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

leginfo.legislature.ca.gov

391–400 of 468 posts

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

#391

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…

> 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

Breaking an ankle is not a "decision". Tuberculosis is not a "decision". Cancer is not a "decision". Alzheimer's is not a "decision". "Getting old" is not a "decision".

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

#392
post #147

Earlier quoted context omitted.

How about we get rid of Prop 13, a not-so-stealth tax on the young.

There are many bad things about Prop 13. Indeed I'm straining to think of anything good about it. But the worst is that it applies to commercial property as well.

> But the worst is that it applies to commercial property as well.

ding. Got it in one.

Normal residential properties transact roughly every 10-15 years with 40-50 years being on the way outside. So, most residential properties aren't too far behind their real value in taxes.

Commercial properties never transact; they just add more subleases. We had one property we rented which had 23 layers of sublease to avoid Prop 13.

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

#393
post #384

Earlier quoted context omitted.

Couldn't they still pay extra and get it? Can't you do that in Canada?

Nope! Physicians either have to be a part of the public system 100% or 0%. No doing both. As a result, there are very few private options for healthcare in Canada.

Right. As I mentioned in my post, there is a concern that allowing otherwise would erode the public system. Perhaps it's justified; I don't know. Also, those who can afford it can travel to the US or elsewhere if they want to pay for services, which reduces the motivation to create a private alternative here, although it turns out in practice that happens rarely. This is a good overview, also covering the differences in wait times between the systems: https://motherboard.vice.com/en_us/article/fact-checking-tru...

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

#394
post #378

Earlier quoted context omitted.

Completely agree. The trick is making sure it's well-executed so that other states can use it as a template. Once one state proves that single-payer can be done well, I suspect it will cascade inevitably. With 100% seriousness, if the ACA is repealed I will likely be choosing between Massachusetts (where Romneycare would hopefully take priority again) or another country. It's too risky to do otherwise. My extended an…

California had guaranteed issue before the ACA. Any small business with at least 2 employees could get it. Premiums were reasonable as the "rating adjustment factor" was capped on these plans. A one time 6 month waiting period on pre-existing conditions is waived if you have prior credible coverage without more than a 62 day gap in coverage. For example, a husband and wife working together in a sole proprietorship, w…

Thanks, very helpful to know. Most of my family is in Ohio, and I'm a recent transplant to California.

This appears to be the updated version of AB 1672, which itself ended in 2013:

http://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?...

I'm not remotely capable of parsing all the stuff in there, but it does make me wonder what happens when a State passes a bill to bring itself into compliance with a Federal law and then the Federal law is repealed. I assume it's not automatic that the State bill ceases to function.

Is this even more of an uncertainty-laden mess than I thought? Will dozens of states find that changes to the ACA is interacting in crazy ways with state laws? Somehow I am guessing that we won't find out until it happens.

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

#395

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 know others replied but I'll try to do a full, in-depth explanation of how it works here because the alternative is that I do producive work after lunch and screw that.

Everyone earning a taxable income pays a "medicare levy" of 2% of your total taxable income which funds the public system [1]. You pay that regardless of whether you use it or not - it's a fixed part of your income taxes. There are waivers for low income earners as detailed in [1] so that teens working in cafes to get through uni aren't smacked with extra taxes but by and large if you're a fulltime employee you'll be probably paying it.

In addition to that, you pay another 1-1.5% of your total income (1% for $90-105k, 1.25% for $105-140k and 1.5% for 140k+) as the "medicare levy surcharge" [2], however you get a partial or full refund of this if you have private health insurance. This encourages high income earners to take out private health insurance, ostensibly to shift the burden off the public health system because if they have private insurance they're more inclined to use it.

Lastly, if you do not take out private health insurance once you turn 30, your premiums on private health insurance increase by 2% per year for every year that you don't hold it over 30 (with some exceptions) [3]. After 10 years of paying this increased loading on fees, it disappears (ie: if you take out private health insurance for the first time at 40 you'll be paying 120% premiums until 50 then it'll drop back to 100%). This is supposed to incentivise people to take it out earlier in life and hold on to it, rather than take it out towards the end of life when they get sick all the time. By doing so, it (in theory, i'm dubious) keeps down premiums for everyone overall because private insurance companies don't have to price in people only buying it when they're sick.

As for how this works, I think it works pretty good on balance. Everyone gets a green medicare card at age 18 (under 18 they're on their parents one, unless broken families etc. necessitate an individual one earlier) and it entitles you to basically walk in to a public hospital and get care if you need it, though the public system usually requires waits based on your current state (ie: even if you're in emergency with a broken wrist, they'll put you aside with some painkillers if there's someone with an exploding appendix presenting at the same time). It also covers other procedures that are non-life-threatening, though there's significant (months+) wait times - you go see a specialist who registers you into the public system for a procedure, then you wait until you get a letter in the mail setting a date for your procedure. Even for semi-urgent procedures there might be waits of months depending on how muc hdemand there is, though to their credit the public system does try to keep tabs on whether your health degrades during that time and will prioritise you accordingly relative to others waiting for the same procedure.

I had a completely non-life-threatning, almost cosmetic surgical procedure in the public system and I was waiting for about a year or so but given it had no effect on my day to day life I was happy to wait and it meant it was completely free. I saw my GP and he referred me to a specialist (who I think saw me under the public system, so I didn't pay for that). I saw the specialist and he scheduled me for the procedure. When I got my date for it, I went in mid-morning, went under a local, woke up a few hours later and walked home that afternoon with absolutely no out-of-pocket cost to me whatsoever.

