Should California Pass Single Payer?

[radcen]

Its very difficult for a state to have single payer because a state cannot easily borrow money during economic downturns to pay for it. Healthcare needs are unrelated to economic growth. Just because a state is in an economic recession does not mean there will be less cancer patients or less heart attacks.

Just the same, California already has the best HMO in the country with Kaiser Permanente that provides more affordable coverage and gets better outcomes than just about any other insurer in the country. That would go away if they went to a single payer system. There are other market innovations in some California markets with hope of controlling health care costs in the future as well like Reference Pricing. That would go away as well with a single payer system.

The problem with going with a single payer system, aside from it being politically impossible, is that you lose some good with the bad. Health insurance is expensive because many providers are charging exorbitant prices. Your health premiums on the individual market for a family can be 20k a year because you have orthopedic surgeons billing more than 800k a year, anesthesiologists double billing for their nurse, hospitals charging over 400 dollars for a 22 dollar metabolic panel because they bill for each result individually even though its just one test, plastic surgeons charging tens of thousands of dollars for a couple of stitches in an emergency room after trauma, Neurologists charging 5k to spend a couple of minutes glancing at a CT scan result. Specialists doing 2 minute drive-bys with patients for no reason other than they can bill a couple of grand each time they do it. The list goes on an on, its a racket and we would call it fraud if it were any other industry.

Going to a single payer system doesn't fix any of that by itself. It just changes who pays for it. Neither party ever really talks about healthcare costs themselves (other than drug prices which is only 10 to 15% of over all health spending), they just talk about insurance premiums which are just a symptom of the problem. The closest either party gets to talking about curbing actual healthcare costs is when you have them pushing high deductible "consumer driven" plans which put the expense of routine care on patients rather than insurers. The idea being that you will then shop routine and ancillary care based on cost. The problem with that is that routine care and ancillary care are not the problem in terms of overall healthcare costs, seeing your GP for a yearly wellness is not that expensive to begin with. You will spend more in a 2 day hospital stay than you would in a lifetime of routine care. It is chronic and catastrophic healthcare costs that are the problem (which would still be paid for by a catastrophic plan), and no one in either party ever talks about doing anything to curb those costs.

I had Kaiser when I lived there, and they won me over. They were great. That's one thing I do miss since I moved.

 

[Cardinal]

FOR THIS POLL, ASSUME A FEDERAL SINGLE PAYER IS NOT AN OPTION.

California likes to point out that it is the 5th largest economy in the world, making it larger than Great Britain, which has a Single Payer Healthcare System.

Should California enact a Single Payer Healthcare System, as has been proposed?

It's interesting, but I wonder if free commerce and travel within the United States would pose a unique challenge when compared to all the other countries that have successfully instituted single payer.

 

[Cardinal]

Its very difficult for a state to have single payer because a state cannot easily borrow money during economic downturns to pay for it. Healthcare needs are unrelated to economic growth. Just because a state is in an economic recession does not mean there will be less cancer patients or less heart attacks.

Just the same, California already has the best HMO in the country with Kaiser Permanente that provides more affordable coverage and gets better outcomes than just about any other insurer in the country. That would go away if they went to a single payer system. There are other market innovations in some California markets with hope of controlling health care costs in the future as well like Reference Pricing. That would go away as well with a single payer system.

The problem with going with a single payer system, aside from it being politically impossible, is that you lose some good with the bad. Health insurance is expensive because many providers are charging exorbitant prices. Your health premiums on the individual market for a family can be 20k a year because you have orthopedic surgeons billing more than 800k a year, anesthesiologists double billing for their nurse, hospitals charging over 400 dollars for a 22 dollar metabolic panel because they bill for each result individually even though its just one test, plastic surgeons charging tens of thousands of dollars for a couple of stitches in an emergency room after trauma, Neurologists charging 5k to spend a couple of minutes glancing at a CT scan result. Specialists doing 2 minute drive-bys with patients for no reason other than they can bill a couple of grand each time they do it. The list goes on an on, its a racket and we would call it fraud if it were any other industry.

Going to a single payer system doesn't fix any of that by itself. It just changes who pays for it. Neither party ever really talks about healthcare costs themselves (other than drug prices which is only 10 to 15% of over all health spending), they just talk about insurance premiums which are just a symptom of the problem. The closest either party gets to talking about curbing actual healthcare costs is when you have them pushing high deductible "consumer driven" plans which put the expense of routine care on patients rather than insurers. The idea being that you will then shop routine and ancillary care based on cost. The problem with that is that routine care and ancillary care are not the problem in terms of overall healthcare costs, seeing your GP for a yearly wellness is not that expensive to begin with. You will spend more in a 2 day hospital stay than you would in a lifetime of routine care. It is chronic and catastrophic healthcare costs that are the problem (which would still be paid for by a catastrophic plan), and no one in either party ever talks about doing anything to curb those costs.

