9 ms·

Vermont tried this a few years ago, they had to cancel it since in the end it wasn't financially feasible [1]. CA is already dealing with severe budget issues [

• unabridged 10y ago
  California 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 ago
    How about we get rid of Prop 13, a not-so-stealth tax on the young.
    • CalChris 10y ago
      There 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.
  • nosuchthing 10y ago
    That requires an effort to repeal Prop 13 asap.
    • Apocryphon 10y ago
      Maybe the time to begin such an initiative is now. And maybe the tech industry, which has long suffered from the related housing crisis, should back such an initiative.
  • DrScump 10y ago
    The Legislature is free to pass a Legislative Constitutional Amendment to remove part or all of Prop 13 protections (e.g. for commercial or rental property at least); all it would take is a simple majority of voters to take effect. They can even pick and choose which statewide election to use.
• api 10y ago
  I wonder how much taxing legal marijuana will help the state's budget issues?
  • bdamm 10y ago
    Not likely to matter very much. Some local benefits but compared to income tax it's a rounding error.
• __jal 10y ago
  As I understand it, a big part of Vermont's problem was due to numbers. They had too small of a population. California does not have that problem.
• TheSageMage 10y ago
  I'm very new to the single-payer idea, but Vermont rates 49th for population in the US, California ranks 1st. I thought one of the strengths of a single-payer system was to leverage the power of large numbers to help drive costs down. Would this not make it more viable?
  • trishume 10y ago
    We even know California's population is large enough to support its own single-payer system since Canada has a slightly smaller population and a single payer system. The trick is whether the transition to a single payer system is feasible. Both in terms of taxes, and existing organizations and incentives.
    • gnopgnip 10y ago
      Australia did it. It won't happen overnight, but the planning has to start somewhere.
    • DrScump 10y ago
      "We even know California's population is large enough to support its own single-payer system since Canada has a slightly smaller population and a single payer system." Except Canada can (for the most part) control who can enter, stay, and participate in the system, while California is at the mercy of its open borders (newcomers from other states or countries).
    • astrange 10y ago
      It's a bad idea to compare California to Canada or Australia, because even with our great economy we don't control our currency. Countries can deficit-spend but we have to actually pay for things. This is the same flaw (see Strong Towns) that leads cities to tear down useful buildings and replace it with parking lots and highways, because the federal government gave them money to build them, but not to maintain them… so they go broke. Huh, I just realized I'm wrong because California voters always approve state bond measures. We're safe after all.
  • davidw 10y ago
• mmanfrin 10y ago
  [2] is about CalPERS, which is separate from the budget of the State. There may be a current budget shortfall, but CalPERS is fine (it is the largest non-country pension fund in the world; and comes in the top 10 when listed among countries). [3] mentions that tax revenues will fall because of the end of temporary tax increases; those increases are likely to be renewed. Categorizing these as 'severe budget issues' is disingenuous and misleading. California has had a bumper crop in terms of tax revenue over the past decade, and this stupid meme about California being out of money needs to be corrected. That being said, health care is not an inexpensive line-item, and will have to be funded with taxes. But as a Californian, I'm sure as shit happy to pay more in taxes for a universal single single-payer. I have many friends who are either contractors or who earn very little and find themselves in that uncomfortable valley of having to pay for expensive insurance -- I'd rather that people (like me) who are better off financially foot a bit more of a communal bill so that no one would need to worry about it.
  • ng12 10y ago
    > it is the largest non-country pension fund in the world; and comes in the top 10 when listed among countries Yes, and that's the problem. It's funding is at 73% and dropping -- that 27% is an astronomical deficit. Numbers here: https://www.calpers.ca.gov/page/newsroom/calpers-news/2017/annual-report-details-fund-finances https://www.calpers.ca.gov/page/newsroom/calpers-news/2017/a...
  • chaostheory 10y ago
    > is about CalPERS, which is separate from the budget of the State. There may be a current budget shortfall, but CalPERS is fine It's 'separate' from the state budget, but doesn't California still ultimately pay for pensions? How is this fine when there's a huge difference between the projected costs and the actual costs? Doesn't 70% of CA tax revenue go towards paying pension obligations? Current CA pension debt is $965 Billion. http://news.stanford.edu/2015/10/15/cali-pension-tracker-101515/ http://news.stanford.edu/2015/10/15/cali-pension-tracker-101... http://www.pensiontracker.org/index.php http://www.pensiontracker.org/index.php
    • 10y ago
• conradev 10y ago
  The Affordable Care Act has a provision in it that allows states to apply for "waivers for state innovation"[1] starting this year. That waiver program might allow for this to receive federal funding. That said, the future of the Affordable Care Act is currently unclear. [1] https://en.wikipedia.org/wiki/Patient_Protection_and_Affordable_Care_Act#State_waivers https://en.wikipedia.org/wiki/Patient_Protection_and_Afforda...
