California Politics: Madame Senator, this is a morgue

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revolther: May 27, 2008

Dead Reckoning posted:

to be subject to that section of the penal code, you would have to knowingly be a member of a group dedicated to the violent overthrow of the state. I can't see someone joining one of those by accident, then just deciding to stick with it.

Eh I'd consider anyone who supports: the State of Jefferson, the Tea Party, the inaction of libertarianism, or has ever donated to a PAC, as having joined a group dedicated to the violent overthrow of the state. Most of them don't realize that's what those groups support while simultaneously being unable to shut up about that's what they really want.

# ? May 24, 2017 19:15

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# ? May 15, 2024 01:47

Skyscraper: Oct 1, 2004; Hurry Up, We're Dreaming

revolther posted:

Eh I'd consider anyone who supports: the State of Jefferson, the Tea Party, the inaction of libertarianism, or has ever donated to a PAC, as having joined a group dedicated to the violent overthrow of the state. Most of them don't realize that's what those groups support while simultaneously being unable to shut up about that's what they really want.

Don't forget Black Lives Matter, who is 100% what this is going to be used against.

# ? May 24, 2017 19:19

revolther: May 27, 2008

And those radicals in the League of Women voters.

# ? May 24, 2017 20:03

Aeka 2.0: Nov 16, 2000; Have you seen my apex seals? I seem to have lost them.; Dinosaur Gum

Hills love to ignite in the IE as well as the river bottom, here is the river on fire from my backyard a few years ago:

# ? May 24, 2017 20:25

Roland Jones: Aug 18, 2011; by Nyc_Tattoo

So according to what I'm seeing online, both SB 562 and 179 are set for a hearing tomorrow. With the utterly disastrous CBO score for the AHCA dropping today, hopefully that will influence the former's hearing and help it through, because wow, it is bad. And it qualifies for reconciliation, so there's a risk of it actually passing.

# ? May 24, 2017 22:27

CPColin: Sep 9, 2003; Big ol' smile.

I think tomorrow's meeting is purely voting on stuff they already discussed and took public commentary on, which is why the agenda is a mile long. I'm hoping they chair the meeting with an auctioneer, for maximum throughput!

# ? May 24, 2017 22:51

CPColin: Sep 9, 2003; Big ol' smile.

Streams for the upcoming Appropriations Committee meeting:

Audio: http://stream.senate.ca.gov:1935/live/_definst_/TV2_audio/chunklist_w206564956.m3u8
HD Video: http://senatestream-lh.akamaihd.net/i/Sen_TV2@118078/index_720_av-p.m3u8
SD Video: http://senatestream-lh.akamaihd.net/i/Sen_TV2@118078/index_360_av-p.m3u8

# ? May 25, 2017 17:56

Mister Mind: Mar 20, 2009; I'm not a real doctor,
But I am a real worm;
I am an actual worm

Dead Reckoning posted:

Color me surprised that stone cold of all people is weighing in on the side of the uninformed yet opinionated. Who could have foreseen this shocking development.

This isn't some covert NKVD loyalty test, to be subject to that section of the penal code, you would have to knowingly be a member of a group dedicated to the violent overthrow of the state. I can't see someone joining one of those by accident, then just deciding to stick with it. Do you think that group membership should not be scrutinized? Would you be OK with a member of the Aryan Nation on the state personnel board?

I'd be OK with a Quaker working for CSU East Bay,, but...oops!

# ? May 25, 2017 18:14

CPColin: Sep 9, 2003; Big ol' smile.

SB 179 passed the committee and will go to the Senate floor.

# ? May 25, 2017 19:08

Anza Borrego: Feb 11, 2005; Ovis canadensis nelsoni

CPColin posted:

SB 179 passed the committee and will go to the Senate floor.

Reading up on this turned up this amazing website, whose owner is very concerned about "exploding the envelope of sexual anarchy". :allears:

https://www.savecalifornia.com/oppose-nonexistent-3rd-gender.html

# ? May 25, 2017 19:18

Skyscraper: Oct 1, 2004; Hurry Up, We're Dreaming

Noggin Monkey posted:

"exploding the envelope of sexual anarchy"

Welp, found a new line for my business card.

# ? May 25, 2017 19:29

CPColin: Sep 9, 2003; Big ol' smile.

Aaaa my stream froze right as it got to the Healthy California Act!

# ? May 25, 2017 19:31

Mordiceius: Nov 10, 2007; If you think calling me names is gonna get a rise out me, think again. I like my life as an idiot!

