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There is absolutely a logical reason to believe it will improve things. Your opposition is ostensibly based on a pearl-clutching "but what if the insurance companies say no?! California can't force them!" hypothetical. It's not that there's no reason to believe it would succeed, it's that there is a chance that it may fail. That's your justification for opposing it entirely. Maybe you'd be a better person if your dad made you try out for the softball team.
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Jul 4, 2017 21:42
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Cup Runneth Over posted:Maybe you'd be a better person if your dad made you try out for the softball team. I'm with you up to the ad-hominem. Don't think that's productive. All the same, the bill was a skeleton the last time I saw it. As far as procedural concerns, has it been finalized and can it be reviewed publicly? Or go we have to unlock this process before we can make changes?
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Jul 4, 2017 22:17
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y'all can just ignore DR and maybe she'll go awayJo posted:I'm with you up to the ad-hominem. Don't think that's productive. All the same, the bill was a skeleton the last time I saw it. As far as procedural concerns, has it been finalized and can it be reviewed publicly? Or go we have to unlock this process before we can make changes? the bill was a skeleton because the democrats in the legislature were too terrified to be seen voting for a tax hike. The funding parts exist, they were just deliberately not included in the bill
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Jul 4, 2017 22:27
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Dead Reckoning posted:"Better to have tried and failed than never to have tried at all" is what you tell your kid when they're nervous about going out for the softball team. It is not a rationalization for spending millions of dollars on quixotic projects that are incomplete, poorly thought out, or doomed to fail (all three, in this case) because of some pearl-clutching "we have to do *something*!!" mindset. No matter how lovely the status quo is, it is irrational to endorse change if there is no logical reason to believe it will actually improve things. Cup Runneth Over posted:There is absolutely a logical reason to believe it will improve things. Your opposition is ostensibly based on a pearl-clutching "but what if the insurance companies say no?! California can't force them!" hypothetical. It's not that there's no reason to believe it would succeed, it's that there is a chance that it may fail. That's your justification for opposing it entirely. Maybe you'd be a better person if your dad made you try out for the softball team. If California were to create a prescription wholesale distribution system called CalMeds and it would be an effective monopsony for 40 million people. This is because the CalMeds would actually buy all of the medication and distribute it at minimal profit to local pharmacies. This is how the VA does it, it runs its own pharmacies and distribution systems. This would be ~31 billion USD (lets just assume that any decrease in cost would be made up by increased demand due to lower cost) Now the Government of California can't actually setup this system because their state constitution is loving broke when it comes to funding any sort of government program. Remove the taxpayer revolt amendments and then California would be able to build whatever system it wants. In regards to federal single payer that allows the US to keep the federal health care entitlements but reduces flexibility of state and local governments to provide for care in the gaps of the federal program. Are we going to start to say that cities and counties won't be able to levee property taxes to pay for a city and county hospital expenses when there are cost overruns? You have the same problem with state level single payer. Medicaid could be rolled into a State single payer plan but you have problems with Medicare. Unlike Medicaid, Medicare is an entitlement to the patient that the hospital will be payed directly out of Medicare Part A, the doctor will be payed directly out of Medicare part B and the pharmacist will be payed out of Medicare part D. There is no part of the Medicare system that allows for the State to act as an intermediary. So instead we have this shitstorm in the Californa bill. quote:(2) It is the intent of the Legislature for the state to work to obtain waivers and other approvals relating to Medi-Cal, the state’s Children’s Health Insurance Program, Medicare, the PPACA, and any other federal programs so that any federal funds and other subsidies that would otherwise be paid to the State of California, Californians, and health care providers would be paid by the federal government to the State of California and deposited in the Healthy California Trust Fund. We are asking that the federal government weaken entitlement healthcare programs and block grant the money to the States so that there is a check mark on "single payer". The State could easily create a Medigap program but that would be a violation of single payer because for people over 65 you would have Medicare A, B, D and the state Medigap covering 100% of the care. Quad-payer is not single-payer.
