8 ms·

> to fund a first-in-the-nation single-payer health-care system. This is key here. So instead of paying this out to a private insurance company I pay it in tax

> to fund a first-in-the-nation single-payer health-care system. This is key here. So instead of paying this out to a private insurance company I pay it in taxes, there by my actual change is net zero, in most cases. I have a feeling most reactions might be headline driven here. I think it’s worth doing the math on how much it costs you in healthcare coverage before really judging a book by its cover here. If my compound deductions are the same who cares if it’s just taxes?

lax4ever 5y ago
Do you actually pay that much a year in insurance premiums? I don't live in CA, but I sure don't and my health coverage is pretty good. Keep in mind, this is also just the insurance premium, there's no talk of what co-pays or deductibles would be. In addition, your employer now has to pay more based on their gross receipts and if you make more than 150k a year you are paying even more.
- spamizbad 5y ago
  I mean, my employer technically sponsors part of mine, but to cover my family I'm still paying roughly $10K each year in premiums.
  - lax4ever 5y ago
    My employer sponsors some of mine as well, but even if they weren't my premiums are still around half of what they listed in the article ($12.5k I think is listed in the article if I read it right). This is with coverage that has a minimal deductible and that includes great mental health coverage amongst other things.
- KZerda 5y ago
  Keep in mind as well that your employer probably pays a significant chunk of your insurance premiums right now, usually around 3/4 of the full costs of providing you insurance. This is what tends to bite people when they need COBRA coverage or other gap coverage when changing jobs, etc.
- arebop 5y ago
  I live in CA and according to my W2 box 12 DD, my cost is much more than this. Sure, maybe under this tax proposal my personal expense would go up but judging by my W2 and a quick scan of ACA estimated costs for a 22yo, the aggregate cost of this is much lower than what we're collectively paying today.
- sam0x17 5y ago
  I pay $1.3k/month for myself + husband in MD, both early 30s.
  - mahirsaid 5y ago
    OMG!
- lukemercado 5y ago
  Uh, yeah. My business budgets out 20k/year for insurance premiums on the employer side per employee. This might be an old shorthand, but it's what we use in our models. Some employees pay extra out of pocket for added dependents.
- thehoff 5y ago
  Also not CA, but I pay almost $3,600 a year while my employer pays almost $10,000. So $13,600 for just myself. My wife and son are on her plan since it works out to be cheaper that way. We have good plans too but still have our deductibles which, if I remember right, are around $1,000.
- jdashg 5y ago
  Most people make far less than 150k in California, though you wouldn't know it if you're steeped in tech circles, or over-focused on SF. 150k was above 85%ile of returns in CA in 2018. (90%ile 179k, 75%ile 97k, 50%ile 47k) And this is in returns, so each MFJ/household can statistically replace two lower earners with one higher-earning return.
- jjav 5y ago
  $2500/month here (silicon valley) for blue shield PPO (company pays a small part of that, I pay directly most of it). So that's 30K/year just in the premiums plus of course a lot out of pocket since insurance fights against paying for so many services.
  - bradlys 5y ago
    I assume that’s paying for more than yourself. Also - that’s really high overall… I mean - plans my work offers (which aren’t even the best) are like $500/month out of pocket for the entire family - and that’s for really good coverage with no deductibles and low copays. The plans they offer aren’t even the best I’ve gotten…
  - bsagdiyev 5y ago
    That is insane, I pay right around $100/mo for myself, my spouse and 2 year old. My employer pays less than $1000/mo as their part. Our health insurance is pretty damn good.
- usefulcat 5y ago
  I have the cheapest insurance plan offered at my company. The deductible is near $10k and it costs more than my mortgage. For a family of 4.
- DougN7 5y ago
  If you get health insurance from the federal marketplace, and get no help offsetting the cost, $14K/year for a couple is typical. Don’t ask me how I know :’(
davesque 5y ago
Also, I guess in theory an employer could pass through the savings of paying for your insurance to your salary. Of course, I'm pretty cynical about that.
- hadrien01 5y ago
  Can't you see how much of your salary goes to your insurance on your pay slip? In France, I can see how much "I" pay every month for my employer insurance plan (which covers most of the time 10% of the healthcare expenses, the other 90% being covered by the public healthcare system)
  - toast0 5y ago
    In the US, part of the insurance premium is paid by the employer and part by the employee; only the employee part would be shown on pay stubs. (however, yearly pay statements (w-2) mostly have the employer part listed as well). Of course, sometimes the employer part is zero. It's a little trickier to account for when the employer is 'self-insured' for healthcare. They'll use an insurance company to administer benefits (and pay for that), but they'll pay the costs for treatment rather than paying into an insurance pool and having the pool pay the costs.
- coding123 5y ago
  They won't. They will take the savings from you.
- topaz0 5y ago
