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Healthy California Act: proposal to make findings about single-payer healthcare
- deleted 10y ago[deleted]
- exabrial 10y agoWho will pay for it?
- mmoche 10y agoAll of its residents.
- kingmanaz 10y agoSans illegal aliens.
- darkstar999 10y agoWell, even illegal immigrants pay taxes one way or another if they have a job or buy anything.
- whafro 10y agoOf course, they also pay lots of taxes too, including sales tax, and presumably some of that, directly or indirectly, would offset the costs of this kind of program.
- DennisP 10y agoIn theory they could have a problem with really sick people moving to California for the healthcare, raising their costs. But that takes time, so maybe before it becomes a big problem, other states will do similar things.
- bsimpson 10y agoInteresting idea. In practice, I wonder if there'd be a grace period, e.g. your insurance doesn't kick in until you've lived in California a year. However, since so many jobs start your insurance benefits on day 1, I'd expect this would have to as well.
- kcorbitt 10y agoThis isn't really an "in theory." Welfare states are fundamentally incompatible with open borders until we live in a world where equivalent levels of welfare are available everywhere. The incentives just don't add up. On the other hand it could still work if the benefit is only available to Californians who have lived there for X years. Not sure about the legality of this though -- states can discriminate this way for in-state University tuition, but in Zobel v. Williams the Supreme Court ruled that Alaska couldn't pay out Permanent Fund dividends based on how long you had lived in Alaska (https://en.wikipedia.org/wiki/Alaska_Permanent_Fund https://en.wikipedia.org/wiki/Alaska_Permanent_Fund).
- tylersmith 10y agoIf that were true there would be no need for taxes. But in reality poor people will steal from non-poor people. That's what taxes are. "everybody pays" is a worthless statement if you don't include amounts.
- deleted 10y ago[deleted]
- adamnemecek 10y agoI feel like you know the answer.
- SwellJoe 10y agoCalifornia 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 a competitive advantage on some vectors, so maybe it would have a net positive impact on economic growth in the state. 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 (but, maybe this is just me having a selective memory). But, the CA economy is very, very, big (the biggest, and bigger than many other states combined). If any state could do it, it would be CA. It'd be interesting, anyway. Somebody has to go first.
- dragonwriter 10y ago> 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.
- 013a 10y agoA valid concern considering the state is projected to be running on a deficit before long [1] [1] http://www.latimes.com/politics/la-pol-sac-jerry-brown-budget-trump-risks-20170110-story.html http://www.latimes.com/politics/la-pol-sac-jerry-brown-budge...
- dragonwriter 10y agoThe taxpayers of the state would be the (trivial) cost this bill would incur (basically, the cost of printing it: it's a statement of intent and nothing more) out of existing taxes.
- Chinjut 10y agoWho pays for healthcare now? Why would it be harder to support in a cheaper system like single payer?
- df3 10y agoA 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.
- erichocean 10y agoI'd be okay with single-payer in CA if we implemented the system in Denmark. Great mix of "everyone is covered" with choice/doctor control. I wish more people wanted it. :( If we're just going to keep doing the ACA, no thanks. What a piece of shit that legislation turned out to be.
- jbhatab 10y agoHere's the only thing I'm confused about. Do we have examples of the government running a service better than the private sector? I'm not 100% on this, but it seems all of the best aspects of American services come from competition and letting capitalism thrive. Would love a counter opinion.
- toomuchtodo 10y ago> Would love a counter opinion. Every other first world country? https://en.wikipedia.org/wiki/List_of_countries_with_universal_health_care https://en.wikipedia.org/wiki/List_of_countries_with_univers...
- maxerickson 10y agoSeveral of those countries implement universal coverage using a private insurance model.
- toomuchtodo 10y agoIn almost all European countries, its provided by the government and funded by taxation. My point stands.
- masterleep 10y agoWe are doomed.
- drdeadringer 10y agoWhy?
- tylersmith 10y agoBecause for hundreds of years collectivism has been accelerating and it's become nearly, if not entirely, out of control at this point.
- darkstar999 10y agoSerious question: what do you propose we do with the people dying in the street?
- tylersmith 10y agoMake them move out of the streets and into the country.
- drdeadringer 10y agoThat's the entire plan? Drop them off in the forest and drive off? There's a bit more to homelessness and surviving in the country.
- Apocryphon 10y agoAh yes, "collectivism." What you call that, the masses of humanity call civilization.
- tylersmith 10y agoExactly, that's the problem.
