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

leginfo.legislature.ca.gov

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

#71

Post by mullingitover »

brutus1213 wrote: post #35
darkstar999 wrote: post #17

Earlier quoted context omitted.

How so?

This will likely be funded from income tax. As a mid-30s person who earns a decent tech salary and has zero hope of buying a house in the decent parts of the SF Bay area, I think this is another case of taking from the young to feed the old. We should totally do this single-payer thing and pay for it via a wealth tax (that takes the current price of your home into account). Lets make it tiny .. say 0.5% a year.

Repeal Prop 13 for non-residential properties, pay for it with property taxes. Side effect: commercial property is used in a vastly more efficient manner.

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

#72

Post by rdmcfee »

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 35% for overhead. From what I can tell, a similar visit in Washington State will run between $60 and $200 USD when billed to insurance.

Why is this the case? What are the factors in the American system that prevent reasonable pricing?

http://www2.gov.bc.ca/assets/gov/health/practitioner-pro/med...

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

#73

Post by mahyarm »

marcell wrote: post #54
old-gregg wrote: post #41

Earlier quoted context omitted.

Yes you can. As a 6th largest economy in the world [1] California can negotiate prices down by 50-60% to be comparable to Canada/UK. [2] Besides, the existing state program (medi-cal) already covers over 1/3 of CA residents [3]. So it looks like if we lower the cost by 60% we can get pretty close to normal healthcare situation using the existing budget. [1] https://en.wikipedia.org/wiki/Comparison_between_U.S._states…

Some of the numbers for [2] confuse me. How can an office visit cost $30 in Canada? When I go in for an office visit, it typically takes about 30 minutes of staff time, around 15 minutes with a medical assistant and 15 minutes with a doctor. If that's $30, the implied wage is $60/hr for the medical staff, if you assume that all the money goes to staff. That just doesn't seem feasible. Some of the other numbers seem m…

It's around $50 for 'off plan' visits (your not a canadian resident, or it's not covered by the healthcare plan).

The math should be $120/hr for the office. The assistant gets $20/hr and the doctor gets $100/hr. If you use the $50 rate, then it's $200/hr. If the doctors share an assistant, it becomes even more efficient. Because of the lower prices, there are less doctors, so they get higher utilization rates for the ones that are there.

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

#74

Post by mmanfrin »

davidw wrote: post #37
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.

Very much agree. I wrote this about single payer, entrepreneurship and my time in Italy: https://journal.dedasys.com/2017/02/22/entrepreneurship-and-...

I managed to crash my bike in to a car in Italy; I remember the process of going to a doctor (which happened to be the closest door on the sidewalk where I hobbled over to) and having them send me to a hospital. I got looked at, xrayed, and given a diagnosis without having to even talk about money or anything beyond a 4-line form for my information.

Single-payer is wonderful, and I believe an absolute necessity as we march towards a future of automation and enormous economic inequality.

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

#75

Post by 11thEarlOfMar »

If this would replace my private health insurance premiums with State taxes, I'd have about $21,600 to contribute for a family of 4, generally healthy humans.

- Does it mean no such thing as 'in or out of network'? That alone cost me $10,000 in 2015, over an above the $21,600 premiums.

- Will it be PPO or HMO-style? Some of us like Kaiser, some don't.

- Will I be forced to change providers? A real sore spot from the ACA for me.

I guess I'm saying, do it, but for God's sake, get it right the first time.

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

#76

Post by tylersmith »

darkstar999 wrote: post #49
brutus1213 wrote: post #35

Earlier quoted context omitted.

This will likely be funded from income tax. As a mid-30s person who earns a decent tech salary and has zero hope of buying a house in the decent parts of the SF Bay area, I think this is another case of taking from the young to feed the old. We should totally do this single-payer thing and pay for it via a wealth tax (that takes the current price of your home into account). Lets make it tiny .. say 0.5% a year.

> 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?

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

#77

Post by ClassyJacket »

ThomPete wrote: post #48

Here is the problem. How do you deal with illegal immigrants? At least in the current system there are ways for them to get treated, but in a single payer system? Single-payer works great in countries were everyone have a ssn. Not sure its feasible in the US as much as i think it would be great.

How does this stop illegal immigrants getting treated the same way they do now?

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

#78

Post by dragonwriter »

SwellJoe wrote: post #18
exabrial wrote: post #2

Who will pay for it?

California tax payers, obviously. Perhaps the bulk of it will come from folks (and companies?) who have driven real estate prices up to the point no working class person can afford to buy a home in any major city in California. There may be some negative consequences to that, as well, in the form of some companies or people moving out of California. But, hey, maybe that'd help solve the housing crisis. And, it's also…

> I, honestly, have no idea how it'd work, especially for a state that has managed to have a budget crisis seemingly every year for decades

Those crises were artifacts of requiring a supermajority for passing a budget, which meant as long as parties voted as blocks, the minority party could prevent the majority party from passing any budget; crises were, then, deliberately engineered to extract concessions. Since going to a majority-rule for passing budgets (retaining the supermajority requirement for tax increases), the annual budget crises have disappeared.

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

#79

Post by conradev »

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…

The Affordable Care Act has a provision in it that allows states to apply for "waivers for state innovation"[1] starting this year. That waiver program might allow for this to receive federal funding.

That said, the future of the Affordable Care Act is currently unclear.

[1] https://en.wikipedia.org/wiki/Patient_Protection_and_Afforda...

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

#80

Post by fsargent »

AnimalMuppet wrote: post #46
marcell wrote: post #27

I can't get over the cognitive dissonance of these two points: > (2) Californians, as individuals, employers, and taxpayers have experienced a rise in the cost of health care and health care coverage in recent years > (4) Individuals often find that they are deprived of affordable care and choice because of decisions by health benefit plans guided by the plan’s economic needs rather than consumers’ health care needs.…

No, there's another option: Health care company profits could go down. (But I suspect that people who want both (2) and (4) overestimate how far they can go before they reach zero, at which point we quit having health care companies, and then we have no health care coverage...)

Either way you're going to be reducing rent (ie, gaining market efficiency) until you're not doing that anymore. There are testable ways to evaluate the market's ability to handle cost reductions and operate effectively. Even better that California can rely on the US and Canadian market overall to compare itself.
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