  I'm all for being cynical about the devotion of employers to their employees, but I think it's reasonable to expect a good chunk of their savings on health care costs will be shifted to other kinds of compensation. Of course, the employer will try to spend as little as possible on their employees conditional on being able to hire the workers they need. But they won't be able to hire the workers they need if they are out of line with the market in compensation. Part of that calculus in today's world is that employees expect their employers to provide them with good health insurance. If the employee is instead paying for that health insurance through their taxes, they will expect to be paid more. This will only work for the employees who have some power to bargain with their employers, i.e. workers whose skills are in demand. But then, the same goes for healthcare in the current situation.
after_care 5y ago
It’s very hard to do the math here. It’s largely invisible to me how much my employer is paying in health insurance premiums and it’s unknown that they will add that sum to my salary.
- jjoonathan 5y ago
  Which is why it's important to structure the "tax" to land in exactly the same place that health care costs land.
  - lukemercado 5y ago
    Yes, at first that is SUPER important, but wouldn't you ultimately want to fully decouple it from employers and just go to income taxes per individual for it? The distinction is subtle, but in my mind having it structured as an individual paid income tax would yield better results for edge cases and not incentivize bad corporate behavior like running 1099 contractors instead of FTEs.
- coderintherye 5y ago
  It's not invisible at all, what your employer pays for your health insurance is clearly stated on your W-2 in Box 12 unless you work for an exempt company. https://www.irs.gov/affordable-care-act/form-w-2-reporting-of-employer-sponsored-health-coverage https://www.irs.gov/affordable-care-act/form-w-2-reporting-o...
- thrwn_frthr_awy 5y ago
  I'm not sure either, but during my time at Apple (one the richest and most advanced companies in the world) an additional $5-$6k was taken out of my paycheck if I wanted health care for me and my family. It's not like health care is automatically free for the working population.
- thatfrenchguy 5y ago
  Your employer is required to tell you the value of the benefit, you can notably find it in the imputed income sheet for unmarried folks.
sokoloff 5y ago
Gross receipts taxes seem a particularly bad type of tax to me. If you love vertically integrated, massive conglomerates, GRT is one path to improving their relative competitiveness. I suspect a GRT is also a regressive form of taxation (just as sales taxes are, though many [most?] states exempt food and other staples from their sales taxes, to minimize the regressive nature of these).
mindslight 5y ago
100% agree. The headline and the article are utterly dishonest. How much are people currently paying in de facto mandatory payments (aka taxes) for health "insurance" ? How much will the total tax on people in various financial situations change? The article doesn't say, distracting with a myopic definition of taxes instead. As a libertarian, false dichotomies between de jure and de facto government are really bothersome. There are certainly arguments to be debated about single payer. There are certainly arguments to be debated about this particular attempt at "single payer". There are certainly arguments to be debated about who may be shouldering more or less of the costs with this plan. None of them are discussed here.
justicezyx 5y ago
Sure, I'll be happy to accept this. Just waiting for this disfunctioning government to deliver this pipedream in 100 years.
ren_engineer 5y ago
when has California's government recently shown any capability to successfully implement big projects or spend tax payer money efficiently? How is the high speed train project coming along?
- cobrabyte 5y ago
  This is my thought, as well. When your private insurance company stinks, you find a new insurer. When you're forced to pay the government for health insurance, you're stuck without options. Health insurance isn't one of the services that I trust the government to be able to run well. They don't have a particularly great track record where efficiency, customer service, and speed are concerned.
  - Drunk_Engineer 5y ago
    In theory, single payer should offer more choices. With private insurance, you are stuck with certain doctors and hospitals, and can only change plans at years-end.
  - larkost 5y ago
    Here is the breakdown from this article for 2020: https://www.census.gov/library/publications/2021/demo/p60-274.html https://www.census.gov/library/publications/2021/demo/p60-27... 8.6% are uninsured Of the insured: - 54.4% of the ensured on employer based insurance - 10.5% purchase theirs directly - the rest get theirs from one government program to the other (Medicare 18.4%, Medicaid 17.8%, TRICARE 2.8%, and VA and the like 0.9%) So your comment only covers less than 10.5% of people at the moment... a little more than the number of people who have no health coverage (a good portion not out of real choice). And that does not even cover how horribly this sort of market functions: you never know how good or bad your coverage actually is until you go to use it for a particular problem, and then you don't really know that until it is over and you are maybe bankrupt. Health insurance is the worst place to try and use market forces to regulate it... well maybe after military, fire, and police...
