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In a word, the answer is still "cost". You can try to dance around it and talk about how " A single-payer program would inevitably incur additional taxes, but t

In a word, the answer is still "cost". You can try to dance around it and talk about how " A single-payer program would inevitably incur additional taxes, but the overall health care costs would be lower for most people and businesses", but at the end of the day, it's going to cost a lot of money. This article claims it'd "only" cost about an additional $100b or so in CA; I think critics would be very skeptical of that, especially since costs are claimed to come from "reduced overhead" areas. I'm not sure that governments have a history of keeping costs low, so voters would likely be skeptical of that. Ultimately I imagine it boils down to voters in a state with already very high taxes (by American standards) being very wary of voting to significantly increasing their taxes again.

Shivetya 9y ago
Even Vermont; Green Mountain Care; ran away from the idea simply because they could not find the stomach to pay for it. It was supposed to start in 2017 when the ACA permitted such arrangements. to even get close to a palatable number they would force cuts in payments to doctors, hospitals, and more, by nearly twenty percent while doing nothing to reduce the operational costs of such providers. Another nail in the coffin is that of the many proposals to shift tax deductions away from the rich is to remove the Federal deduction for State and local taxes. High tax states need this deduction to hide their spending. It reduces by a lot the amount of Federal taxes paid in those states to benefit local coffers. Without the deduction tax increases become a real threat by increasing the chance those with large taxable incomes move
FullMtlAlcoholc 9y ago
_
- gonmf 9y ago
  The rest of the developed world affords it by paying up to 60% in taxes, like where I live, and still seeing private doctors if you don't want to wait months.
  - twoodfin 9y ago
    Also much lower salaries for doctors and nurses, as well as building hospitals that are more like public schools and less like luxury hotels. Certainly much of our spending is inefficient or flatly wasteful, but it would be very difficult to slice it by 20 or 40% at the stroke of a pen. Those hospitals have been built and require maintenance. Those doctors and nurses went heavily into debt for their educations, and so on.
  - dboreham 9y ago
    > paying up to 60% in taxes, like where I live Citation required. Also are you talking about the marginal rate or effective rate?
twoodfin 9y ago
Agree cost is a huge factor, but another key issues is the inconvenient fact that most Americans with employer-provided coverage are satisfied with it. Convincing them to take a leap into the dark with no credible promises that they could still see the same PCPs and specialists they can see today and with similar wait time/referral requirements would be politically Herculean.
- jellicle 9y ago
  > they could still see the same PCPs and specialists they can see today What do you think single-payer is? There's no such thing as "out of network".
  - twoodfin 9y ago
    I don't think single-payer works the way you seem to think it does in nations where it's been implemented. I have an expensive employer-provided plan. I can, without any referral, make an appointment with a specialist (surely making $300K+) at a top teaching hospital and expect to wait weeks at the most. There is no way to offer that level of service to anyone and not explode costs, let alone contain them.
    - dyeje 9y ago
      Do you have anything to backup that claim?
      - smokeyj 9y ago
        Is that whole "supply and demand" thing not convincing enough?
    - toomuchtodo 9y ago
      > There is no way to offer that level of service to anyone and not explode costs, let alone contain them. * Import more doctors from other countries with a streamlined visa process * Provide free training to doctors for underserved specialties This is not hard. It is supply and demand. If demand increases, you find ways to increase supply in a cost-efficient manner.
deleted 9y ago
[deleted]
jellicle 9y ago
But the net cost to voters is highly negative, and voter support is very high. If you can save $10 by paying $5, and your argument for why you won't do it is that it costs too much, I'm going to tell you that you need a math course. What it seems to actually boil down to is bribery.
- JonFish85 9y ago
  "If you can save $10 by paying $5, and your argument for why you won't do it is that it costs too much, I'm going to tell you that you need a math course." It's not simple math though, it's politics and projections from people with an agenda. If you tell me I can save $10 by paying $5, it's my responsibility to decide if you're lying to me, to question your assumptions, etc. Maybe it costs $8 to save $10, but I give up significant other rights/options/etc. TLDR, it's not just math, and the math isn't that simple.
- chimeracoder 9y ago
  > If you can save $10 by paying $5 I wish I had $1 for every time someone told me I was "guaranteed" to save $10 later by paying $5 today. Now, instead of an alleged guarantee, let's change that to "we admit we don't even have a concrete budget estimate that demonstrates how this will save money, but take our word for it that at some point it'll pay off. And in the mean time, we need to triple the state annual budget". That's a much harder sell, especially at this scale, and especially when the majority of people are actually satisfied with their personal insurance situation as it is.
- CWuestefeld 9y ago
  If you can save $10 by paying $5, and your argument for why you won't do it is that it costs too much, I'm going to tell you that you need a math course. But you won't be saving money. Think of it as a conservation of matter problem in physics. The current insurance model covers some set of care for some subset of people. The goal is to provide more comprehensive care for more people - i.e., much more care will be provided in total. The supporters of government-provided healthcare (whether it's this CA bill, or ACA) don't want to look at this bigger picture and acknowledge that they really are proposing to spend a lot more. Not only will this cost more, but pushing more care through the existing infrastructure will also result in long waits for care and the other kinds of things people in Canada and the UK complain about. If the infrastructure was built with a given amount of usage, vastly increasing that usage will overtax the infrastructure. And with the financial concerns that surround the problem, it's quite a stretch to say that the capacity will be increased.
wavefunction 9y ago
Private insurance and delivery of healthcare is the crux of the cost problem. If the government provides blanket insurance and it's being delivered by private providers, there's nothing to control costs. This is the exact problem with government educational loans. Society can't control the costs of tuition so costs balloon. And the costs are ballooning because of stupid things like fancy dorm rooms and expensive sporting facilities. You walk into many hospitals and they look more like a luxury hotel these days. That and all the administrative staff and the fact the hospitals are private and need to turn profits and compete against each other. And I don't really feel like I'm getting my money's worth from my private employer-provided health insurance either. I am fortunate to be relatively healthy in my middle-age so I go see the doctor once a year, they weigh me, take some blood samples and send me on my way. So I pay an entire year for that. I have no expectations that anything positive or proactive is really going to come out of my "health care." I ended up diagnosing my father's Parkinson's and I see him less frequently each year than his doctor. So mass private insurance and mass private health care providers seems completely inefficient and a screwed up way to try to properly provide healthcare within a rational cost framework. I want my fellow Americans insured and I want my health care providers freed up to focus on providing health care. People who work in insurance can get retrained for something else.
Brakenshire 9y ago
> I'm not sure that governments have a history of keeping costs low, so voters would likely be skeptical of that. In general that's true, but in healthcare it's not. As a percentage of GDP, the US spends as much taxpayer money as the UK, but clearly gets far less for it - the NHS vs. Medicaid, Medicare and other limited programs. I suppose the problem is that states would have to set up a parallel system with costs on top of the existing federal structures, which as you say would be expensive.
jrs95 9y ago
No, it really isn't. It was just botched legislation. The "bill" was totally unfeasible without more details and a plan for how to pay for it. It's not like it's inherently unaffordable or that the cost is too high. The estimates in the article are pretty much in line with what California already spends on healthcare. Perhaps if legislators actually knew how to legislate this would have stood a chance at passing.
- chimeracoder 9y ago
  > The estimates in the article are pretty much in line with what California already spends on healthcare. Nowhere close. It would have doubled the budget at an additional $200 billion dollars, and this is for a state in which 70% of healthcare expenses are already paid for by public funds.
jernfrost 9y ago
Why should voters care if they pay the government for a service instead of private enterprise, if government can provide the service for a lower price? I don't get why voters think there is something inherently worse with paying taxes than paying insurance companies. Taxes have the benefit that they can not typically be higher than your income, while insurance can easily be higher than your income. If you are sick for a long time with say cancer treatment and lose your job, then your insurance costs will quickly get higher than your income.
DiNovi 9y ago
Sure, but what literally killed it is a constitutional provision that non revenue neutral laws need to be introduced by a popular vote.