- consultutah 10y agoI think this is great. California gets to experiment with a single payer system and I, as a Utahan, get to watch and see whether it works or not. Unless it completely fails, then we'll all need to bail Cali out. Can we try this in North Dakota first? ;)
- r00fus 10y agoWhy would you as a Utahn need to bail out California? You know that CA ran deficits for years? Be happy - just like MJ legalization, this is true federalism at work - states rights and all. Of course, as a CA resident, I'd be happy that people here have an option aside from the horrible individual insurance market (which, despite Obamacare, is still very expensive).
- Joof 10y agoWorked for many other countries. Seems to be quite a bit cheaper for individuals and nations as well. Not sure if it will work on a state level though.
- darkstar999 10y agoOnly if CA can negotiate lower costs, especially pharmaceuticals.
- 086421357909764 10y agoand establish uniform pricing for services across the board
- darkstar999 10y agoNot sure if that's totally fair, Califoria is very diverse. Rates that work in SF might not work in rural CA.
- fsargent 10y ago
- deleted 10y ago[deleted]
- AdeptusAquinas 10y agoWelcome to the rest of the civilised world.
- deleted 10y ago[deleted]
- tlrobinson 10y agoSeems like a bit of a work in progress...?
- unethical_ban 10y agoI congratulate the senators on proposing universal health-care in a way that in federally Constitutional: that is, through the states! Though I'm usually skeptical of government overreach and innefficiency, I do believe a minimum of preventative care would save people and the system a lot in terms of money, time, and life. So go for it, and let the rest of the country see how it goes.
- dragonwriter 10y agoNote that this bill, in its current form, has no substantive effect; it would only "make findings and declarations with regard to the availability and affordability of health care coverage and would state 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." The actual legislation establishing single-payer health coverage and a cost control system has not been proposed.
- dang 10y agoThanks, we added 'make findings' above. If someone suggests a better (more accurate and neutral) title we can change it again.
- marcell 10y agoI 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. So (2) is saying health care costs are rising, which is bad. And (4) is saying insurance companies are making decisions based on price, which is also bad. You can't have it both ways. Either we should keep costs down, in which case some procedures will be denied as they are too expensive, or we pay for every procedure imaginable, causing prices to go up.
- old-gregg 10y agoYes 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_and_countries_by_GDP_(nominal) https://en.wikipedia.org/wiki/Comparison_between_U.S._states... [2] https://www.washingtonpost.com/news/wonk/wp/2013/03/26/21-graphs-that-show-americas-health-care-prices-are-ludicrous/?utm_term=.09e01c5211e5 https://www.washingtonpost.com/news/wonk/wp/2013/03/26/21-gr... [3] https://en.wikipedia.org/wiki/Medi-Cal https://en.wikipedia.org/wiki/Medi-Cal
- ars 10y ago> can negotiate prices down by 50-60% You can only do that by paying Doctors less. Good luck with that. If you did it anyway, good luck finding enough Doctors. When people think "negotiate prices" they usually think of drugs, but Doctors is the real problem. Medi-Cal (and Medicaid in general for all states) only works because the regular rates subsidize the under-market charity rates. That only works up to a point, then it doesn't. That BTW is why hospitals never publish rates - they need the higher rates to subsidize the charity rates. Until you change that, you will never have single payer, it's impossible to do.
- wjossey 10y agoI'm excited to see this show up on hacker news. As a Santa Monica resident, I'd gladly pay more in taxes for universal coverage. The only way that we are going to achieve federal universal coverage is via states paving the way. Just as "Romney care" was a predecessor to the ACA, so can healthy California pave the way for the US to join the rest of the modern world with guaranteed access.
- __realtime 10y agoGlad you have that luxury, CA has some of the highest taxes anywhere and I would definitely be opposed to more.
- Upvoter33 10y agoum, not really. the property taxes are so broken that many people own multi-million dollar homes and pay for them as if they were worth nearly nothing. that said, sales tax and state tax rates are high, so if you just mean that, you are right.
- sharkmerry 10y ago>> that said, sales tax and state tax rates are high, so if you just mean that, you are right. This is a result of the property taxes being fixed(ish) though, isnt it? Since they cant get true value from that, they have to raise other taxes to make up for it.
- acdha 10y agohttps://taxfoundation.org/state-and-local-sales-tax-rates-2016/ https://taxfoundation.org/state-and-local-sales-tax-rates-20... “The five states with the highest average combined state and local sales tax rates are Tennessee (9.46 percent), Arkansas (9.30 percent), Louisiana (9.0 percent), Alabama (8.97 percent), and Washington (8.90 percent).”