• esturk 10y ago
  Interesting tidbit from the 3rd article: "Ultimately, Thornberg believes California would be better served with a Texas-style tax revenue system where there's less reliance on personal income taxes and capital gains tied to the stock market, and more of a focus on property taxes and sales taxes." So long as high priced real-estate are exchanging hands, CA will reap the benefit.
  • wahern 10y ago
    Real estate is expensive in CA precisely because of Prop 13. In order to switch to a property tax revenue model you need to repeal Prop 13, at which point real estate prices and thus prospective revenue will plummet. Prop 13 incentivizes homeowners to stay put until they die. In other words, it puts tremendous downward pressure on the housing supply which results in a self-reinforcing feedback loop whereby the more real estate prices grow the greater the tax incentive to stay put. Changing this state of affairs is near impossible. Nobody is going to trade increased mobility and a more efficient housing market for a precipitous drop in the paper value of their primary asset, even though on the whole it'd probably be better for everybody. Why precipitous? Because locking in, under Prop 13, your first year property valuation is a huge part of the calculus for determining affordability and your bidding price. If a new home owner doesn't get the benefit of Prop 13, he's going to pay far less for a house. Which means you can't even ease California out of the cycle by grandfathering existing homeowners in the hopes of avoiding their ire. Repealing Prop 13 just isn't politically viable. It's a fascinating state of affairs.
• Lazare 10y ago
  Yep. Trying to solve this at the state level is a nice idea (and it certainly needs to be solved!), but it's actually harder to solve than at the federal level because you get all the same issues plus a few new ones, plus you can't actually change some key rules that are set at the federal level. If your proposed solution doesn't start with a plan to bring healthcare costs into line with the OECD average, then even if your plan works it's like trying to bail out a leaky boat by scooping water up and pouring it back into the boat. This one...doesn't even try. Yes, if health care cost the same in the US as it did in Germany this plan would work great...but it doesn't. You can paint a Yugo red, but it doesn't magically turn into a Porsche. (And before anyone asks...no, the best estimates of potential savings from switching to single payer is orders of magnitude too low. The NHS works because medical care is cheap to provide in the UK; medical care isn't cheap to provide in the UK because of the NHS.)
  • alexqgb 10y ago
    In general this true, but California is unique among American states in that its got an economy and a population bigger than most other nations in the OECD. That is to say, we've reached a scale where we absolutely can start thinking and acting like a nation state. That doesn't mean that smaller, poorer, and weaker states can simply copy what we do directly, one-by-one. But it does mean they can band together to see that a demonstrably good model gets implemented at the Federal level.
    • Lazare 10y ago
      I live in New Zealand, population 4 million. If scale alone was critical, then Aetna (which covers about 23 million people in the US) would be squeezing really good pricing deals out of their suppliers, while NZ would be seeing really high costs. Nothing could be further from the truth. (This is true, incidentally, because in large part NZ's low costs come from just buying less stuff. Fewer fancy drugs, fewer fancy machines, smaller and older hospitals, and lower salaries for doctors and nurses. Works great, but this is politically infeasible in the US, to say the least, which is probably why California isn't even dreaming about trying it.) Yes, California has 38 million people or whatever, but other large groups of in the US can't get good deals (be that insurers like Aetna or Kaiser, or government programs like Medicare). They're not larger than Medicare, so that's out. Are they going to be greedier that Aetna? Really? Or is the famously dysfunctional and lobbyist dominated government in Sacremento going to make some hard choices and piss off the voters? > But it does mean they can band together to see that a demonstrably good model gets implemented at the Federal level. I'm a very strong proponent of federalism and the states as laboratories of democracy and all that. But... What California is proposing to do is not really new or untested. It's an expansion of a system that already exists in the US, and closely replicates systems from other countries. Yes, it works great if costs are low, and will bankrupt the state if costs are high. Costs are currently high. How do you square that circle?