SB562 passes Appropriations with 5-2 vote, contingent on funding. Headed to full Senate vote by June 2.

# ? May 25, 2017 19:41

Cup Runneth Over: Aug 8, 2009; She said life's
Too short to worry
Life's too long to wait
It's too short
Not to love everybody
Life's too long to hate

Start calling your loving state senators.

# ? May 25, 2017 20:54

Doc Hawkins: Jun 15, 2010; Dashing? But I'm not even moving!

Cup Runneth Over posted:

Start calling your loving state senators.

Mine wrote the bill!

...I'll call to thank him.

# ? May 25, 2017 22:38

CPColin: Sep 9, 2003; Big ol' smile.

SB 179 is item #61 on today's agenda. They're currently talking over item #49, which seems impossibly deep into the list after half an hour. Anyway, looks like it'll come up for a vote today. Healthy California, SB 562, is #131 on the agenda, so will probably wait until tomorrow, unless they skip some stuff.

http://findyourrep.legislature.ca.gov/

Edit: They're now voting on item #14 on the agenda, which makes more sense.

Edit2: They're discussing SB 179 now. Vote is imminent.

Edit3: Currently has 18 Yes votes, when it needs 21. A bunch of senators weren't in the room, so they put it on hold and will call for more votes later today.

CPColin fucked around with this message at 19:12 on May 31, 2017

# ? May 31, 2017 18:15

CopperHound: Feb 14, 2012

I just called Bill Dodd's office. Don't know why I put it off so long, it is a pretty simple process.

# ? May 31, 2017 20:21

Lemming: Apr 21, 2008

Press release about the economic study just went out http://www.healthycaliforniaact.org/new-findings-sb-562-would-cut-state-spending-on-healthcare-by-18-percent/

Here's the actual thing http://www.healthycaliforniaact.org/wp-content/uploads/Pollin-Economic-Analysis-SB-562.pdf

So if you have any gently caress head representatives who lie and say they're totally in support of single payer but they're just concerned about how we're gonna pay for it, you can tell them "with a tiny tax that's more than offset by reductions in healthcare spending you traitorous mother fucker"

# ? May 31, 2017 20:49

Megaman's Jockstrap: Jul 16, 2000; What a horrible thread to have a post.

Thanks for the links!

# ? May 31, 2017 22:38

Trabisnikof: Dec 24, 2005

Lemming posted:

Press release about the economic study just went out http://www.healthycaliforniaact.org/new-findings-sb-562-would-cut-state-spending-on-healthcare-by-18-percent/

Here's the actual thing http://www.healthycaliforniaact.org/wp-content/uploads/Pollin-Economic-Analysis-SB-562.pdf

So if you have any gently caress head representatives who lie and say they're totally in support of single payer but they're just concerned about how we're gonna pay for it, you can tell them "with a tiny tax that's more than offset by reductions in healthcare spending you traitorous mother fucker"

I'm looking forward to a layperson who thinks he's in a position to give the California Nurses Association and team of economists at the Political Economy Research Institute (PERI) at the University of Massachusetts Amherst, his opinions on how to best manage healthcare.

# ? May 31, 2017 22:45

Combed Thunderclap: Jan 4, 2011

Lemming posted:

Press release about the economic study just went out http://www.healthycaliforniaact.org/new-findings-sb-562-would-cut-state-spending-on-healthcare-by-18-percent/

Here's the actual thing http://www.healthycaliforniaact.org/wp-content/uploads/Pollin-Economic-Analysis-SB-562.pdf

So if you have any gently caress head representatives who lie and say they're totally in support of single payer but they're just concerned about how we're gonna pay for it, you can tell them "with a tiny tax that's more than offset by reductions in healthcare spending you traitorous mother fucker"

This is loving delicious.

And holy poo poo look at these socioeconomic benefits :eyepop:

# ? May 31, 2017 22:50

Mordiceius: Nov 10, 2007; If you think calling me names is gonna get a rise out me, think again. I like my life as an idiot!

SB 179 just passed!

# ? May 31, 2017 22:58

CPColin: Sep 9, 2003; Big ol' smile.

SB 179 just passed 25-12. :unsmith:

# ? May 31, 2017 22:58

Dirk the Average: Feb 7, 2012; "This may have been a mistake."

Combed Thunderclap posted:

This is loving delicious.

And holy poo poo look at these socioeconomic benefits

Wait, how the hell are super high incomes getting a -% of money spent on health insurance?

