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The right question is -- why is this forced onto Uber rather than being a question of national healthcare. Because one political party has spent the last 4 dec

The right question is -- why is this forced onto Uber rather than being a question of national healthcare. Because one political party has spent the last 4 decades fighting to prevent "national healthcare," forcing states and businesses to deal with it. Hell, they've spent the last 10 years trying to demolish a law that the overwhelming majority of voters support, including those within their own party.

TuringNYC 6y ago
Totally agree on the root cause here. Curious though - can California deal with this by offering some a state-level single-payer benefit and charging employers? That would be a broader solution that would address many things in one swoop.
- Shebanator 6y ago
  California has seriously discussed doing exactly that. But given the situation in DC, it is likely that they would be actively sabotaged by the federal government if they tried. So much for "states rights"....
- gamblor956 6y ago
  They have tried, but the aforementioned political party blocked such efforts at the state level in the past, and currently federal law (again, due to that same political party) requires the state to get permission from the federal government to implement a single-payer healthcare system. However, as currently envisioned, the single-payer system would not charge employers; it would be part of the taxes levied on all taxpayers (including employers), which would spread out the costs more.
  - chrisco255 6y ago
    Do Californians get a lot of benefit for the high taxes they currently pay? Californians seem to be voting with their feet, moving to lower tax states: https://www.ocregister.com/2019/10/31/190122-more-people-left-california-last-year-vs-arrived-a-38-jump/ https://www.ocregister.com/2019/10/31/190122-more-people-lef... Do you feel strongly that one more tax would solve all of California's problems?
    - gamblor956 6y ago
      Most of the people leaving CA were of the far-right political persuasion, so good riddance to them. And generally, CA is already overpopulated for the amount of housing currently available (or constructable within the near future), so having fewer people actually relieves a lot of the overusage issues currently plaguing many of the public services in CA. With specific respect to the tax issue, the flipside of "one more tax" to pay for a single-payer system is that it would replace health insurance premiums. Because premiums are currently set for smaller risk sharing pools than a statewide pool of nearly 40 million, and those premiums must also include significant profit margins to pay for health executive's multimillion dollar annual bonuses, it would be very easy for a single-payer tax levy to undercut premiums by more than 50% (and for the single-payer proposals currently under consideration, the employee savings range from 50-90%). If anything, the problem with a tax for a single-payer health system is that people would be saving so much money compared to paying health insurance premiums that CA would have too many people moving into the state for the rest of our public services to handle.
      - refurb 6y ago
        Most of the people leaving CA were of the far-right political persuasion, so good riddance to them. Ha! Yeah, CA is known for it’s multitude of far-right groups. And if they are so far right, why are they leaving and voting for left wing policies in other states? Suffice to say CA has some of the highest taxes of any state, yet it also has some of the worst social problems - poverty, homelessness, etc. I’d say it CA inability to run a tight ship despite all the taxes that is causing people to leave.
        TuringNYC 6y ago
        >> Suffice to say CA has some of the highest taxes of any state, yet it also has some of the worst social problems - poverty, homelessness, etc. I was under the impression that much of the homelessness problem is because CA is a nice place to live (with or without a home) and because the climate is temperate and thus safer to live than most other places (where a homeless person could literally freeze to death.) Sorry if this sounds insensitive -- I really want to understand this: I concede that cost of housing could lead to homelessness, but I dont understand this -- isnt the housing cost really a problem just in the two major metro areas? Is housing exorbitant once you leave those areas? For someone who is homeless, is there any gravity anymore to -- say -- being close to SF/SV/Hollywood?
  - refurb 6y ago
    That’s a disingenuous take on it. CA could fix it’s own health system to cover everyone. Yes, there are federal rules they’d need to work around, but they could do it. https://www.nytimes.com/2018/05/25/business/economy/california-single-payer.html https://www.nytimes.com/2018/05/25/business/economy/californ... Basically, one someone tallied up the cost, it ran out of steam. Just like in VT.
    - gamblor956 6y ago
      It's pretty clear that the opinionists didn't actually read the studies they linked to, since at least one of the studies they cited to claim that single-payer would increase costs actually said single-payer would do the opposite, to the tune of a more than 8% reduction of 2017 amounts, which was before a number of health insurers jacked up their premiums just because they could. https://www.peri.umass.edu/media/k2/attachments/PollinZetZalZECONOMICZANALYSISZOFZCAZSINGLE-PAYERZPROPOSAL---5-31-17.pdf https://www.peri.umass.edu/media/k2/attachments/PollinZetZal...
maerF0x0 6y ago
> national healthcare Let me anecdotally tell you that a large healthcare program has not been good in my experience. Single Payer maybe good though so long as there is choice and competition. Another consideration is that the US has been setup to allow a sort of localism where states can design their own solutions. It might be best for each system to be setup as a state level item.
- philjohn 6y ago
  Does that not ignore the massive disparity in population between states. In California the risk pool would be wide enough that it wouldn't be a problem, in states with < 1 million residents that suddenly becomes very difficult indeed.
  - maerF0x0 6y ago
    Decent question, I'm not qualified to answer. Few, (none?) companies have 1M employees, how do they/insurance do it?
    - philjohn 6y ago
      Looking at rates that employers (and then employees pay, especially in copays) the answer would appear to be "expensively". Look at the NHS in the UK, on average it costs £3k per person per year, outcomes are broadly similar (if not better, especially in areas like post-partum mortality) and as a % of GDP is half as expensive as US healthcare.
deleted 6y ago
[deleted]
chrisco255 6y ago
ACA (in particular the forced care provision) was extremely unpopular and it led to the formation of the Tea Party, which swept the House in 2010. There's many good reasons to avoid nationalized healthcare. Have you been to the post office or the DMV?
- deleted 6y ago
  [deleted]
- MisterBastahrd 6y ago
  ACA was extremely unpopular because of how it was characterized. It is extremely popular today. Have I been to the post office or the DMV? Sure. And when there are a ton of people who want to use a service, you tend to have to wait. Have YOU been to a for-profit emergency room? Or a for-profit, non-fast-food restaurant? Hell, go to a Fed Ex or UPS store. They won't be perfect, and you will wait in line.
- mcherm 6y ago
  > Have you been to the post office or the DMV? Yes, I have. The post office seems to do an EXCELLENT job of delivering mail at an absurdly low price (for standard letters or postcards), although when I lived in Chicago for a few years I found that a certain portion of letters were never delivered. A number of years ago the DMV (I was in New York and New Jersey at the time) offered terrible customer service; these days the DMV I have gone to (New Jersey and Pennsylvania) seem to do an excellent job. What I can conclude from this is that quality varies, whether in private industry or public services.
- NationalPark 6y ago
  The ACA has always hovered around 50% favorability and 40% unfavorability nationally, so "extremely unpopular" isn't accurate. Additionally, support among voters for Medicare for all is about 70%. The Tea Party predates the ACA and was more a general anti-Obama movement than specifically motivated by one policy.
- gamblor956 6y ago
  A single-payer system isn't a state healthcare system. It's a public-private healthcare system in which a single entity pays all healthcare providers for health services rendered. Individual providers would still be free to negotiate their own rates with the single-payer entity. Individual providers would still be free to provide concierge medical services or other non-covered medical services (for example, most plastic surgery). Individual providers would still be free to distinguish themselves on the basis of patient service. And with all due respect, the problem with the post office is that the GOP requires it to pay for decades of upfront expenses now rather than when those expenses are incurred, unlike a private business, and the GOP won't actually let the post office operate anything like a private business. If the post office could operate like a private company it would shut down every rural post office in America, since those are just money drains that detract from the profitable urban and suburban facilities. If the post office could operate like a government agency again (like it did before Reagan), it would run as smooth as butter.