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Jul 4, 2017 22:42
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karthun posted:Remove the taxpayer revolt amendments Agreed.
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Jul 4, 2017 22:46
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Single payer would be an absolute disaster on a state level, and would delay the national passage for decades if not complete generations. I have no idea who wants to make healthcare better in the long term would want it passed, unfortunately the pro side is being massively disingenuous. Raskolnikov38 posted:y'all can just ignore DR and maybe she'll go away  my echo chamber
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Jul 5, 2017 19:56
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Just like gay marriage and marijuana legalization! Massachusetts and Hawaii suggest that state-level healthcare system laws can work, so what makes single-payer so uniquely impossible?
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Jul 6, 2017 01:31
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TROIKA CURES GREEK posted:Single payer would be an absolute disaster on a state level, and would delay the national passage for decades if not complete generations. I have no idea who wants to make healthcare better in the long term would want it passed, unfortunately the pro side is being massively disingenuous. Yeah, and the side with the health insurance companies defending their take on it isn't being disingenuous at aaaaaall
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Jul 6, 2017 01:39
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CA's restrictions on raising taxes and not being able to run deficits in bad times/ surplus in good ones are the biggest hurdles. But if we find a way around those and we do get UHC then even more people will want to move here.
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Jul 6, 2017 01:40
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Anti-single payer people are impossible to argue with. As perfectly epitomized by the way Dead Reckoning always posts in this thread, they have no solutions. They don't want to talk about it. They just say "no." There's no constructive dialogue on this topic, it's pure pathological aversion. Leverage is a problem? Well, what do you suggest we do about that? Nothing, don't even try. Meanwhile people continue to die, and they'd rather just sit on their thumbs than come up with numbers and solutions, despite the many examples of it working elsewhere, ostensibly because there's some places where it didn't work. (And there's nothing pearl-clutchy about that, any more than pointing out the AHCA will kill millions. It's a fact. People are dying.)
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Jul 6, 2017 01:44
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snyprmag posted:CA's restrictions on raising taxes and not being able to run deficits in bad times/ surplus in good ones are the biggest hurdles. But if we find a way around those and we do get UHC then even more people will want to move here. This seems like a good place to start, regardless of stance on single-payer. Not to ask you to, "do my homework for me," but is there somewhere I can get better informed on this policy so I don't sound like a dumbass when I talk to my reps?
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Jul 6, 2017 02:17
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TROIKA CURES GREEK posted:Single payer would be an absolute disaster on a state level, and would delay the national passage for decades if not complete generations. I have no idea who wants to make healthcare better in the long term would want it passed, unfortunately the pro side is being massively disingenuous. People in this thread don't dislike you two for disagreeing with us. We dislike you for having poo poo arguments. I'm happy to hear specific arguments for why single payer won't work in CA, but poo poo like "but Vermont" isn't that.
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Jul 6, 2017 03:51
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Jo posted:This seems like a good place to start, regardless of stance on single-payer. Not to ask you to, "do my homework for me," but is there somewhere I can get better informed on this policy so I don't sound like a dumbass when I talk to my reps? Prop 13 makes it so we need a 2/3rds majority in both houses for raising taxes. I guess I was wrong about the deficit thing, cause apparently we have a $1.6b deficit this year. The state would need to capture enough of the money that businesses currently spend to pay for their employee's health benefits. Overall it should costs businesses less than what they currently pay, but Americans always seem wiling to spend more for private industry stuff than pay dreaded taxes.