# ? May 31, 2017 23:29

Trabisnikof: Dec 24, 2005

Dirk the Average posted:

Wait, how the hell are super high incomes getting a -% of money spent on health insurance?

Tax subsidies.

# ? May 31, 2017 23:34

Cup Runneth Over: Aug 8, 2009; She said life's
Too short to worry
Life's too long to wait
It's too short
Not to love everybody
Life's too long to hate

Dirk the Average posted:

Wait, how the hell are super high incomes getting a -% of money spent on health insurance?

I assume it results in greater income for them. :v:

# ? May 31, 2017 23:35

Dead Reckoning: Sep 13, 2011

Lemming posted:

Here's the actual thing http://www.healthycaliforniaact.org/wp-content/uploads/Pollin-Economic-Analysis-SB-562.pdf

Trabisnikof posted:

I'm looking forward to a layperson who thinks he's in a position to give the California Nurses Association and team of economists at the Political Economy Research Institute (PERI) at the University of Massachusetts Amherst, his opinions on how to best manage healthcare.

I don't really need to, you can read the report yourself:

quote:

One potential concern in using the VA price-setting system as a comparison point for California is that the VA system serves a limited sample of the U.S. population�i.e. veterans, who are all adults, and are mainly male adults. By contrast, the California population obviously includes young people and women distributed in their normal demographic proportions. It is therefore useful to consider another pharmaceutical procurement system that does itself also serve all demographic groups according to a normal demographic distribution. An appropriate comparison system here is Canada�s publicly-funded health care system, which is called Medicare
...
on average, per capita drug prices in Canada are 31 percent lower than those in the U.S
...
the Canadian system is governed by the Patented Medicine Prices Review Board. This is an independent quasi-judicial body responsible for ensuring that the prices of all patented medicines sold in Canada are not excessive. If the prices are found excessive the board may order them to be lowered.
...
Given this basic evidence for both the U.S. VA system and Canadian Medicare, we conclude that the cost savings potential in the area of pharmaceutical pricing within Healthy California should be at least 30 percent.

So, their two examples are the VA, which straight up refuses to cover certain drugs by default, and can get away with it because they primarily serve a homogeneous population of older, male veterans, and Canada, which regulates drug prices by legal fiat.

You'll recall that Cali tried to vote for "just demand that drug companies give us a discount" in the last election, and the legislative analyst's take was that California has no means to make drug companies play ball, and it would not work.

But hey, this paper says, let's just assume that we can get the same discount as a sovereign nation anyway.

Their payments structure assumes that California will be able to negotiate the same price for services as Medicare

quote:

Table 7 shows estimated savings under the Healthy California program in which Medicare rates are used to determine provider payments. The estimates assume that Medicare rates are 78 percent of private insurance rates (a 22 percent discount) and that MediCal spending is 35 percent below private rates for physician and clinical services and 40 percent below for
hospital services.

and just sort of assumes that hospitals, physicians, and other service providers will simply suck it up and take a 22% to their reimbursement while providing the same quality and level of service.

I haven't yet been able to untangle the logic by which they assume that going to a single payer system will halve administrative costs with no downsides, but if that has any basis on a real world example, I'd love to hear about it.

Recall that when the state's legislative analyst looked at the bill, they noted that it would require "unprecedented changes to a mature healthcare system" and cost an additional $200 billion. The lower number from this paper seems to be based on some unwarranted optimistic assumptions.

# ? Jun 1, 2017 00:40

Mordiceius: Nov 10, 2007; If you think calling me names is gonna get a rise out me, think again. I like my life as an idiot!

She just said "We've done 42 bills. We've got to do about 58 more." Is that 58 more today or just this week? Because if today, that means they should hit SB 562 today. They're 40 away from it.

# ? Jun 1, 2017 00:41

The Glumslinger: Sep 24, 2008; Coach Nagy, you want me to throw to WHAT side of the field?; Hair Elf

Dead Reckoning posted:

Their payments structure assumes that California will be able to negotiate the same price for services as Medicare and just sort of assumes that hospitals, physicians, and other service providers will simply suck it up and take a 22% to their reimbursement while providing the same quality and level of service.

I haven't yet been able to untangle the logic by which they assume that going to a single payer system will halve administrative costs with no downsides, but if that has any basis on a real world example, I'd love to hear about it.

Recall that when the state's legislative analyst looked at the bill, they noted that it would require "unprecedented changes to a mature healthcare system" and cost an additional $200 billion. The lower number from this paper seems to be based on some unwarranted optimistic assumptions.