  - jjav 5y ago
    > This is my thought, as well. When your private insurance company stinks, you find a new insurer. You can't, because the health insurance is provided by your employes so you get whatever they give you. My health insurance (blue shield) is absolutely terrible (right now I need some medicine they refuse to let me have because it cuts into their profit margins) but there's nothing I can do about it. And that's after paying $2500/month for the privilege.
arebop 5y ago
This is much cheaper than the cost of my big tech health insurance. It's at about the bottom 25th percentile by total estimated cost of ACA plans for a 22 year old. The article discusses some issues with the details but I'd happily approve a tax increase of this magnitude in exchange for achieving this efficiency of healthcare provision.
devmunchies 5y ago
I hope Kaiser Permanente lobbies this or we can opt out. I've lived in many states and my exp with Kaiser in California is among the best. I don't see the state (especially bloated California) doing better. (I pay out of pocket via a side business, not from my current employer.)
- dillondoyle 5y ago
  I personally love kaiser but I know others who strongly disagree. Maybe it would be a good idea to lean on the better insurance companies (are there more than kaiser?) to administer. Personally I think there needs to be stronger regulation so that they can still make some profit (not obscene) for incentive to get more efficient, while regulating they can't take that profit at the expense of patients & access to care.
- jjav 5y ago
  Kaiser posted $3B in profits in a quarter. All that money is overhead that can be removed from the costs if health care didn't have to funnel through a private company taking profits from it. https://www.fiercehealthcare.com/hospitals/kaiser-permanente-posts-3b-profits-q2-as-membership-health-plan-increases https://www.fiercehealthcare.com/hospitals/kaiser-permanente...
  - devmunchies 5y ago
    Yeah but from an operational POV you should factor in competition, efficiency, etc into overhead and profits. I don’t believe the state would be as concerned about keeping out bloat, so it would accrue a different kind of overhead.
  - conanbatt 5y ago
    Profits is not what makes healthcare expensive…
    - jjav 5y ago
      What do you think makes it expensive in the US then? Certainly not the salaries to actual health professionals (doctors, nurses, techs, etc). When you see a doctor for 10 minutes and get billed $400, the vast majority of that money goes all the layers who are extracting their slice of profit from it, only a small bit goes to the doctor.
commandlinefan 5y ago
> my actual change is net zero Really? From what I can find on the internet, CA state income taxes are usually in the 10% range for most folks. Are you really paying 10% of your income for health insurance? I'm paying about 2.5% right now.
- deleted 5y ago
  [deleted]
- wbsss4412 5y ago
  What your employer obliges you to pay directly is arbitrary. What matters is what percentage of your total compensation from your employer is healthcare costs. I highly doubt that number is only 2.5%.
  - cagey 5y ago
    Data point: I just switched from FTE to unemployed (likely transitioning to retirement) and am leveraging COBRA to pay in full to retain my former employer's High Deductible Anthem PPO plan (plus dental plan and VSP) for a family of 4. The COBRA monthly pricetag is $2093. While employed (at this Fortune 300 company's San Jose, CA office), I was paying $425 per month out of pocket for the same set of plans.
    - wbsss4412 5y ago
      This would seem to line up well with this bls data from March of 2020 [1], which shows an average split of ~20-25% employee to 75-80% employer. [1] https://www.bls.gov/ncs/ebs/factsheet/medical-care-premiums-in-the-united-states.htm https://www.bls.gov/ncs/ebs/factsheet/medical-care-premiums-...
- jdashg 5y ago
  Most California income tax returns are AGI 47k or less[2], which we can round up to the top of that (6% marginal!) bracket: 48k. This next bracket, which probably starts at the 51 or 52%ile, is taxed by CA at "$1,672.87 plus 8% of the amount over $48,435."[1], which is about 3.45% actual state tax rate. The 9.3% marginal bracket stretches from 61k-313k. (260k is the 95%ile for CA tax returns, so minor-increase brackets above this one don't matter all that much) 10.3% is 313k-375k. 11.3% is 375k-625k. (99%ile is 680k) At 61k, at the end of the 8% bracket, the real tax rate is still just 4.40%. At 100k, 6.30% actual. At 150k, 7.30% actual. At 313k, 8.32% actual. At 375k, 8.67% actual. At 625k, still only 9.72% actual tax rate. We finally cross 10% actual at about $702k AGI. It's really, really important to keep in mind how much marginal rates mess with calculations, particularly when estimating. Also, Californians are statistically much poorer than people often expect, especially around here. [1]: https://www.nerdwallet.com/article/taxes/california-state-tax https://www.nerdwallet.com/article/taxes/california-state-ta... [2]: https://www.irs.gov/statistics/soi-tax-stats-adjusted-gross-income-agi-percentile-data-by-state https://www.irs.gov/statistics/soi-tax-stats-adjusted-gross-...
artificialLimbs 5y ago
Monetary cost isn't the only thing to worry about. Can you imagine the DMV/social security office version of healthcare? God what a clusterfuck. *edit: spelling
kyrra 5y ago