• anonymid 10y ago
  I wouldn't mind paying more taxes in order to provide others with something I consider a human right. Under single-payer, CA employers will no longer need to provide insurance for their employees. That money could in some way pay for this. It also makes the idea of a 'gig economy' much more palatable, since people working in short-term / part-time situations will no longer have to go without employer-provided insurance. It could be a source of further economic growth since that makes CA a much more friendly place to start a business. More centralized healthcare systems also have two arguments for driving down cost - one being that such a system is more effective at promoting timely / preventative care (which is a lot cheaper than emergency care). The second is that such a system can negotiate prices with providers more effectively, and invest in long-term projects to reduce the cost of care, driving down the cost of healthcare overall.
  • Uhhrrr 10y ago
    California is already running a budget deficit, in part because of the health subsidies it already provides. Also, it allows voluntary contributions, so you can already pay more taxes: https://www.ftb.ca.gov/individuals/vcfsr/vcf_faqs.shtml https://www.ftb.ca.gov/individuals/vcfsr/vcf_faqs.shtml Thus far I have been able to resist the tempation to do so.
    • magicalist 10y ago
      > Also, it allows voluntary contributions, so you can already pay more taxes That's for charitable contributions...
      • Uhhrrr 10y ago
        If you don't specify a charity it goes into the general fund. It's mentioned somewhere in that page.
• FullMtlAlcoholc 10y ago
  > CA is already dealing with severe budget issues [2][3], False. California has a budget surplus of nearly $3 billion and will be able to weather a mild recession without major budget cuts or tax increases for the next 4 years.
  • cmdrfred 10y ago
    Jerry Brown says there is a projected 1.6 billion dollar deficit. Where did you get your numbers from? 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...
    • FullMtlAlcoholc 10y ago
      The 2016-2017 fiscal year! year. Interesting, thanks for the correction
• cft 10y ago
  California legislature is much more financially reckless than Vermont's
• feld 10y ago
  Because they didn't add provisions to control pharma and hospital gouging. Let them run free and they'll suck you dry.
• abalone 10y ago
  The article you cite points at resistance to tax increases as the culprit. No state can afford single payer without a tax increase to fund it, so the talk of "budget issues" is misleading. It's simply a matter of convincing everyone to trade paying private insurers for a tax increase. Vermont got pushback from the business community saying it would hurt the economy, but that seems suspect to me considering they would not have to pay private premiums anymore. That and the economic benefits of a healthy population.
• hackuser 10y ago
  > it sounds nice in theory I'm hesitant to believe the finances actually work out. Many places pull it off around the world, though at a national level. Probably few are as wealthy as California.
• cpncrunch 10y ago
  As [1] points out, overall costs are less with single payer healthcare. Taxes go up, but insurance premiums go down more and people end up paying less overall. It's a no brainer...
• pje 10y ago
  It seems to be working pretty well in Canada.
• deleted 10y ago
  [deleted]
• cmurf 10y ago
  It's financially feasible if everyone's contributing. So if it were done as a progressive tax, just like income tax, rather than making a portion of it employer paid while then exempting employers who operate in multiple state; in fact in today's world exempting companies that don't even do business in the state other than having employees in that state is a problem. There's also no integration with Medicaid or Medicare. Anyway, there's no reason it's a financial funding problem. No matter what it's some kind of tax. Either it's a government tax for a government operated health care system (single payer); or it's a tax on the business vis a vis employer based insurance where they are the true customer not those who are insured; or it's a tax on the employee getting a plan on the market place if the employer doesn't provide one. The number one problem is that it's simply too profitable for doctors, hospitals, clinics, and insurance companies right now, to have system that incentivizes pay per procedure per per visit, rather than paying for health. It is not health care, it's sick care. Very little of our system incentivizes health. A miniscule number of insurers pay if you actually show up at a gym, not merely pay for the gym; or pay you to lose weight by actually getting weighed at an approved clinic, and so on. It's presently politically untenable that we have for-profit education to become a doctor, and salaried doctors. And there probably isn't a way to make this work on a scale like Vermont. It's probably possible to do it on the scale of California, but deeply depends on the politics. Democrats basically took a dump on ACA. They tried to get Republicans on board, which is why they went with the Heritage Foundation plan. But then Republicans didn't go for it anyway. So what they should have done, hindsight being 20/20, is offer Americans a way to buy into Medicare rather than set up all these stupid state exchanges to expand a busted for-profit system. Oh well!
• newman314 10y ago
  I'd rather pay for single payer than see $54B go to the military [1] or $20B for a pointless wall. And honestly, having a healthier populace would likely lower the overall cost over time. I don't think we spend enough effort on preventative care as opposed to treatment. [1] This shows how crazy the current spend is already. https://i.redd.it/6srj4xgpmriy.png https://i.redd.it/6srj4xgpmriy.png