One point that confuses me is how the government acting as the sole negotiator operates as a mechanism for keeping health care costs down.

 

[Cephus]

One point that confuses me is how the government acting as the sole negotiator operates as a mechanism for keeping health care costs down.

It doesn't, in fact, the inefficient bureaucracy would likely just drive it up, but since people figure it doesn't come directly out of their pocket, who cares what it costs?

The only way to reduce health care costs is to control what health care actually costs. This simply does not get addressed.

 

[Lovebug]

Its very difficult for a state to have single payer because a state cannot easily borrow money during economic downturns to pay for it. Healthcare needs are unrelated to economic growth. Just because a state is in an economic recession does not mean there will be less cancer patients or less heart attacks.

Just the same, California already has the best HMO in the country with Kaiser Permanente that provides more affordable coverage and gets better outcomes than just about any other insurer in the country. That would go away if they went to a single payer system. There are other market innovations in some California markets with hope of controlling health care costs in the future as well like Reference Pricing. That would go away as well with a single payer system.

The problem with going with a single payer system, aside from it being politically impossible, is that you lose some good with the bad. Health insurance is expensive because many providers are charging exorbitant prices. Your health premiums on the individual market for a family can be 20k a year because you have orthopedic surgeons billing more than 800k a year, anesthesiologists double billing for their nurse, hospitals charging over 400 dollars for a 22 dollar metabolic panel because they bill for each result individually even though its just one test, plastic surgeons charging tens of thousands of dollars for a couple of stitches in an emergency room after trauma, Neurologists charging 5k to spend a couple of minutes glancing at a CT scan result. Specialists doing 2 minute drive-bys with patients for no reason other than they can bill a couple of grand each time they do it. The list goes on an on, its a racket and we would call it fraud if it were any other industry.

Going to a single payer system doesn't fix any of that by itself. It just changes who pays for it. Neither party ever really talks about healthcare costs themselves (other than drug prices which is only 10 to 15% of over all health spending), they just talk about insurance premiums which are just a symptom of the problem. The closest either party gets to talking about curbing actual healthcare costs is when you have them pushing high deductible "consumer driven" plans which put the expense of routine care on patients rather than insurers. The idea being that you will then shop routine and ancillary care based on cost. The problem with that is that routine care and ancillary care are not the problem in terms of overall healthcare costs, seeing your GP for a yearly wellness is not that expensive to begin with. You will spend more in a 2 day hospital stay than you would in a lifetime of routine care. It is chronic and catastrophic healthcare costs that are the problem (which would still be paid for by a catastrophic plan), and no one in either party ever talks about doing anything to curb those costs.

I go with this one as a hypothetical, but would like to add that all Ca residents must partake, the rich and the poor. Why? Because I like Hollywood to put their money where their mouth is.

 

[radcen]

It doesn't, in fact, the inefficient bureaucracy would likely just drive it up, but since people figure it doesn't come directly out of their pocket, who cares what it costs?

The only way to reduce health care costs is to control what health care actually costs. This simply does not get addressed.

I believe that our evolved insurance-driven market has done just that, too. People really don't care what something costs, they only care what their co-pay and/or deductible is.

 

[ALiberalModerate]

One point that confuses me is how the government acting as the sole negotiator operates as a mechanism for keeping health care costs down.

Well it has to because if you just have one payer, then they can negotiate far more reasonable rates from providers as that one payer represents all customers.

However, the same can be achieved by large fully integrated health systems that work like an HMO on the insurance side, but own all the providers in their network. Thus you get rid of the fee for service, and everyone is paid a salary. Everyone also works together as well. The GP can email a specialist lab results and get their opinion without having to refer you over. Moreover, they have an incentive to keep you healthy because you will most likely be a member for decades and thus they want to avoid as many preventable conditions as possible.

 

[radcen]

Well it has to because if you just have one payer, then they can negotiate far more reasonable rates from providers as that one payer represents all customers.

However, the same can be achieved by large fully integrated health systems that work like an HMO on the insurance side, but own all the providers in their network. Thus you get rid of the fee for service, and everyone is paid a salary. Everyone also works together as well. The GP can email a specialist lab results and get their opinion without having to refer you over. Moreover, they have an incentive to keep you healthy because you will most likely be a member for decades and thus they want to avoid as many preventable conditions as possible.

Key word: "can".

They could also agree to higher rates and costs due to successful lobbying, and if there's no comparison, who's to know?