I thought Vermont already tried single-payer healthcare? https://www.washingtonpost.com/national/health-science/why-vermonts-single-payer-effort-failed-and-what-democrats-can-learn-from-it/2019/04/29/c9789018-3ab8-11e9-a2cd-307b06d0257b_story.html https://www.washingtonpost.com/national/health-science/why-v...
- omgwtfbyobbq 5y ago
  They tried to try it, but there were too many hurdles so they abandoned it. California could be the same, but there are benefits it has the Vermont didn't, as well as a significantly larger number of people to negotiate on behalf of. >As with any attempt to dismantle one American health-care system and replace it with another, Green Mountain Care was always going to be a long game. For starters, it would not be until 2017 that any state could get federal permission to change the way it used insurance subsidies created under the ACA.
  - commandlinefan 5y ago
    > so they abandoned it Did they repeal the tax increase?
    - salawat 5y ago
      Asking the important questions.
    - omgwtfbyobbq 5y ago
      There wasn't a tax increase to repeal. https://en.wikipedia.org/wiki/Vermont_health_care_reform https://en.wikipedia.org/wiki/Vermont_health_care_reform
- Kye 5y ago
  I had to close this immediately due to the auto-playing video. Do you have an article from a less obnoxious source?
wsinks 5y ago
Yeah, that was my exact reaction here. "Doubling my taxes?!" Oh... for a CA based single payer healthcare system that for the last 10-20 years people have continually asked for again and again? (Ok, maybe not just for CA, but... sometimes ya gotta start somewhere) So now I'm back into the evaluation phase after headline whiplash. Will definitely consider the 'total compensation package'.
- ___q 5y ago
  > after headline whiplash The headline is no accident, The Tax Foundation is a center-right, fiscally conservative organization, generally critical of tax increases.
cliftonk 5y ago
Families with kids w/ under 200k combined income pay > 10% of their income in health insurance. Premiums for a decent plan with 2 adults + 1 kid is $20k a year.
- texasbigdata 5y ago
  So $7k per person per year.
- coolspot 5y ago
  SoCal Kaiser HMO 30 ($30 copay) for 2 adults and 2 kids is like $1k/month, paid before taxes.
dillondoyle 5y ago
It goes beyond deductions too. Though maybe you're referring to total costs of premiums or company pays costs that probably come out of your comp. I was shocked to learn how much my parent's insurance costs. Even though ostensibly employed by a huge multi-national, my dad technically operates as his own S-corp so they have to buy on the market. That seems to be a trend in the gig economy which is worse for low 'wage' earners. I also am on private market as I own my business. Mine is $500 a month at 32 and healthy. Theirs is 2k ish and increases significantly each year (65 and 62). That is really hard for almost all older Americans to afford. By the time they are 75 or even older the cost would be insane if this continues. I agree that messaging is what's holding back reform. The messaging is so easy to short circuit. Just look at the headline of this post. No one wants their taxes to double.
- ENOTTY 5y ago
  The messaging on this article likely comes from the Tax Foundation's political viewpoint, which is generally anti-tax
- sokoloff 5y ago
  > By the time they are 75 or even older the cost would be insane if this continues. That's more or less why Medicare exists.
  - dillondoyle 5y ago
    Yeah it does look helpful and pretty good for what it does cover. But still a lot of out of pocket costs and premiums if you want drug coverage and more. Correct me if I'm wrong but it doesn't really cover if you need long term care which is insanely expensive.
eat_veggies 5y ago
Another thing that people are missing is that a net zero change, or even a small loss would be worth it in terms of freedom. You're no longer compelled to stay at your current job just to keep your healthcare, and if you lose your job then you only have one problem rather than two -- especially in the middle of a pandemic, when lots of people are getting laid off and needing to go to the hospital due to covid
- jdashg 5y ago
  HN and VCs ought to be extremely interested in single-payer for this reason. Healthcare (for themselves and their families) is a big reason why, in practice, people stick around at stable employers. Also, private stock valuation can't simply pay health insurance bills.
  - 1991g 5y ago
    I certainly couldn't ever seriously consider early stage startups, as my spouse is unfortunately heavily dependent on my healthcare. It'd be cool if that was no longer a blocker.
- RickJWagner 5y ago
  Yes. I imagine many homeless or underemployed people would love this. Then again, with many wage-earners already leaving the state, this may turn toxic.
jobu 5y ago
Yeah, the headline could easily be flipped with the subheading and most people's reaction would be drastically different. Overall I think a single-payer system is for the best. Having healthcare tied to your job creates another anchor to keep people tied to large, stable companies instead of taking risks with startups or small businesses. The main downside is that companies have started doing tiered healthcare costs based on things like smoking or health indicators. Having income tax based on your weight or smoking status is probably a non-starter, so it removes some of the incentives for people to make good choices (and reduce healthcare costs).
- Fatnino 5y ago
