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Setting up single-payer in California would end up being unnaturally more expensive because of the tradeoff with some federal benefits. Also, in the current na

Setting up single-payer in California would end up being unnaturally more expensive because of the tradeoff with some federal benefits. Also, in the current national political environment, there is very little chance that if implementation of such a plan were to actually go forward, that the federal government wouldn't start coming up with punitive measures (because fuck those rich elitist Hollywood liberals).

dragonwriter 9y ago
> Setting up single-payer in California would end up being unnaturally more expensive because of the tradeoff with some federal benefits. How so? Are you just referring to the overlap with Medicaid (a state benefit with federal standards) and Medicare? You'd need to get federal permission to do it, but you could conceivably formally do it by expanding Medi-Cal (the states Medicaid program) to cover the entire population, with those not eligible federally being an optional state-funded population (California already does that with some populations, but obviously not as broadly) and simultaneously make it (or a carve out within it) a Medicare Managed Care Plan (there are, again, Medi-Cal/Medicare joint managed care plans in the state already.) There'd be some administrstive and compliance costs for this, and some coverage and other mandated limiting (but not eliminating) flexibility particularly on the Medicare side. The Administration’s plan to block-grant Medicaid would, while it's likely to be horrible for CA financially in any case, both reduce the administrative burden and federal involvement here, and reduce the marginal cost of a single payer system. > Also, in the current national political environment, there is very little chance that if implementation of such a plan were to actually go forward, that the federal government wouldn't start coming up with punitive measures (because fuck those rich elitist Hollywood liberals). That's a valid concern, though even the pretense of a facially-neutrsl policy reason may be hard to come up with. OTOH, that assumes the political composition of the present federal government, with undivided Republican control, survived long enough to effect any single-payer program.

dragonwriter 9y ago

> Setting up single-payer in California would end up being unnaturally more expensive because of the tradeoff with some federal benefits. How so? Are you just referring to the overlap with Medicaid (a state benefit with federal standards) and Medicare? You'd need to get federal permission to do it, but you could conceivably formally do it by expanding Medi-Cal (the states Medicaid program) to cover the entire population, with those not eligible federally being an optional state-funded population (California already does that with some populations, but obviously not as broadly) and simultaneously make it (or a carve out within it) a Medicare Managed Care Plan (there are, again, Medi-Cal/Medicare joint managed care plans in the state already.) There'd be some administrstive and compliance costs for this, and some coverage and other mandated limiting (but not eliminating) flexibility particularly on the Medicare side. The Administration’s plan to block-grant Medicaid would, while it's likely to be horrible for CA financially in any case, both reduce the administrative burden and federal involvement here, and reduce the marginal cost of a single payer system. > Also, in the current national political environment, there is very little chance that if implementation of such a plan were to actually go forward, that the federal government wouldn't start coming up with punitive measures (because fuck those rich elitist Hollywood liberals). That's a valid concern, though even the pretense of a facially-neutrsl policy reason may be hard to come up with. OTOH, that assumes the political composition of the present federal government, with undivided Republican control, survived long enough to effect any single-payer program.