- refurb 10y agoThat analysis ignores the income brackets. If I have the choice of living where the state income tax hit 8% at $50K vs. %9 at $200K, I'd gladly live in the state with the "higher" state income tax rate.
- darkstar999 10y agoI 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 point of this?
- tylersmith 10y ago> Maybe I'm uneducated on "acts"? "acts" are how smarter Californians let the lesser Californians what to do. > What is the point of this? To make people feel good about themselves.
- jkimmel 10y agoThe 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.
- gavman 10y agoVermont 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-113711 http://www.politico.com/story/2014/12/single-payer-vermont-1... [2] http://www.latimes.com/projects/la-me-pension-crisis-davis-deal/ http://www.latimes.com/projects/la-me-pension-crisis-davis-d... [3] http://www.cnbc.com/2016/05/26/californias-revenue-picture-dims.html http://www.cnbc.com/2016/05/26/californias-revenue-picture-d...
- unabridged 10y agoCalifornia could get rid of their budget issues instantly with a progressive property tax. How about an extra bracket for nonhomesteads starting at values over $1M?
- jquery 10y agoHow about we get rid of Prop 13, a not-so-stealth tax on the young.
- CalChris 10y agoThere 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.
- bsder 10y ago> 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.
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- michaelchisari 10y agoHealthcare is such a massive hurdle to entrepreneurship, this would be huge!
- deleted 10y ago[deleted]
- ThomPete 10y agoIt has very little effect if any. denmark have a true single payer system and social wellfare program you can only dream of in the us. Yet the number of startups created are declining just like ine the us. It creates a very different mindset.
- michaelchisari 10y agoIt creates a very different mindset. Danes aside, are you saying that single payer healthcare would convince Californians to be more conservative towards entrepreneurship?
- ThomPete 10y agoNo i am saying that its not going to change anything and that longer term it changes how people think of risk.
- michaelchisari 10y agoI find that a bold assertion.
- ThomPete 10y agoYeah well i have tried both.
- michaelchisari 10y agoWhat have you tried both of?
- ThomPete 10y agoHere 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.
- amluto 10y agoBy giving them healthcare? There aren't actually a large number of illegal immigrants sitting around contributing nothing to the CA economy.
- mahyarm 10y agoA lot of them even pay taxes with stolen SSNs!
- ThomPete 10y agoits not that easy. Once you have a single payer system suddenly you need to follow a budget. You now have to put limits on how many can be treated, for what, what kind of treatments and machines you have budgets for. Thats the thing with healtcare you can never spent enough on it and that alone will affect the willingness to pay for others.
- FT_intern 10y agoI did a quick search and an estimated 11 million illegal immigrants pay an estimated $11.6 billion in taxes, so $1,000 per person. It's a huge net loss. Not to mention the fallout from stolen SSNs and creating demand for stolen SSNs
- amluto 10y agoYou're making an incorrect assumption that taxes paid are proportional to GDP contribution. Do you really think that, for example, low-paid migrant farm workers contribute correspondingly little to economic output? They contribute hugely to farm output! As an extreme example, unpaid workes (slaves in places and times with slavery, interns, etc) still contribute to their employers' output. The right thing to do isn't to reduce their rights and benefits to be commensurate with their nonexistent salaries; instead, their rights and benefits (and hence taxes) should be increased to be (at least) commensurate with their value to the economy. The stolen SSN issue is a bizarre strawman. There's a trivial solution: give them real SSNs.
- bawana 10y agoif health care prices were mandated to be public (like calorie counts on food) then we would all be better off
- cortesoft 10y agoKnowing health care prices doesn't help much, though. If you break your leg, you aren't going to go to a bunch of different hospitals, compare prices, and choose the best value option. If you are in a car accident and unconscious, the paramedic isn't going to figure out where you can get the best deal. Medical decisions are a TERRIBLE candidate for a free market. You are never in a position to be a rational actor in them.
- Keverw 10y agoSeems like an interesting idea. With California being the only state in the country doing this, I wonder what is there to stop people from other states using it. Someone from Washington or Texas driving up and getting a short term apartment/changing their ID just so they are covered for a really expensive surgery. It seems like if they're the only state doing it, it'd be a target for the entire nation to go to when they really need care they cannot afford where they are currently.