  Some system to earn tax credits if you can prove that you lead a healthy lifestyle. Maybe verified by the doctors in the unified health system.
  - Maarten88 5y ago
    A sugar tax will accomplish a lot and is much easier.
    - jimbob45 5y ago
      Yeah I was going to say this. If you want smokers and the obese to partially fund their own healthcare, you can very easily slap taxes on cigarettes and soft drinks, earmark that money to go to insurance, and call it a day.
      - fortran77 5y ago
        I think the obese should pay for their externalities directly. Also, if the best treatment for something is “lose weight” then that should be tried first and no other treatments given until the weight is lost. 80% of people with Type II diabetes who are also overweight or obese would be asymptomatic if they lost weight. Why spend public money if there exists a free treatment? Save the public resources for right-weight type IIs and type Is.
apendleton 5y ago
> my actual change is net zero, in most cases It's designed to be a progressive system, unlike current health insurance, so almost nobody's change will be net zero, even assuming the cost of providing the service is the same (which, who knows). Low-income earners can probably expect to pay considerably less, and high-income earners can expect to pay considerably more; only people right at the crossover point would expect no change.
- bryanlarsen 5y ago
  Even better, on average it will be net zero. Since some high earners skew the average considerably, it will be net positive for a significant majority of taxpayers.
  - thrill 5y ago
    Well sure it's better for most taxpayers, since it'll be a proportion of income the higher paid person will be paying for their own and a dozen others' healthcare.
TheMagicHorsey 5y ago
This is not taking into account CA government efficiency. I've lived here for 30 years. I'm not putting my family health into the hands of a government that has zero successful large scale projects under its belt and can't even run a parental benefits system where people can get their checks sent to the right address. No thanks. We're moving. More real estate and jobs for the rest of you true believers. Enjoy the weather. I will miss it.
hourislate 5y ago
Typical the argument is that a single payer system is to avoid waste. California Government would be the perfect candidate for this since they are so fiscally responsible and do such an amazing job managing their finances. God Speed.
- _moof 5y ago
  California had a $75 billion surplus last year.
  - verdverm 5y ago
    That in itself is not a signal of responsibility. You could have increased revenues or cut the wrong programs.
  - kyboren 5y ago
    That's thanks to the Federal Congress and Jerome Powell, not to California's supposed fiscal prudence. California has benefited from the Federal spending bonanza and also has famously high tax rates, treats capital gains as ordinary income, and has a lot of rich people. The FTB seems to have screwed up the links[1] and I can't find later data for a complete fiscal year, but check out "Ordinary Dividends" and "Capital Gain" in exhibit A9 for FY2019[2] to get a sense of how important that is to the state budget. [1]: https://data.ftb.ca.gov/stories/s/Other-Tax-Data/sgxz-494k#department-of-finance-exhibits https://data.ftb.ca.gov/stories/s/Other-Tax-Data/sgxz-494k#d... [2]: https://data.ftb.ca.gov/download/d6s8-gyup/application%2Fpdf https://data.ftb.ca.gov/download/d6s8-gyup/application%2Fpdf
  - quartesixte 5y ago
    That surplus was on made on extra taxes collected, and not on lean government spending. I love this state’s geography and food scene, but the various governments here (local, county, state) aren’t exactly the pinnacle of smart governance.
_moof 5y ago
The way this headline is written reminds me of a recent article that asked if you would rather have a treatment with a 10% chance of death or one with a 90% chance of success. This is from an advocacy organization that is more or less anti-tax. There are probably much more balanced takes on this proposal from other sources.
parkingrift 5y ago
>I think it’s worth doing the math on how much it costs you in healthcare coverage before really judging a book by its cover here. If my compound deductions are the same who cares if it’s just taxes? Have you done this analysis? Most employers cover a portion of your employer sponsored health insurance. Are you expecting that your employer will just add this amount back to your salary? At no point in my career, going back to fast food in college, have I ever spent 5-10% of my income on insurance. I would have to include the employer portion to even get close to that.
conanbatt 5y ago
Unless it sucks, and then you just pay it twice.
Justin_K 5y ago
Except anybody you consider to be a "good" doctor won't take this insurance because the payouts are too low. So, your employer will still buy "aftermarket" plans to provide better care. Now you'll be paying both for a plan you won't use and a plan you will use.
- dragonwriter 5y ago
  > Except anybody you consider to be a "good" doctor won't take this insurance because the payouts are too low When you are the single payer for the entire state, yes, I think the doctors in the state will take it.
- rapind 5y ago
  FWIW, as a Canadian, I don’t have any health insurance beyond what my government provides and I don’t think or worry about it. I have a lot of complaints about my government (like most people), but the idea of universal healthcare isn’t one.