Knowing a lot of physicians, I'd say alot of them would take deal, since they almost never get face value on anything that they charge and have to employee tons of people to argue with insurance and medicaid to get payments

# ? Jun 1, 2017 00:51

acksplode: May 17, 2004

Dead Reckoning posted:

But hey, this paper says, let's just assume that we can get the same discount as a sovereign nation anyway.

California has a larger GDP and population than Canada

# ? Jun 1, 2017 00:53

Trabisnikof: Dec 24, 2005

Dead Reckoning posted:

But hey, this paper says, let's just assume that we can get the same discount as a sovereign nation anyway.

Ah yes, the classic trick of quoting where the paper says "assume" then not quoting the well reasoned analysis that follow that immediate sentence in an attempt to discredit the entire paper.

Lets take a look at that section:

quote:

Given this basic evidence for both the U.S. VA system and Canadian Medicare, we conclude that the cost savings potential in the area of pharmaceutical pricing within Healthy California should be at least 30 percent. In fact, additional evidence with respect to current trends in the U.S. pharmaceutical market reinforces our conclusion that this 30 percent cost reduction
figure is a lower-end figure.

One important consideration is that much of the recent and projected increase in pharmaceutical spending in the U.S. has been shifting strongly to expensive specialty medicines from traditional treatments. According to Quintiles IMS (formerly IMSHealth), national spending on specialty medicines as a share of total drug spending has increased from 22 percent in 2007 to 40 percent in 2016.32 Moreover, this trend is occurring primarily in the non-retail segment of the market. Specialty drugs account for one-third of spending in the retail segment
and 58 percent of total drug spending in non-retail settings. Specialty medications are generally expensive and are frequently dispensed in hospitals and physician offices. These drugs are therefore excluded from the pharmaceutical category in the national health accounts (i.e. they fall under the non-retail segment of the pharmaceutical market). Thus, the 30 percent of savings on drug expenditures under Healthy California may underestimate the true savings that are possible because our estimates are derived from the national health accounts and do not include drugs purchased through non-retail channels. In addition, we apply the 30 percent savings to all drugs, including generics, which are lower in price than branded medications. However, while generics account for more than 80 percent of all prescriptions, they contribute only about one-quarter to drug expenditures. In addition, there is growing evidence of rising prices in the generic market, particularly among older established generics. One group of researchers recently noted that established generics have been increasing in prices since at least 2007.33 Similarly, the U.S. Government Accountability Office (GAO) recently reported that between 2010 and 2015, 300 of the 1,441 established generic drugs analyzed had at least one extraordinary price increase of 100 percent or more.34

Given all these considerations, we assume, as a conservative estimate, that, under Healthy California, pharmaceutical prices in California can be maintained at a level that is, on average, 30 percent below the prices that prevail presently under the state�s existing health care system. We show this in Table 7 as a 30 percent saving within the pharmaceutical category of overall health care spending in California.

# ? Jun 1, 2017 00:56

Dead Reckoning: Sep 13, 2011

The Glumslinger posted:

Knowing a lot of physicians, I'd say alot of them would take deal, since they almost never get face value on anything that they charge and have to employee tons of people to argue with insurance and medicaid to get payments

This makes literally no sense; since we'd be going to essentially a Medicare for all system, they would still need billing agents to argue with Healthy California to get reimbursements. Unless we're also socializing doctors' practices as well, which is not something the bill addresses.

acksplode posted:

California has a larger GDP and population than Canada

Which is irrelevant because it doesn't have a patent office (or other means to force drug companies to deal with it.)

# ? Jun 1, 2017 00:58

Dead Reckoning: Sep 13, 2011

Trabisnikof posted:

Lets take a look at that section:

That section is saying that the authors think that they can get even deeper discounts on specialty medications, and doesn't in any way address the issue of how those discounts would be achieved in the first place.

# ? Jun 1, 2017 01:03

Trabisnikof: Dec 24, 2005

Dead Reckoning posted:

That section is saying that the authors think that they can get even deeper discounts on specialty medications, and doesn't in any way address the issue of how those discounts would be achieved in the first place.

Do you have anything besides your lay opinion to discredit this report? Because you seem to be just confused by the fact this is an analysis of the bill and is focused on the outcomes rather than being a document laying out every single answer to every question you might ask.

# ? Jun 1, 2017 01:15

CPColin: Sep 9, 2003; Big ol' smile.