 

[ALiberalModerate]

Key word: "can".

They could also agree to higher rates and costs due to successful lobbying, and if there's no comparison, who's to know?

Well that is the problem. Healthcare providers are the biggest spending lobbyists. That is why I think that before we even think about going to single payer, we need to mandate true price transparency with providers, break up provider monopolies and so on.

 

[Ikari]

FOR THIS POLL, ASSUME A FEDERAL SINGLE PAYER IS NOT AN OPTION.

California likes to point out that it is the 5th largest economy in the world, making it larger than Great Britain, which has a Single Payer Healthcare System.

Should California enact a Single Payer Healthcare System, as has been proposed?

No, it's impossible to do this on the state level well enough. If a single state does it, they'll attract a lot of folk who won't be paying into the system and it's going to grow too expensive quickly. The only way to have some single payer is to aggregate it over the whole, so a national single payer.

 

[RabidAlpaca]

So? Neither is Britain under the EU. Nothing stops California from providing care to Californians.
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Okedoke. Tell us about the border control measures Britain has that keeps non-British citizens out in such a way that they can have Single Payer, but California can't
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The difference is that almost all of Europe has some form of single payer healthcare with near 100% of their citizens insured. If one state in the US did it, when people get sick and their own state's healthcare system would massively **** them over and send them into astronomical debt, they would temporarily move to California as a medical tourist to get treatment.

Americans already do this with other nations and instead of blaming the ****ty healthcare system that created the situation in the first place we'd blame California's for not having a sustainable system because they're being flooded with people from out of state who won't spend years before and after their issue paying into the system. A single payer system can't work if people just pop in for treatment then leave.

 

[Surrealistik]

Healthcare costs are one of the most common topics discussed on NPR shows and I never hear any Democrats or Republicans talk about provider costs on them. Perhaps its because healthcare providers spend more on lobbying than anyone else.

Sure, single payer would be less expensive and cover more people. However, it is politically impossible. Progressives would be far better served by focusing on what is remotely possible like true price transparency with providers, requiring providers to provide a good faith cost estimate for a procedure at the time of consent, lowering the Medicare eligibility age down to about 55 or so, breaking up provider monopolies (half of all healthcare markets are a monopoly where one health system owns everything), reference pricing, promoting physician cooperatives, and much stronger insurer regulation.

Finally, California already has a model healthcare system with Kaiser Permanente, why would we throw that away and go to single payer when we ought to figure out a way to build on that model and expand it. Kaiser Permanente Is Seen as Face of Future Health Care - The New York Times

How on earth is SP politically impossible stateside?

Even after hearing the tax implications Californians are in majority support of SP.

The one and only reason SP isn't already on its way to law in SP is because of that traitor/pharma and insurer shill Democrat Anthony Rendon ( Democrats Help Corporate Donors Block California Health Care Measure, And Progressives Lose Again | International Business Times ), and it was a move made out of pure desperation. He and his kind can't keep it back forever, and the backlash thus far has been substantial. California should throw its existing system away because the SP alternative is almost certainly better assuming no willful sabotage during implementation.

The difference is that almost all of Europe has some form of single payer healthcare with near 100% of their citizens insured. If one state in the US did it, when people get sick and their own state's healthcare system would massively **** them over and send them into astronomical debt, they would temporarily move to California as a medical tourist to get treatment.

Americans already do this with other nations and instead of blaming the ****ty healthcare system that created the situation in the first place we'd blame California's for not having a sustainable system because they're being flooded with people from out of state who won't spend years before and after their issue paying into the system. A single payer system can't work if people just pop in for treatment then leave.

It's a valid point, but Cali can (and will likely have to) make a residence requirement for X years and as part of that, issue a health photo ID card to control access similar to what we have in Ontario (we ultimately were forced to issue such cards to stop mass defrauding of our healthcare system from Americans in the northern states).

One point that confuses me is how the government acting as the sole negotiator operates as a mechanism for keeping health care costs down.

This is probably the simplest part to understand. If you are familiar with how economies of scale work, and the negotiating power associated with bulk purchasers, you will readily understand this.

When you are the biggest buyer of a service or commodity, you have the biggest negotiating power to barter prices down; this is how Walmart for example can squeeze suppliers for lower prices.

The danger of course, especially in America, is that govt negotiators are captured by special interests.

 

[Greenbeard]

FOR THIS POLL, ASSUME A FEDERAL SINGLE PAYER IS NOT AN OPTION.

California likes to point out that it is the 5th largest economy in the world, making it larger than Great Britain, which has a Single Payer Healthcare System.

Should California enact a Single Payer Healthcare System, as has been proposed?