lax4ever 5y ago

Do you actually pay that much a year in insurance premiums? I don't live in CA, but I sure don't and my health coverage is pretty good. Keep in mind, this is also just the insurance premium, there's no talk of what co-pays or deductibles would be. In addition, your employer now has to pay more based on their gross receipts and if you make more than 150k a year you are paying even more.

spamizbad 5y ago
I mean, my employer technically sponsors part of mine, but to cover my family I'm still paying roughly $10K each year in premiums.
- lax4ever 5y ago
  My employer sponsors some of mine as well, but even if they weren't my premiums are still around half of what they listed in the article ($12.5k I think is listed in the article if I read it right). This is with coverage that has a minimal deductible and that includes great mental health coverage amongst other things.
KZerda 5y ago
Keep in mind as well that your employer probably pays a significant chunk of your insurance premiums right now, usually around 3/4 of the full costs of providing you insurance. This is what tends to bite people when they need COBRA coverage or other gap coverage when changing jobs, etc.
arebop 5y ago
I live in CA and according to my W2 box 12 DD, my cost is much more than this. Sure, maybe under this tax proposal my personal expense would go up but judging by my W2 and a quick scan of ACA estimated costs for a 22yo, the aggregate cost of this is much lower than what we're collectively paying today.
sam0x17 5y ago
I pay $1.3k/month for myself + husband in MD, both early 30s.
- mahirsaid 5y ago
  OMG!
lukemercado 5y ago
Uh, yeah. My business budgets out 20k/year for insurance premiums on the employer side per employee. This might be an old shorthand, but it's what we use in our models. Some employees pay extra out of pocket for added dependents.
thehoff 5y ago
Also not CA, but I pay almost $3,600 a year while my employer pays almost $10,000. So $13,600 for just myself. My wife and son are on her plan since it works out to be cheaper that way. We have good plans too but still have our deductibles which, if I remember right, are around $1,000.
jdashg 5y ago
Most people make far less than 150k in California, though you wouldn't know it if you're steeped in tech circles, or over-focused on SF. 150k was above 85%ile of returns in CA in 2018. (90%ile 179k, 75%ile 97k, 50%ile 47k) And this is in returns, so each MFJ/household can statistically replace two lower earners with one higher-earning return.
jjav 5y ago
$2500/month here (silicon valley) for blue shield PPO (company pays a small part of that, I pay directly most of it). So that's 30K/year just in the premiums plus of course a lot out of pocket since insurance fights against paying for so many services.
- bradlys 5y ago
  I assume that’s paying for more than yourself. Also - that’s really high overall… I mean - plans my work offers (which aren’t even the best) are like $500/month out of pocket for the entire family - and that’s for really good coverage with no deductibles and low copays. The plans they offer aren’t even the best I’ve gotten…
- bsagdiyev 5y ago
  That is insane, I pay right around $100/mo for myself, my spouse and 2 year old. My employer pays less than $1000/mo as their part. Our health insurance is pretty damn good.
usefulcat 5y ago
I have the cheapest insurance plan offered at my company. The deductible is near $10k and it costs more than my mortgage. For a family of 4.
DougN7 5y ago
If you get health insurance from the federal marketplace, and get no help offsetting the cost, $14K/year for a couple is typical. Don’t ask me how I know :’(

davesque 5y ago

Also, I guess in theory an employer could pass through the savings of paying for your insurance to your salary. Of course, I'm pretty cynical about that.

hadrien01 5y ago
Can't you see how much of your salary goes to your insurance on your pay slip? In France, I can see how much "I" pay every month for my employer insurance plan (which covers most of the time 10% of the healthcare expenses, the other 90% being covered by the public healthcare system)
- toast0 5y ago
  In the US, part of the insurance premium is paid by the employer and part by the employee; only the employee part would be shown on pay stubs. (however, yearly pay statements (w-2) mostly have the employer part listed as well). Of course, sometimes the employer part is zero. It's a little trickier to account for when the employer is 'self-insured' for healthcare. They'll use an insurance company to administer benefits (and pay for that), but they'll pay the costs for treatment rather than paying into an insurance pool and having the pool pay the costs.
coding123 5y ago
They won't. They will take the savings from you.
topaz0 5y ago
I'm all for being cynical about the devotion of employers to their employees, but I think it's reasonable to expect a good chunk of their savings on health care costs will be shifted to other kinds of compensation. Of course, the employer will try to spend as little as possible on their employees conditional on being able to hire the workers they need. But they won't be able to hire the workers they need if they are out of line with the market in compensation. Part of that calculus in today's world is that employees expect their employers to provide them with good health insurance. If the employee is instead paying for that health insurance through their taxes, they will expect to be paid more. This will only work for the employees who have some power to bargain with their employers, i.e. workers whose skills are in demand. But then, the same goes for healthcare in the current situation.

after_care 5y ago

It’s very hard to do the math here. It’s largely invisible to me how much my employer is paying in health insurance premiums and it’s unknown that they will add that sum to my salary.

