apply for publicly-funded GME every year than there are positions available, yes.

* However, almost nobody (roughly speaking) applies for self-funded residency positions (which do exist).

I don't know how those two facts combine to say that "the demand is there" - there is not excess demand at market-clearing rates. There is only excess demand at a subsidized rate. People are not willing to work for less than they currently are; the supply is highly substitutable, and we're already seeing the effects of that.

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

#287

Post by nikdaheratik » Thu, Mar 09, 2017, 1:54 AM UTC

gautamnarula wrote: post #243

stale2002 wrote: post #223

Earlier quoted context omitted.

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.

It seems to work okay for the most part, and the population of Australia is much smaller than that of California so I don't believe it would be impossible to do by itself. There are always political discussions in the background about changes to cost or services, but it has a high level of public support across the spectrum of politics, which helps.

The main thing to consider is that the tax base is much different from the U.S. There is an across the board GST which is managed federally, so no local/state options. The income tax overall is higher, though the part that is earmarked specifically for healthcare is only a small percentage of overall income tax. This means that general revenues make up a larger portion of funding than it would appear from a single item on your paystub.

Also, the pricing for public health services is heavily regulated, though there are completely private hospitals and clinics that are separate from that system. Ambulance is also separate from the system, which means either a local tax in some areas or you would need to pay for insurance coverage.

Overall, patient cost is lower, but take-home pay is also lower. Also, I don't believe you can make a sustainable public system without also having a large number of regulated "public" clinics and hospitals. If done correctly, I believe there would be alot of buy in from doctors and other professionals who are just as tired of dealing with the payment headaches as patients are. But you have to get alot of buy in from both them and patients to make it work, and you need an option for people who want to pay for their own "cadillac plans" if you want to keep insurance companies and the very wealthy from getting upset at the effect on choice and lifestyle.

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

#288

Post by DrScump » Thu, Mar 09, 2017, 1:54 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…

  California has had a bumper crop in terms of tax revenue

... but is outspending even that! There was a "surprise" extra $1.9 billion deficit hit from Medi-Cal last fiscal year[0] (which should tell you something about the government's inability to track or control spending), and an overall budget deficit is projected for the current year.

And this doesn't even count the huge infrastructure deficiencies and deferred maintenance.

[0] http://www.pressdemocrat.com/news/6563825-181/19-billion-err...

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

#289

Post by nickv » Thu, Mar 09, 2017, 1:55 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…

How many Americans do you think get to go and get their cancer treated at Memorial Sloan Kettering?

The US private health care system doesn't mean everyone who gets cancer goes to MD Anderson. And, you'd still be very hard pressed to have many private insurance plans cover truly experimental treatments. If I had to choose who gets advanced treatments between those who can pay the most vs those who need it the most I'd go with the latter.

It's funny, many of my Canadian friends talk about the "you can't get the best treatment in the world" problem with their system which, to me, shows how they really don't understand the dire nature of US health care. Wait a year for a surgery? Millions of Americans can only go to emergency rooms.

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

#290

Post by orclev » Thu, Mar 09, 2017, 1:55 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…

Mostly because the cost of drugs isn't dominated by manufacturing costs the way it is with electronics. The vast majority of the cost of a drug is in the development of it. Further, of the costs for developing it, the cost is split fairly evenly between paying for the skilled researchers who actually do the development, and the administrative costs of testing and certification. As for the actual production of the finished drug, that is off-shored for savings, but since most of the cost of the drug is actually going towards offsetting the massive piles of money poured into researching and developing not just that drug but to offset the costs of all the failed drugs, reducing the actual production cost barely moves the needle.

The above is of course talking about newly developed drugs. There is however a rather disturbing recent predatory practice some drug manufacturers have started to engage in of either purchasing an existing drug and jacking up the price if they're the sole manufacturer, or else making a trivial change to an existing drug and then re-releasing it at massively inflated price. In either case the effect is the same, they're selling a drug that has no appreciable research costs associated with it, just the manufacturing price, but they're continuing to charge as if they were having to offset the research costs and they get away with it because that's what people are used to.