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Jul 6, 2017 04:46
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Put language in the single-payer bill that says the law will only go into effect subject to a November 2018 ballot initiative that exempts it from prop 13, 98, and whatever other dumb California poo poo is in the constitution otherwise it's void. Problem solved. If the opponents of single payer are so certain that Californians will vote it down then there's no risk here (they aren't, they are afraid it will pass and poor people will get healthcare, which will make them feel less special for having it and that feeling of specialness is so important they're willing to risk financial ruin should they have a problem expensive enough for their employer to fire them or insurer to drop them)
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Jul 6, 2017 05:17
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snyprmag posted:But if we find a way around those and we do get UHC then even more people will want to move here. You have now turned me against single payer. Not really but how is even more people driving down wages and driving up rents a good thing
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Jul 6, 2017 05:22
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Minimum wage and rent control?
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Jul 6, 2017 06:44
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Grand Prize Winner posted:You have now turned me against single payer. Not really but how is even more people driving down wages and driving up rents a good thing More people drives down wages? Midwest must be loaded these days.
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Jul 6, 2017 06:51
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Prop 98 refers to the general fund. There's almost certainly a work around. Perhaps we could set up a trust or public corporation like with social security.
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Jul 6, 2017 08:32
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It's been a while since I read the bill, but I think it does indeed set up a trust that's separate from the General Fund. Edit: Yep. CPColin fucked around with this message at 15:41 on Jul 6, 2017 |
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Jul 6, 2017 14:20
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Progressive JPEG posted:More people drives down wages? Midwest must be loaded these days. I suppose I can see where this claim comes from. If we assume a non-uniform distribution of persons with educational levels sampled from the US population and take the data about median income from that, if you add a single person to your state population, they're more likely to be below the median educational level than above and, by virtue of the skew curve, more likely to be below the median income than above it. I don't know if this pans out. I have neither crunched the numbers nor looked at studies, but it doesn't seem inconceivable. Are there any federal laws preventing Cal-Single-Payer from requiring a California ID or license? (Similarly, does Canada require citizenship for medical benefits?)
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Jul 6, 2017 16:29
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Jo posted:Are there any federal laws preventing Cal-Single-Payer from requiring a California ID or license? (Similarly, does Canada require citizenship for medical benefits?) http://law.justia.com/constitution/us/amendment-14/96-right-to-travel.html
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Jul 6, 2017 16:38
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Jo posted:Are there any federal laws preventing Cal-Single-Payer from requiring a California ID or license? (Similarly, does Canada require citizenship for medical benefits?) The bill itself extends eligibility to "every resident" of California, though it does not define how one is considered a "resident." I'm guessing that determination is codified elsewhere. The federal Medicare for All Act, which will also never reach a vote, uses a "treat first, ask questions later" approach to eligibility, which is nice.
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Jul 6, 2017 17:10
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CopperHound posted:IANAL but maybe the 14th amendment? Presumably any sane proposal would include provisions for visitors, e.g. like the NHS does in the UK: https://www.hr.admin.cam.ac.uk/hr-services/relocating-uk/living-uk/healthcare/eligibility-nhs-treatment A California ID would grant no-cost access to care: if you do not have one, you pay via some other means. Either your out-of-state insurer has an agreement with the CA system to pay whatever prices CA healthcare has set (sort of the reverse of what Medicare does with hospitals) or you pay a set price up front (single payer should hopefully force more standardized pricing than the current clusterfuck between private insurers and Medicare). Edge cases are unavoidable--emergency care is always a problem but it's not like the current system handles that perfectly for people without insurance either. People moving into the state solely to obtain medical care is something new, but probably more of an edge case than you'd expect.
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Jul 6, 2017 19:04
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CPColin posted:The bill itself extends eligibility to "every resident" of California, though it does not define how one is considered a "resident." I'm guessing that determination is codified elsewhere. Wouldn't they just use the same residency requirements that the UC and CSUs use for determining in-state tuition?
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Jul 6, 2017 19:09
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Probably!