They probably shouldn't enact what was proposed, no. But a more thoughtful version? Sure, give it a go.

 

[phattonez]

I kind of want them to pass it just so that the state can go bankrupt and then the Feds have to take it over and in the process clean up the corruption. California could use a nice reconstruction.

 

[phattonez]

Where is the "if they want to. It is up to them" option?

That hasn't been possible since Californians have been dispossessed over the past decades.

 

[phattonez]

But I do have reservations as to how it will work, since Cali has no immigration provisions against citizens of other states! I fear a flood of uninsured, poorly insured, and financially compromised sick people from around the nation relocating to enjoy the healthcare.

We've been dealing with a flood of uninsured, poorly insured, and financially compromised sick people from around the world relocating to enjoy the healthcare and other benefits for decades. It's why this state is the huge mess that it is.

 

[phattonez]

It is also not a country with a border

Neither is the United States.

 

[Greenbeard]

One point that confuses me is how the government acting as the sole negotiator operates as a mechanism for keeping health care costs down.

The mechanism proponents would point to is essentially the opposite of a labor union. Whereas a labor union is a monopoly seller that lets you bargain up wages, single-payer would be a monopsony buyer that lets you bargain down wages.

In practice it's hard to see the politics of that approach working as described.

 

[phattonez]

No, it's impossible to do this on the state level well enough. If a single state does it, they'll attract a lot of folk who won't be paying into the system and it's going to grow too expensive quickly. The only way to have some single payer is to aggregate it over the whole, so a national single payer.

Gee I wonder if we applied this logic to immigration what kind of conclusions we would draw. Hmmm!

 

[Chomsky]

We've been dealing with a flood of uninsured, poorly insured, and financially compromised sick people from around the world relocating to enjoy the healthcare and other benefits for decades. It's why this state is the huge mess that it is.

Well, say what one wants about Trump, he has got the illegal immigration problem right.

I was blown away when Reagan was in the process of granting amnesty, to find illegal aliens could receive public benefits! Wha? Why?

 

[Surrealistik]

They probably shouldn't enact what was proposed, no. But a more thoughtful version? Sure, give it a go.

What's your problem with existing proposals?

The mechanism proponents would point to is essentially the opposite of a labor union. Whereas a labor union is a monopoly seller that lets you bargain up wages, single-payer would be a monopsony buyer that lets you bargain down wages.

In practice it's hard to see the politics of that approach working as described.

Billings, pharmaceuticals and other medical supplies would be the primary targets of focus, not so much wages directly, so yes, given the zeitgeist where people are finally cognizant of what a complete racket health costs are in America, this is more than politically viable.

Absolutely!

States are the laboratories of democracy. Let them be the test case. We can get some real-world American data.

But I do have reservations as to how it will work, since Cali has no immigration provisions against citizens of other states! I fear a flood of uninsured, poorly insured, and financially compromised sick people from around the nation relocating to enjoy the healthcare.

But yes, if Californians desire to try this route, by all means they should not be hindered - particularly by Washington!

Do what we in Ontario have done out of necessity due to Americans defrauding our healthcare system in the 90s en masse ( Americans Filching Free Health Care in Canada - NYTimes.com ): implement a photo ID required to receive SP covered govt healthcare. I would also probably add a 1+ year residence requirement before you are eligible for SP and get your card.

 

[phattonez]

Do what we in Ontario have done out of necessity due to Americans defrauding our healthcare system in the 90s en masse ( Americans Filching Free Health Care in Canada - NYTimes.com ): implement a photo ID required to receive SP covered govt healthcare. I would also probably add a 1+ year residence requirement before you are eligible for SP and get your card.

ID cards are racist. Democrats told me.

 

[earthworm]

Health care MUST be equal, fair, respecting, AND affordable .. today, IMO, its none of these .. for the ''poor'' and middle .
HC MUST NOT be free ..but, it MUST be taught in our schools ..We must know how to take care of ourselves ..far too many do not ..
How many know how , and when to apply a Band-Aid ?
How many know how to blow their nose ?!?

 

[earthworm]

ID cards are racist. Democrats told me.

Ha !
But they can be .. and its conservatives who cause this ....

 

[Chomsky]

Do what we in Ontario have done out of necessity due to Americans defrauding our healthcare system in the 90s en masse ( Americans Filching Free Health Care in Canada - NYTimes.com ): implement a photo ID required to receive SP covered govt healthcare. I would also probably add a 1+ year residence requirement before you are eligible for SP and get your card.

Yes. But as you alluded to in your last sentence, Americans can simply hop in their car and legally resettle as citizens permanently residing in California.