- birken 10y agoYou could say the same thing for people qualifying for in-state tuition to University of California colleges (which is significantly cheaper than out-of-state tuition). Just moving to CA and making yourself a CA resident isn't enough, I think the rule there is you need have physically lived in a residence in CA for 1 year and intend to stay living in CA. No reason why they couldn't make a similar restriction for health care.
- deleted 10y ago[deleted]
- AYBABTME 10y agoSame way as it's solved in Canada - each province manages it's own healthcare system and provides health insurance cards to its residents. You get health insurance IFF you're resident, and you're resident IFF you pay taxes in that province. So that lines up
- rdmcfee 10y agoA 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/medical-services-plan/msc-payment-schedule-december-2016.pdf http://www2.gov.bc.ca/assets/gov/health/practitioner-pro/med...
- jbhatab 10y agoWhy is single payer better? Genuinely curious. I just don't have any solid proof of the American Government doing a better job than the private industry enabled by competition.
- davewritescode 10y agoIt's hard to quantify 'better' but there are some major advantages to a single payer systems in terms of efficiencies. For example, a single standard for billing is in itself a major win.
- apathy 10y agoContracts and practice plans are considerably simplified ;-)
- apathy 10y agoassuming 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. (There's a reason that being on call instead of waiting for referrals is called "service") Most physicians in (e.g.) the UK do participate in the single-payer market (there are a small number who make a living offering pay-as-you-go services, but they are the vanishing minority), since it dominates demand. In the US there are a great many physicians who simply won't accept Medicare rates (they're viewed as too low by most) and since there are alternative sources of patients, that's who they treat (typically privately insured). This leads to the cases that show up at County or the ER being a hell of a lot more expensive than necessary as they tend not to be survivable for long. (A running joke at most county hospitals is that conditions believed "incompatible with life" routinely walk or roll into the ER and clinics.) If you have 1-3 insurance companies and MediCal/Medicaid and Medicare then you have different rates for different groups, almost all of it horrendously opaque, and the 3rd party insurers are not incentivized to pay for anything. As far as private vs. public, the issue here is the same as for schools, a private insurer or school can choose not to insure or educate a "customer", the government by law cannot. In the handful of cross-over studies of charter schools or vouchers, after controlling for subject-specific effects, the children who switched from public to charter or private tended to do slightly worse than expected based on their test scores from public schools. (It is a difficult experiment to run for numerous reasons.) Medical care, unlike most goods and services, is stunningly inelastic in demand -- you either need it and will do whatever is required to get it, or you don't and won't, by and large. (Elective surgeries for cosmetic purposes are a separate matter; nobody goes in for a stent "just because" or visits the trauma unit just to poke their head in) Furthermore, a substantial amount of the cost is centered on the first and last few years of a person's life. Unless you would like the "market driven solution" of even higher infant mortality and elderly culling to proceed, 3rd party insurers don't have the incentives to make it go.
- 11thEarlOfMar 10y agoIf 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.
- tarr11 10y agoAs a CA small business owner, I'd be much happier to just pay a simple payroll tax per employee than have this multi-step octopus process around open enrollment periods, health insurance brokers, differing city regulations (like SF), multiple vendors, audits, etc. Single payer would also make hiring and HR a lot simpler.
- mahyarm 10y agoIn Canada it's like one very large HMO that covers the country or province. Part of single payer is not being able to avoid participation. I don't know if your provider will be able to avoid participating unless they move out of CA.
- cmdrfred 10y agoI don't think single payer is viable in the US, yet I am happy that it is being attempted here. America was originally designed to be a marketplace of ideas. With a limited federal government each state can enact laws that it sees fit. If the law works well, more states will adopt it. This is a perfect example of "states rights" at work. I hope it gets implemented (if the people of California wish it so) and that comprehensive data is provided so I and others can make a truly informed decision on the matter.
- knodi 10y agoI will 100% be moving to Cali if this passes. I won't mind paying higher taxes for this as well. Right now my shit health care plan costs me $260/month in MI. If the taxes increase by 300-400/month I'm all for it and will gladly pay it.
- cft 10y agoWill there be a private insurance alternative? Many of my parents' Canadian friends visit the US for complex procedures and surgeries (because of both quality and wait times).
- gator-io 10y agoI simultaneously believe in universal coverage as a moral imperative, but also the efficiency of markets over government AND basic income as a necessity as automation displaces millions of workers. So, why not combine concepts - start off with basic income that has to be spent on health care insurance. Start with enough for coverage against major issues, but people can spend more for more coverage. Universal coverage is attained immediately without any individual mandates. Giant, wasteful bureaucracies go away. Prices are controlled via market forces. And it paves the way for a system of basic income...