jjoonathan 5y ago
Which is why it's important to structure the "tax" to land in exactly the same place that health care costs land.
- lukemercado 5y ago
  Yes, at first that is SUPER important, but wouldn't you ultimately want to fully decouple it from employers and just go to income taxes per individual for it? The distinction is subtle, but in my mind having it structured as an individual paid income tax would yield better results for edge cases and not incentivize bad corporate behavior like running 1099 contractors instead of FTEs.
coderintherye 5y ago
It's not invisible at all, what your employer pays for your health insurance is clearly stated on your W-2 in Box 12 unless you work for an exempt company. https://www.irs.gov/affordable-care-act/form-w-2-reporting-of-employer-sponsored-health-coverage https://www.irs.gov/affordable-care-act/form-w-2-reporting-o...
thrwn_frthr_awy 5y ago
I'm not sure either, but during my time at Apple (one the richest and most advanced companies in the world) an additional $5-$6k was taken out of my paycheck if I wanted health care for me and my family. It's not like health care is automatically free for the working population.
thatfrenchguy 5y ago
Your employer is required to tell you the value of the benefit, you can notably find it in the imputed income sheet for unmarried folks.

sokoloff 5y ago

Gross receipts taxes seem a particularly bad type of tax to me. If you love vertically integrated, massive conglomerates, GRT is one path to improving their relative competitiveness. I suspect a GRT is also a regressive form of taxation (just as sales taxes are, though many [most?] states exempt food and other staples from their sales taxes, to minimize the regressive nature of these).

mindslight 5y ago

100% agree. The headline and the article are utterly dishonest. How much are people currently paying in de facto mandatory payments (aka taxes) for health "insurance" ? How much will the total tax on people in various financial situations change? The article doesn't say, distracting with a myopic definition of taxes instead. As a libertarian, false dichotomies between de jure and de facto government are really bothersome. There are certainly arguments to be debated about single payer. There are certainly arguments to be debated about this particular attempt at "single payer". There are certainly arguments to be debated about who may be shouldering more or less of the costs with this plan. None of them are discussed here.

justicezyx 5y ago

Sure, I'll be happy to accept this. Just waiting for this disfunctioning government to deliver this pipedream in 100 years.

ren_engineer 5y ago

when has California's government recently shown any capability to successfully implement big projects or spend tax payer money efficiently? How is the high speed train project coming along?

cobrabyte 5y ago
This is my thought, as well. When your private insurance company stinks, you find a new insurer. When you're forced to pay the government for health insurance, you're stuck without options. Health insurance isn't one of the services that I trust the government to be able to run well. They don't have a particularly great track record where efficiency, customer service, and speed are concerned.
- Drunk_Engineer 5y ago
  In theory, single payer should offer more choices. With private insurance, you are stuck with certain doctors and hospitals, and can only change plans at years-end.
- larkost 5y ago
  Here is the breakdown from this article for 2020: https://www.census.gov/library/publications/2021/demo/p60-274.html https://www.census.gov/library/publications/2021/demo/p60-27... 8.6% are uninsured Of the insured: - 54.4% of the ensured on employer based insurance - 10.5% purchase theirs directly - the rest get theirs from one government program to the other (Medicare 18.4%, Medicaid 17.8%, TRICARE 2.8%, and VA and the like 0.9%) So your comment only covers less than 10.5% of people at the moment... a little more than the number of people who have no health coverage (a good portion not out of real choice). And that does not even cover how horribly this sort of market functions: you never know how good or bad your coverage actually is until you go to use it for a particular problem, and then you don't really know that until it is over and you are maybe bankrupt. Health insurance is the worst place to try and use market forces to regulate it... well maybe after military, fire, and police...
- jjav 5y ago
  > This is my thought, as well. When your private insurance company stinks, you find a new insurer. You can't, because the health insurance is provided by your employes so you get whatever they give you. My health insurance (blue shield) is absolutely terrible (right now I need some medicine they refuse to let me have because it cuts into their profit margins) but there's nothing I can do about it. And that's after paying $2500/month for the privilege.

arebop 5y ago

This is much cheaper than the cost of my big tech health insurance. It's at about the bottom 25th percentile by total estimated cost of ACA plans for a 22 year old. The article discusses some issues with the details but I'd happily approve a tax increase of this magnitude in exchange for achieving this efficiency of healthcare provision.

devmunchies 5y ago

I hope Kaiser Permanente lobbies this or we can opt out. I've lived in many states and my exp with Kaiser in California is among the best. I don't see the state (especially bloated California) doing better. (I pay out of pocket via a side business, not from my current employer.)

dillondoyle 5y ago
I personally love kaiser but I know others who strongly disagree. Maybe it would be a good idea to lean on the better insurance companies (are there more than kaiser?) to administer. Personally I think there needs to be stronger regulation so that they can still make some profit (not obscene) for incentive to get more efficient, while regulating they can't take that profit at the expense of patients & access to care.
jjav 5y ago
Kaiser posted $3B in profits in a quarter. All that money is overhead that can be removed from the costs if health care didn't have to funnel through a private company taking profits from it. https://www.fiercehealthcare.com/hospitals/kaiser-permanente-posts-3b-profits-q2-as-membership-health-plan-increases https://www.fiercehealthcare.com/hospitals/kaiser-permanente...
- devmunchies 5y ago
  Yeah but from an operational POV you should factor in competition, efficiency, etc into overhead and profits. I don’t believe the state would be as concerned about keeping out bloat, so it would accrue a different kind of overhead.
- conanbatt 5y ago
  Profits is not what makes healthcare expensive…
  - jjav 5y ago
    What do you think makes it expensive in the US then? Certainly not the salaries to actual health professionals (doctors, nurses, techs, etc). When you see a doctor for 10 minutes and get billed $400, the vast majority of that money goes all the layers who are extracting their slice of profit from it, only a small bit goes to the doctor.

commandlinefan 5y ago

> my actual change is net zero Really? From what I can find on the internet, CA state income taxes are usually in the 10% range for most folks. Are you really paying 10% of your income for health insurance? I'm paying about 2.5% right now.