TuringNYC 6y ago

Totally agree on the root cause here. Curious though - can California deal with this by offering some a state-level single-payer benefit and charging employers? That would be a broader solution that would address many things in one swoop.

Shebanator 6y ago
California has seriously discussed doing exactly that. But given the situation in DC, it is likely that they would be actively sabotaged by the federal government if they tried. So much for "states rights"....
gamblor956 6y ago
They have tried, but the aforementioned political party blocked such efforts at the state level in the past, and currently federal law (again, due to that same political party) requires the state to get permission from the federal government to implement a single-payer healthcare system. However, as currently envisioned, the single-payer system would not charge employers; it would be part of the taxes levied on all taxpayers (including employers), which would spread out the costs more.
- chrisco255 6y ago
  Do Californians get a lot of benefit for the high taxes they currently pay? Californians seem to be voting with their feet, moving to lower tax states: https://www.ocregister.com/2019/10/31/190122-more-people-left-california-last-year-vs-arrived-a-38-jump/ https://www.ocregister.com/2019/10/31/190122-more-people-lef... Do you feel strongly that one more tax would solve all of California's problems?
  - gamblor956 6y ago
    Most of the people leaving CA were of the far-right political persuasion, so good riddance to them. And generally, CA is already overpopulated for the amount of housing currently available (or constructable within the near future), so having fewer people actually relieves a lot of the overusage issues currently plaguing many of the public services in CA. With specific respect to the tax issue, the flipside of "one more tax" to pay for a single-payer system is that it would replace health insurance premiums. Because premiums are currently set for smaller risk sharing pools than a statewide pool of nearly 40 million, and those premiums must also include significant profit margins to pay for health executive's multimillion dollar annual bonuses, it would be very easy for a single-payer tax levy to undercut premiums by more than 50% (and for the single-payer proposals currently under consideration, the employee savings range from 50-90%). If anything, the problem with a tax for a single-payer health system is that people would be saving so much money compared to paying health insurance premiums that CA would have too many people moving into the state for the rest of our public services to handle.
    - refurb 6y ago
      Most of the people leaving CA were of the far-right political persuasion, so good riddance to them. Ha! Yeah, CA is known for it’s multitude of far-right groups. And if they are so far right, why are they leaving and voting for left wing policies in other states? Suffice to say CA has some of the highest taxes of any state, yet it also has some of the worst social problems - poverty, homelessness, etc. I’d say it CA inability to run a tight ship despite all the taxes that is causing people to leave.
      - TuringNYC 6y ago
        >> Suffice to say CA has some of the highest taxes of any state, yet it also has some of the worst social problems - poverty, homelessness, etc. I was under the impression that much of the homelessness problem is because CA is a nice place to live (with or without a home) and because the climate is temperate and thus safer to live than most other places (where a homeless person could literally freeze to death.) Sorry if this sounds insensitive -- I really want to understand this: I concede that cost of housing could lead to homelessness, but I dont understand this -- isnt the housing cost really a problem just in the two major metro areas? Is housing exorbitant once you leave those areas? For someone who is homeless, is there any gravity anymore to -- say -- being close to SF/SV/Hollywood?
- refurb 6y ago
  That’s a disingenuous take on it. CA could fix it’s own health system to cover everyone. Yes, there are federal rules they’d need to work around, but they could do it. https://www.nytimes.com/2018/05/25/business/economy/california-single-payer.html https://www.nytimes.com/2018/05/25/business/economy/californ... Basically, one someone tallied up the cost, it ran out of steam. Just like in VT.
  - gamblor956 6y ago
    It's pretty clear that the opinionists didn't actually read the studies they linked to, since at least one of the studies they cited to claim that single-payer would increase costs actually said single-payer would do the opposite, to the tune of a more than 8% reduction of 2017 amounts, which was before a number of health insurers jacked up their premiums just because they could. https://www.peri.umass.edu/media/k2/attachments/PollinZetZalZECONOMICZANALYSISZOFZCAZSINGLE-PAYERZPROPOSAL---5-31-17.pdf https://www.peri.umass.edu/media/k2/attachments/PollinZetZal...