Mordiceius posted:

She just said "We've done 42 bills. We've got to do about 58 more." Is that 58 more today or just this week? Because if today, that means they should hit SB 562 today. They're 40 away from it.

That's today's target. They wanted to do something like 75 yesterday, 100 today, and 80 tomorrow, with the option of working Friday, if necessary.

# ? Jun 1, 2017 01:16

Instant Sunrise: Apr 12, 2007; The manger babies don't have feelings. You said it yourself.

quote:

Article 3. Payment for Health Care Services and Care Coordination
100639 [...] (d) The program shall engage in good faith negotiations with health care providers� representatives under Chapter 8 (commencing with Section 100660), including, but not limited to, in relation to rates of payment for health care services, rates of payment for prescription and nonprescription drugs, and payment methodologies. Those negotiations shall be through a single entity on behalf of the entire program for prescription and nonprescription drugs.

Unlike the Federal Medicare Part D bill, which has a clause that specifically requires the government to just pay the whatever price the manufacturer wants for a prescription drug, California can use the fact that it's providing care for 40 million people to bargain a price that's closer to what other first world nations pay.

As for doctor billing? Hospitals and Medical Providers add in huge amounts of markup to what the bill insurance companies, because insurance companies have armies of people whose job it is to figure out how to get out of paying, or negotiate it way down. Without the for-profit insurance industry gumming up the works, medical providers wouldn't need to charge huge amounts just to get something back from insurance.

# ? Jun 1, 2017 01:24

Lemming: Apr 21, 2008

Dead Reckoning posted:

This makes literally no sense; since we'd be going to essentially a Medicare for all system, they would still need billing agents to argue with Healthy California to get reimbursements. Unless we're also socializing doctors' practices as well, which is not something the bill addresses.

Oh word? You're an expert on exactly how much hospitals spend on this overhead? I'd love to see the numbers you calculated yourself, because you surely did that instead of making bad assumptions.

# ? Jun 1, 2017 01:24

Dead Reckoning: Sep 13, 2011

Trabisnikof posted:

Do you have anything besides your lay opinion to discredit this report? Because you seem to be just confused by the fact this is an analysis of the bill and is focused on the outcomes rather than being a document laying out every single answer to every question you might ask.

I'm not performing nuclear research, I'm just reading the assumptions spelled out in the document Lemming linked. If you want to believe that Cali can achieve the same cost saving as Canada despite not having access to the mechanisms Canada uses to control costs, and despite there being no example of a U.S. state having successfully done what the authors propose, (but examples of states failing to do so), and despite the state legislative analyst not providing a similarly sunny outlook, that's no skin off my nose.

Lemming posted:

Oh word? You're an expert on exactly how much hospitals spend on this overhead? I'd love to see the numbers you calculated yourself, because you surely did that instead of making bad assumptions.

The Glumslinger posted that physicians would accept lower reimbursements because they would save money by not having to pay medical billing agents and "argue with insurance and medicaid to get payments." Nothing in the bill itself or the linked paper supports this conclusion, since doctors still use billing staff to interact with public insurance programs like Medicare and Medicaid. I don't see how calculations are relevant to the statement.

# ? Jun 1, 2017 01:45

Trabisnikof: Dec 24, 2005

Dead Reckoning posted:

I'm not performing nuclear research, I'm just reading the assumptions spelled out in the document Lemming linked.

You mocked someone for daring to ask a question about fire policy as a lay person, but presume to know all about healthcare. Yet you only can cite yourself and your misreading of a paper. Got it.

# ? Jun 1, 2017 01:48

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# ? May 15, 2024 01:47

Lemming: Apr 21, 2008

Dead Reckoning posted:

The Glumslinger posted that physicians would accept lower reimbursements because they would save money by not having to pay medical billing agents and "argue with insurance and medicaid to get payments." Nothing in the bill itself or the linked paper supports this conclusion, since doctors still use billing staff to interact with public insurance programs like Medicare and Medicaid. I don't see how calculations are relevant to the statement.

You would need to know how much staff they have to hire to deal with all the different insurance companies, how much less you'd need to spend if you were only dealing with one, and how much less you'd need to spend if you were dealing with a government run payer rather than a private insurer.

And wow there's research to support the idea that you'd save a loving lot of money right there https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4283267/ whoopdie poo poo that took two seconds in google, looks like you're talking out of your rear end what a surprise

# ? Jun 1, 2017 01:48

The Something Awful Forums > Discussion > Debate & Discussion > California Politics: Madame Senator, this is a morgue

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