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Jul 6, 2017 19:57
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CPColin posted:Probably! In the 2040 dramedy remake of Fresh Prince of Bel-Air, Will has to leave Philadelphia because he has leukemia and stay with Uncle Phil and Aunt Viv to get CA residency and get treatment. EDIT: Another serious consideration for CA-only single payer is the brain-drain that will occur in the health sector. Right now, doctors in the US get paid around 66% as much through Medicare as they would for the same services paid with private insurance. Pretty much all single-payer systems pay doctors less. So in the face of a potential ~33% pay cut (along with an increased tax burden) it could result in a lot of doctors picking up and heading to other states to continue their practice. Now, this isn't a big a deal for nations with single-payer coverage, because immigrating to another country is much more difficult than moving between states. Even if a mere 5% of the doctors in the state decide "gently caress it, I'm moving to New York/Texas/etc" that could cause serious problems. LanceHunter fucked around with this message at 20:22 on Jul 6, 2017 |
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Jul 6, 2017 20:06
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Meanwhile, Uncle Phil tosses Jazz out the front door so hard that he loses his health care.
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Jul 6, 2017 20:13
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LanceHunter posted:In the 2040 dramedy remake of Fresh Prince of Bel-Air, Will has to leave Philadelphia because he has leukemia and stay with Uncle Phil and Aunt Viv to get CA residency and get treatment. Health care will not simultaneously become more expensive and pay doctors less. This fear is pretty unreasonable.
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Jul 6, 2017 20:44
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LanceHunter posted:In the 2040 dramedy remake of Fresh Prince of Bel-Air, Will has to leave Philadelphia because he has leukemia and stay with Uncle Phil and Aunt Viv to get CA residency and get treatment. And, as we've seen, doctors and hospitals routinely refuse to accept Medicare patients. Oh wait, no, Medicare's coding systems and patient base are a major component of the American healthcare system because Medicare has huge buying power and refusing to accept Medicare patients would spell bankruptcy for any medical provider that's not solely dealing in extremely specialized treatment that can only be afforded by the extremely well-off anyway.
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Jul 6, 2017 21:02
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Is there/is it possible to make and estimate of how much would be saved by state-provided preventative care and early detection vs the status quo of waiting until health problems are an emergency?
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Jul 6, 2017 21:07
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Dead Reckoning posted:IIRC, the Canadian Patent & Trademark office has a committee that can investigate drug prices and mandate lower prices in some cases. They can do this because they are a sovereign country. California cannot do this, because it is an administrative subdivision of the United States; Cali can only say how much we are willing to pay. We cannot force the manufacturer to sell at that price. This is why I think single payer is something we should be focusing on at the federal level. What is the difference between mandating a lower price and saying how much you're willing to pay? How is Canada forcing the sale? Presumably this means that if drug companies want to sell, they must sell at a certain price, not that they HAVE to sell. In both Canada and California the drug companies can walk away.
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Jul 6, 2017 21:16
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The difference is who is seen as the bad guy. How do you steer the narrative between "profiteering companies killing people" and "state letting patients die because treatment is too expensive"? Who will blink first? Shareholders or politicians? Is there any possibility of something like CPUC or insurance commissioner for drugs and medical devices to rake companies over coals to explain prices? CopperHound fucked around with this message at 21:35 on Jul 6, 2017 |
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Jul 6, 2017 21:30
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The Wiggly Wizard posted:Is there/is it possible to make and estimate of how much would be saved by state-provided preventative care and early detection vs the status quo of waiting until health problems are an emergency? https://www.peri.umass.edu/publication/item/996-economic-analysis-of-the-healthy-california-single-payer-health-care-proposal-sb-562 We could expand coverage to everyone and it would reduce total costs by about 18%
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Jul 6, 2017 21:43
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anatoliy pltkrvkay posted:And, as we've seen, doctors and hospitals routinely refuse to accept Medicare patients. Argue against the conclusion, fine, but "doctors will stay in CA but refuse to take the state's patients" wasn't at all the described concern.