Shivetya 9y ago

Even Vermont; Green Mountain Care; ran away from the idea simply because they could not find the stomach to pay for it. It was supposed to start in 2017 when the ACA permitted such arrangements. to even get close to a palatable number they would force cuts in payments to doctors, hospitals, and more, by nearly twenty percent while doing nothing to reduce the operational costs of such providers. Another nail in the coffin is that of the many proposals to shift tax deductions away from the rich is to remove the Federal deduction for State and local taxes. High tax states need this deduction to hide their spending. It reduces by a lot the amount of Federal taxes paid in those states to benefit local coffers. Without the deduction tax increases become a real threat by increasing the chance those with large taxable incomes move

FullMtlAlcoholc 9y ago

gonmf 9y ago
The rest of the developed world affords it by paying up to 60% in taxes, like where I live, and still seeing private doctors if you don't want to wait months.
- twoodfin 9y ago
  Also much lower salaries for doctors and nurses, as well as building hospitals that are more like public schools and less like luxury hotels. Certainly much of our spending is inefficient or flatly wasteful, but it would be very difficult to slice it by 20 or 40% at the stroke of a pen. Those hospitals have been built and require maintenance. Those doctors and nurses went heavily into debt for their educations, and so on.
- dboreham 9y ago
  > paying up to 60% in taxes, like where I live Citation required. Also are you talking about the marginal rate or effective rate?

twoodfin 9y ago

Agree cost is a huge factor, but another key issues is the inconvenient fact that most Americans with employer-provided coverage are satisfied with it. Convincing them to take a leap into the dark with no credible promises that they could still see the same PCPs and specialists they can see today and with similar wait time/referral requirements would be politically Herculean.

jellicle 9y ago
> they could still see the same PCPs and specialists they can see today What do you think single-payer is? There's no such thing as "out of network".
- twoodfin 9y ago
  I don't think single-payer works the way you seem to think it does in nations where it's been implemented. I have an expensive employer-provided plan. I can, without any referral, make an appointment with a specialist (surely making $300K+) at a top teaching hospital and expect to wait weeks at the most. There is no way to offer that level of service to anyone and not explode costs, let alone contain them.
  - dyeje 9y ago
    Do you have anything to backup that claim?
    - smokeyj 9y ago
      Is that whole "supply and demand" thing not convincing enough?
  - toomuchtodo 9y ago
    > There is no way to offer that level of service to anyone and not explode costs, let alone contain them. * Import more doctors from other countries with a streamlined visa process * Provide free training to doctors for underserved specialties This is not hard. It is supply and demand. If demand increases, you find ways to increase supply in a cost-efficient manner.

deleted 9y ago

[deleted]

jellicle 9y ago

But the net cost to voters is highly negative, and voter support is very high. If you can save $10 by paying $5, and your argument for why you won't do it is that it costs too much, I'm going to tell you that you need a math course. What it seems to actually boil down to is bribery.