The quality of healthcare is reasonable too - many of the specialists who work in the public system also work in the private system for a couple of days a week to boost their income, so it's not uncommon for a specialist you consult with to ask which way you want to go before they direct you to whichever relevant hospital they practice at. The public system also tries to facilitate cross-hospital discussions about particuarly interesting cases, for example doctors from multiple public hospitals in a city will come together to share notes and ask for opinions to help deliver better outcomes. Private, by nature, doesn't necessarily get that exposure.

The private health insurance system here is national - just about anyone in any state can get any policy, more or less. There's easy comparison websites that let you plug in your details and get a quote [4] and they offer all kinds of ranges of cover from 'I want to avoid the surchage for tax purposes, please insure me as minimally as possible' (at about $70/mo in my experience) to 'I want to be able to walk in to a private hospital for absolutely any reason and not pay a cent, please charge me all of the money in fees' ($x00s/mo easily from what I've seen). Cover is sliced into 'basic hospital' cover and 'extras' cover which lets you tailor the two with greater flexibility. Changing between providers is nearly frictionless and that helps keep fees down since they're all competing. The government does place some regulation on the levels of fees and how much they may increase each year, to try to manage costs of private insurance. There's also strict rules governing pre-existing conditions, etc. that you hear about from US insurance horror stories.

The public system is not without its faults for sure, and many people will rubbish the public system as a bad one due to its wait times, its relatively reduced level of personal focus by staff, increased patient:staff ratios etc. but it does remarkably well for the funding it has and is vastly preferable to it not existing. Those who want a private experience can easily get it but those who can't afford it at least won't rock up to a hospital with a broken foot only to be turned away. In that sense, it serves its purpose well as there's the incentive for people to pay to move off the public system (thus managing its burden) whilst ensuring that if you absolutely do need help, you'll get it.

[1]: https://www.ato.gov.au/Individuals/Medicare-levy/

[2]: https://www.ato.gov.au/Individuals/Tax-Return/2016/Tax-retur...

[3]: http://www.privatehealth.gov.au/healthinsurance/incentivessu...

[4]: http://www.iselect.com.au/ as an example if you want to play around

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

#396
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'd rather pay for single payer than see $54B go to the military [1] or $20B for a pointless wall. And honestly, having a healthier populace would likely lower the overall cost over time. I don't think we spend enough effort on preventative care as opposed to treatment.

[1] This shows how crazy the current spend is already. https://i.redd.it/6srj4xgpmriy.png

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

#397
post #383

Earlier quoted context omitted.

If that's true, why does any single doctor in the entire country take Medicare patients then?

> If that's true, why does any single doctor in the entire country take Medicare patients then? Well, independent private practices have been dying out for precisely this reason, and outside of Critical Access regions (which have a higher fee structure), many don't anymore. Some view it as an act of charity (the way lawyers might take on pro bono cases), but the laws regarding insurance segregation have gotten strict…

yeah the doc-in-a-box practice is rapidly becoming a thing of the past. However the corporatization of medicine is not doing anyone any favors save for the administrators, and even then only the executives make out like bandits.

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

#398

I don't understand this. Maybe I'm uneducated on "acts"? > It is the intent of the Legislature to enact legislation that would establish a comprehensive universal single-payer health care coverage program and a health care cost control system for the benefit of all residents of the state. This is literally the meat of the bill. The actual changes would still have to be voted on in separate bills, right? What is the p…

The CA legislature uses a good deal of intent legislation. I assume the purpose is to formally announce the beginning of legislative development process, allowing stakeholders to become involved.

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

#399
post #165

Earlier quoted context omitted.

assuming you're asking in good faith, the answer is pretty simple. A larger population has more leverage, and if all of the citizens bargain as one bloc (i.e., if the government does so on their behalf), it drives the market. Note that a tremendous chunk of the market needs to be involved for this to have maximum effect -- if a physician can "opt out" of Medicare/MediCal and make more money, they will, by and large.…

> In the US there are a great many physicians who simply won't accept Medicare rates (they're viewed as too low by most) Right there is the big problem, though: Medicare reimbursement rates are already below sustainable levels for providers, which actually results in providers charging private insurers for the difference. If Medicare were expanded to everyone, either Medicare would have to increase its reimbursement…

This is interesting -- suppose that the choke point of negotiation was handled by the government on behalf of citizens, but the administration of programs was privatized? That could be interesting.

Lord knows I've had about enough red tape for several lifetimes from NIH, NSF, and similar organs; Medicare as it now stands somehow manages to result in both medicine-at-a-loss and also fraud on a spectacular scale. I'm not a big fan of government but between consolidation and fragmentation, I don't think the current medical care solution is working, nor is it sustainable.

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

#400
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.

Completely agree. The trick is making sure it's well-executed so that other states can use it as a template. Once one state proves that single-payer can be done well, I suspect it will cascade inevitably. With 100% seriousness, if the ACA is repealed I will likely be choosing between Massachusetts (where Romneycare would hopefully take priority again) or another country. It's too risky to do otherwise. My extended an…

> ... stuck in a job or forced to accept unreasonable compensation or a nasty work environment because I have to have health coverage.

Which is what makes this a huge political issue and an incredible leverage point.

I wish we could unite and end the use of healthcare coverage / availability to enslave workers ("enslave" being used loosely for the ones Who are as pedantic as I sometimes am).

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