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Jul 6, 2017 21:54
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Lemming posted:Health care will not simultaneously become more expensive and pay doctors less. This fear is pretty unreasonable. You can pay less per patient/procedure but still have total costs rise because of the additional number of people being covered. Doctors in the US get paid more than in any country with a single-payer system, and one of the inevitable results of single-payer will be doctors making less money. The problem with only having single payer in a single state is that it is much easier for doctors to leave. anatoliy pltkrvkay posted:And, as we've seen, doctors and hospitals routinely refuse to accept Medicare patients. Medicare is also a national program and you can't simply cross over to the next state to suddenly get paid the higher private-insurance rates for those patients. CopperHound posted:The difference is who is seen as the bad guy. How do you steer the narrative between "profiteering companies killing people" and "state letting patients die because treatment is too expensive"? Sometimes neither party will blink and it just means that certain drugs aren't provided to people on the single-payer plan. As I mentioned previously, this is fairly common, and it's something that is part of having a single payer plan. The continued shouts of "CALIFORNIA BUYING POWER" aren't going to cover up the hard realities that would accompany a switch to single-payer. There are certain drugs that aren't going to be covered. There are doctors who will choose not to practice in California. We shouldn't try to pretend that this isn't going to happen, but instead should decide if these are trade-offs that we're willing to make.
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Jul 6, 2017 21:58
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LanceHunter posted:You can pay less per patient/procedure but still have total costs rise because of the additional number of people being covered. Doctors in the US get paid more than in any country with a single-payer system, and one of the inevitable results of single-payer will be doctors making less money. The problem with only having single payer in a single state is that it is much easier for doctors to leave. The specific criticism is against the claim of a double whammy of getting paid less and then getting taxed more for health care. Again, by every metric costs will go down for the individual, so you can't claim two conflicting problems will happen at the same time.
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Jul 6, 2017 22:08
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Lemming posted:The specific criticism is against the claim of a double whammy of getting paid less and then getting taxed more for health care. Again, by every metric costs will go down for the individual, so you can't claim two conflicting problems will happen at the same time. I've yet to see anyone claim that there would be no raise in taxes needed for California to be able to afford a single-payer plan. Who knows what form it will take, but there will be tax increases to pay for single-payer. Sure, that tax increase may be offset for the majority of Californians by not having to pay for insurance, but it'll still be a tax increase. So yes, doctors will be seeing a tax increase and a wage cut. That said, I imagine the wage cut will be a much bigger factor in any doctors that choose to leave.
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Jul 6, 2017 22:20
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LanceHunter posted:I've yet to see anyone claim that there would be no raise in taxes needed for California to be able to afford a single-payer plan. Who knows what form it will take, but there will be tax increases to pay for single-payer. Sure, that tax increase may be offset for the majority of Californians by not having to pay for insurance, but it'll still be a tax increase. So yes, doctors will be seeing a tax increase and a wage cut. That said, I imagine the wage cut will be a much bigger factor in any doctors that choose to leave. Ok, you're just being completely disingenuous then. People are going to move away because their taxes go up but their premiums and related health care costs, which are higher than the taxes, go away. Show some research that supports that point or shut up about it because it's a completely stupid point.
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Jul 6, 2017 22:28
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Lemming posted:Ok, you're just being completely disingenuous then. People are going to move away because their taxes go up but their premiums and related health care costs, which are higher than the taxes, go away. Show some research that supports that point or shut up about it because it's a completely stupid point. You're really just picking at anything possible to try and pretend that there wouldn't be a brain-drain issue. Some doctors near retirement shut down their practices rather than going through the process of digitalization required by Obamacare, even though ultimately that would have been a cost-saving measure. People can overweigh immediate costs when making decisions. Once again, though, a much bigger factor than the tax increases in the potential brain-drain situation would be the 30% pay cut.
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Jul 6, 2017 22:39
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Maybe doctors (and their staff) can make up that pay cut by not wasting so much time dealing with the loving insurance companies.
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Jul 6, 2017 22:49
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