JonFish85 9y ago
"If you can save $10 by paying $5, and your argument for why you won't do it is that it costs too much, I'm going to tell you that you need a math course." It's not simple math though, it's politics and projections from people with an agenda. If you tell me I can save $10 by paying $5, it's my responsibility to decide if you're lying to me, to question your assumptions, etc. Maybe it costs $8 to save $10, but I give up significant other rights/options/etc. TLDR, it's not just math, and the math isn't that simple.
chimeracoder 9y ago
> If you can save $10 by paying $5 I wish I had $1 for every time someone told me I was "guaranteed" to save $10 later by paying $5 today. Now, instead of an alleged guarantee, let's change that to "we admit we don't even have a concrete budget estimate that demonstrates how this will save money, but take our word for it that at some point it'll pay off. And in the mean time, we need to triple the state annual budget". That's a much harder sell, especially at this scale, and especially when the majority of people are actually satisfied with their personal insurance situation as it is.
CWuestefeld 9y ago
If you can save $10 by paying $5, and your argument for why you won't do it is that it costs too much, I'm going to tell you that you need a math course. But you won't be saving money. Think of it as a conservation of matter problem in physics. The current insurance model covers some set of care for some subset of people. The goal is to provide more comprehensive care for more people - i.e., much more care will be provided in total. The supporters of government-provided healthcare (whether it's this CA bill, or ACA) don't want to look at this bigger picture and acknowledge that they really are proposing to spend a lot more. Not only will this cost more, but pushing more care through the existing infrastructure will also result in long waits for care and the other kinds of things people in Canada and the UK complain about. If the infrastructure was built with a given amount of usage, vastly increasing that usage will overtax the infrastructure. And with the financial concerns that surround the problem, it's quite a stretch to say that the capacity will be increased.

wavefunction 9y ago

Private insurance and delivery of healthcare is the crux of the cost problem. If the government provides blanket insurance and it's being delivered by private providers, there's nothing to control costs. This is the exact problem with government educational loans. Society can't control the costs of tuition so costs balloon. And the costs are ballooning because of stupid things like fancy dorm rooms and expensive sporting facilities. You walk into many hospitals and they look more like a luxury hotel these days. That and all the administrative staff and the fact the hospitals are private and need to turn profits and compete against each other. And I don't really feel like I'm getting my money's worth from my private employer-provided health insurance either. I am fortunate to be relatively healthy in my middle-age so I go see the doctor once a year, they weigh me, take some blood samples and send me on my way. So I pay an entire year for that. I have no expectations that anything positive or proactive is really going to come out of my "health care." I ended up diagnosing my father's Parkinson's and I see him less frequently each year than his doctor. So mass private insurance and mass private health care providers seems completely inefficient and a screwed up way to try to properly provide healthcare within a rational cost framework. I want my fellow Americans insured and I want my health care providers freed up to focus on providing health care. People who work in insurance can get retrained for something else.

Brakenshire 9y ago

> I'm not sure that governments have a history of keeping costs low, so voters would likely be skeptical of that. In general that's true, but in healthcare it's not. As a percentage of GDP, the US spends as much taxpayer money as the UK, but clearly gets far less for it - the NHS vs. Medicaid, Medicare and other limited programs. I suppose the problem is that states would have to set up a parallel system with costs on top of the existing federal structures, which as you say would be expensive.

jrs95 9y ago

No, it really isn't. It was just botched legislation. The "bill" was totally unfeasible without more details and a plan for how to pay for it. It's not like it's inherently unaffordable or that the cost is too high. The estimates in the article are pretty much in line with what California already spends on healthcare. Perhaps if legislators actually knew how to legislate this would have stood a chance at passing.

chimeracoder 9y ago
> The estimates in the article are pretty much in line with what California already spends on healthcare. Nowhere close. It would have doubled the budget at an additional $200 billion dollars, and this is for a state in which 70% of healthcare expenses are already paid for by public funds.

jernfrost 9y ago

Why should voters care if they pay the government for a service instead of private enterprise, if government can provide the service for a lower price? I don't get why voters think there is something inherently worse with paying taxes than paying insurance companies. Taxes have the benefit that they can not typically be higher than your income, while insurance can easily be higher than your income. If you are sick for a long time with say cancer treatment and lose your job, then your insurance costs will quickly get higher than your income.

DiNovi 9y ago

Sure, but what literally killed it is a constitutional provision that non revenue neutral laws need to be introduced by a popular vote.