maerF0x0 6y ago

> national healthcare Let me anecdotally tell you that a large healthcare program has not been good in my experience. Single Payer maybe good though so long as there is choice and competition. Another consideration is that the US has been setup to allow a sort of localism where states can design their own solutions. It might be best for each system to be setup as a state level item.

philjohn 6y ago
Does that not ignore the massive disparity in population between states. In California the risk pool would be wide enough that it wouldn't be a problem, in states with < 1 million residents that suddenly becomes very difficult indeed.
- maerF0x0 6y ago
  Decent question, I'm not qualified to answer. Few, (none?) companies have 1M employees, how do they/insurance do it?
  - philjohn 6y ago
    Looking at rates that employers (and then employees pay, especially in copays) the answer would appear to be "expensively". Look at the NHS in the UK, on average it costs £3k per person per year, outcomes are broadly similar (if not better, especially in areas like post-partum mortality) and as a % of GDP is half as expensive as US healthcare.

deleted 6y ago

[deleted]

chrisco255 6y ago

ACA (in particular the forced care provision) was extremely unpopular and it led to the formation of the Tea Party, which swept the House in 2010. There's many good reasons to avoid nationalized healthcare. Have you been to the post office or the DMV?

deleted 6y ago
[deleted]
MisterBastahrd 6y ago
ACA was extremely unpopular because of how it was characterized. It is extremely popular today. Have I been to the post office or the DMV? Sure. And when there are a ton of people who want to use a service, you tend to have to wait. Have YOU been to a for-profit emergency room? Or a for-profit, non-fast-food restaurant? Hell, go to a Fed Ex or UPS store. They won't be perfect, and you will wait in line.
mcherm 6y ago
> Have you been to the post office or the DMV? Yes, I have. The post office seems to do an EXCELLENT job of delivering mail at an absurdly low price (for standard letters or postcards), although when I lived in Chicago for a few years I found that a certain portion of letters were never delivered. A number of years ago the DMV (I was in New York and New Jersey at the time) offered terrible customer service; these days the DMV I have gone to (New Jersey and Pennsylvania) seem to do an excellent job. What I can conclude from this is that quality varies, whether in private industry or public services.
NationalPark 6y ago
The ACA has always hovered around 50% favorability and 40% unfavorability nationally, so "extremely unpopular" isn't accurate. Additionally, support among voters for Medicare for all is about 70%. The Tea Party predates the ACA and was more a general anti-Obama movement than specifically motivated by one policy.
gamblor956 6y ago
A single-payer system isn't a state healthcare system. It's a public-private healthcare system in which a single entity pays all healthcare providers for health services rendered. Individual providers would still be free to negotiate their own rates with the single-payer entity. Individual providers would still be free to provide concierge medical services or other non-covered medical services (for example, most plastic surgery). Individual providers would still be free to distinguish themselves on the basis of patient service. And with all due respect, the problem with the post office is that the GOP requires it to pay for decades of upfront expenses now rather than when those expenses are incurred, unlike a private business, and the GOP won't actually let the post office operate anything like a private business. If the post office could operate like a private company it would shut down every rural post office in America, since those are just money drains that detract from the profitable urban and suburban facilities. If the post office could operate like a government agency again (like it did before Reagan), it would run as smooth as butter.