- neltnerb 10y agoI'm pretty confident that if you get rid of individual mandates while not disqualifying sick people or enforcing benefit caps, premiums will skyrocket. I'm not sure there's really a middle ground here, it's just unavoidable actuary math. So if it is, as you say, a moral imperative, what are your choices? Maybe the EBI will need to be ridiculously high to actually provide the coverage you agree is a moral imperative to provide. But that doesn't really solve the problem, it just ends up meaning that sick people don't have that EBI to cover stuff everyone else can pay for with it. Like food and housing. I'm open to hearing other ideas on how to do it, but I think that you'd have to vary the EBI based on how expensive health care is for the individual getting it, if your goal is to meet the universal coverage moral imperative. And that's very different from what EBI is supposed to be. I don't think it will solve the problem that you're describing.
- gator-io 10y agoThe individual mandate is moot in this system, as everyone will have money they can only spend on insurance. Benefit caps are a really tricky issue. As a society, are we willing to spend a million dollars to extend life for a week? Probably not. On the other hand, do you cut off a cancer patient after a million? Probably not. But there has to be a rational way to balance this without people freaking out over 'death-panels'. I agree, universal coverage means vastly more money spent. Therefore, coverage for major issues is the baseline amount, not the Obamacare standards where people generally have way more insurance than they would choose. The closest proposal I've seen is tax credits for this.
- deepnotderp 10y agoThis is gonna be great for a startup in California!
- home_boi 10y agoWhat effects would this have on the currently generous insurance plans of $huge_tech_company_based_in_CA?
- mindcrime 10y agoso should the government force those people to spend their earned income on healthcare for others? Absolutely not. Pretty much any question that starts with "should the government force ..." can be answered "no". You earned your income, it's yours and it should be up to you how to spend it. Using force / aggression (aka the government forcing you to do something) is a violation of your most fundamental rights, and strips you of your agency and dignity as a human being. And while the end may sound noble ("everybody should have free health care") the truth is that nobody is in a better position to determine how your income should be spent than you, and nobody other than you has any standing to decide what kind of charity (if any) you should engage in. Rather than stealing from Bobby to pay for Suzy's health-care, it would be better to enact policies that A. reduce the cost of health-care, and B. encourage general economic welfare, job creation, etc., such that both Bobby and Suzy can pay for their own health-care from the get-go.
- charles-salvia 10y agoI understand that's the conservative/libertarian position - however the government forces you to pay taxes to support infrastructure and other things. Are you against that as well?
- mindcrime 10y agoI understand that's the conservative/libertarian position FWIW, conflating conservatism and libertarianism is a mistake. There's some incidental overlap, just like there is between libertarianism and liberalism, but that's pretty much the extent of it. Are you against that as well? Yes, of course. Basically, if the word "force" is involved, it's wrong. Come up with a way to collectively fund infrastructure that's voluntary and I'm all for it. But if your idea needs force / violence to be executed, then, well, maybe it isn't such a good idea after all.
- charles-salvia 10y agoRight now, I can't think of a good way to have everyone voluntarily fund infrastructure. No nation-state has ever functioned without the threat of state-imposed force. It's not a pleasant reality, but nobody really knows how to do better at the moment. The only known alternative is scaling back civilization to pre-city-state conditions. But perhaps you have some suggestions on how to actually do this. Regardless, this idea you have - that governmental "force", or any kind of institutional force that suppresses your individual will, is some kind of ultimate evil - seems very misguided. The laws of biology and physics will override your will and force you to degenerate and die. Micro-organisms will force you to cough up blood and die. Wild animals will force you to give up your flesh and die. Collective human institutions are the only things that have successfully imbued individual humans with an order of magnitude more power and more rights than our primitive ancestral conditions would allow. Many of these human institutions are also abusive, however there doesn't seem to be an alternative to forming collective human institutions that require forced large-scale group efforts if we want to actually not die of malaria all the time.
- jljljl 10y agoI wonder what the impact would be on the US insurance market if the state with the largest GDP dropped out?
- Girlang 10y agoAnd how are they going to pay for this?
- nickff 10y agoThe problems with your last argument are that almost nobody is actually a utilitarian, and utilitarianism is wrong.[1][2][3] edit: full disclosure; I am an ethical intuitionist.[4] [1] http://degreesofclarity.com/writing/utilitarianism/ http://degreesofclarity.com/writing/utilitarianism/ [2] https://en.wikipedia.org/wiki/Trolley_problem https://en.wikipedia.org/wiki/Trolley_problem [3] https://en.wikipedia.org/wiki/Utilitarianism#Criticisms https://en.wikipedia.org/wiki/Utilitarianism#Criticisms [4] https://en.wikipedia.org/wiki/Ethical_intuitionism https://en.wikipedia.org/wiki/Ethical_intuitionism
- hprotagonist 10y agoBut it sounds good to sell it to the "fiscal conservatives". I am not a utilitarian, but nobody likes to be hectored into doing things -- and it's easy for an argument from, e.g., personal morality to sound that way.
- nickff 10y agoHave you ever convinced someone of something by using a utilitarian argument? I haven't. I have become completely convinced that either nobody is a utilitarian (i.e. 'utilitarians' just frame their preferences as the utility-maximizing solution), or that there is no consistent way to evaluate utility.
- stale2002 10y agoThe Trolley problem isn't really an example of utilitarianism being wrong. Quite the opposite, I use that example to convince people of how awesome Utilitarianism is, not as a contradiction. What, would you chose to kill 5 people, instead of one?
- nickff 10y agoI gave that as an example of a controversial subject; many people prefer to let things be rather than interfere and kill one or more people. The organ donor example is much tougher.
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- fishywang 10y agoAssuming this is implemented, how does it work in case of Californians traveling in other states/countries? Will it work like the current out-of-network case, that the government reimburse you some percentage, with some restrictions (ER only, for example)? Or will the Californians need to buy a separated insurance before they travel? How does this work for single-payer countries, like Canada?
- ghufran_syed 10y agoGiven how much this country honours its armed forces, I guess we can reasonably expect the standard of care and efficiency to be, at most, equal to that of the Veterans Administration (VA)
- ghufran_syed 10y agoGiven how much this country honours its armed forces, I guess we can reasonably expect the standard of care and efficiency to be, at most, equal to that of the Veterans Administration (VA)
- dpc_pw 10y agoComing from a country with single-payer healthcare: If you have have 5 beds, and 10 people that need to use a bed every day, there is no pure finance management solution to solve it. If you have insurance-based system like in US, only people who can afford insurance will be able to use the beds. Rest will be priced-out. If you have single-payer system like in my country of origin (and what a lot of people in America would want), people will be queued and/or to some extent squeezed to fit on what's available. It often leads to corruption, when people pay extra to cut the line. Or there are some officially approved way to pay your way to get your bed fast and without overcrowding. The reality is of course a bit more complicated, but the point is: the real solution is to either have more beds, or to have less people who need to use them. Why can't more beds be built and operated cheaply? Why there is so many people needing them?
- TheSpiceIsLife 10y agoIf you have have 5 beds, and 10 people that need to use it every day, there is no financial solution to solve it. One financial solution would be to fund construction of the infrastructure to house the beds and fund the operational expenditure to run them. I would guess the reasons this doesn't happen are primarily political.
- joshpadnick 10y ago> The real solution is to either have more beds, or to have less people who need to use them. This is exactly the incentives we've wanted all along. Is healthcare too expensive to cover everyone's current level of need? Now it finally makes sense for government to get serious about investing in prevention. Our current incentives of "the more sick-care you provide, the more you get paid" has exactly the opposite incentive. No solution is perfect, but this feels like a significant step in the right direction.
- luckydata 10y agoCalifornia is roughly the size of Italy, its economy slightly larger but essentially comparable. Italy has single payer and one of the best healthcare outcomes in the world with one of the lowest expenditure per patient in developed countries. Quality of service is uneven geographically (but it's no different anywhere else) and in generally getting care in Italy is a no hassle experience. California, learn from Italy.
- cdransf 10y agoAnything that moves us beyond the gross waste and incompetence of insurance and medical billing is a good thing. My wife and I had a few recent medical issues crop up and, despite having decent coverage, have had to deal with chasing down providers and third parties who consistently fail to bill even the most basic procedures properly. I'd much rather pay more in taxes to have the knowledge we'd be safely covered without dealing with the headache of endless middlemen who add no value to the system.
- HNLogInShit 10y agoWhat is this amateurish and inept junk? I was hoping to see a real plan. This doesn't even make grammatical sense, let alone spell out ANY PLAN WHATSOEVER. Embarrassing.
- pcardh0 10y agoThese talks on healthcare are great, so many domain experts. I think I am going go over to WebMD to get the skinny on latest sorting algorithm.