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wbsss4412 5y ago
What your employer obliges you to pay directly is arbitrary. What matters is what percentage of your total compensation from your employer is healthcare costs. I highly doubt that number is only 2.5%.
- cagey 5y ago
  Data point: I just switched from FTE to unemployed (likely transitioning to retirement) and am leveraging COBRA to pay in full to retain my former employer's High Deductible Anthem PPO plan (plus dental plan and VSP) for a family of 4. The COBRA monthly pricetag is $2093. While employed (at this Fortune 300 company's San Jose, CA office), I was paying $425 per month out of pocket for the same set of plans.
  - wbsss4412 5y ago
    This would seem to line up well with this bls data from March of 2020 [1], which shows an average split of ~20-25% employee to 75-80% employer. [1] https://www.bls.gov/ncs/ebs/factsheet/medical-care-premiums-in-the-united-states.htm https://www.bls.gov/ncs/ebs/factsheet/medical-care-premiums-...
jdashg 5y ago
Most California income tax returns are AGI 47k or less[2], which we can round up to the top of that (6% marginal!) bracket: 48k. This next bracket, which probably starts at the 51 or 52%ile, is taxed by CA at "$1,672.87 plus 8% of the amount over $48,435."[1], which is about 3.45% actual state tax rate. The 9.3% marginal bracket stretches from 61k-313k. (260k is the 95%ile for CA tax returns, so minor-increase brackets above this one don't matter all that much) 10.3% is 313k-375k. 11.3% is 375k-625k. (99%ile is 680k) At 61k, at the end of the 8% bracket, the real tax rate is still just 4.40%. At 100k, 6.30% actual. At 150k, 7.30% actual. At 313k, 8.32% actual. At 375k, 8.67% actual. At 625k, still only 9.72% actual tax rate. We finally cross 10% actual at about $702k AGI. It's really, really important to keep in mind how much marginal rates mess with calculations, particularly when estimating. Also, Californians are statistically much poorer than people often expect, especially around here. [1]: https://www.nerdwallet.com/article/taxes/california-state-tax https://www.nerdwallet.com/article/taxes/california-state-ta... [2]: https://www.irs.gov/statistics/soi-tax-stats-adjusted-gross-income-agi-percentile-data-by-state https://www.irs.gov/statistics/soi-tax-stats-adjusted-gross-...

artificialLimbs 5y ago

Monetary cost isn't the only thing to worry about. Can you imagine the DMV/social security office version of healthcare? God what a clusterfuck. *edit: spelling

kyrra 5y ago

I thought Vermont already tried single-payer healthcare? https://www.washingtonpost.com/national/health-science/why-vermonts-single-payer-effort-failed-and-what-democrats-can-learn-from-it/2019/04/29/c9789018-3ab8-11e9-a2cd-307b06d0257b_story.html https://www.washingtonpost.com/national/health-science/why-v...

omgwtfbyobbq 5y ago
They tried to try it, but there were too many hurdles so they abandoned it. California could be the same, but there are benefits it has the Vermont didn't, as well as a significantly larger number of people to negotiate on behalf of. >As with any attempt to dismantle one American health-care system and replace it with another, Green Mountain Care was always going to be a long game. For starters, it would not be until 2017 that any state could get federal permission to change the way it used insurance subsidies created under the ACA.
- commandlinefan 5y ago
  > so they abandoned it Did they repeal the tax increase?
  - salawat 5y ago
    Asking the important questions.
  - omgwtfbyobbq 5y ago
    There wasn't a tax increase to repeal. https://en.wikipedia.org/wiki/Vermont_health_care_reform https://en.wikipedia.org/wiki/Vermont_health_care_reform
Kye 5y ago
I had to close this immediately due to the auto-playing video. Do you have an article from a less obnoxious source?

wsinks 5y ago

Yeah, that was my exact reaction here. "Doubling my taxes?!" Oh... for a CA based single payer healthcare system that for the last 10-20 years people have continually asked for again and again? (Ok, maybe not just for CA, but... sometimes ya gotta start somewhere) So now I'm back into the evaluation phase after headline whiplash. Will definitely consider the 'total compensation package'.

___q 5y ago
> after headline whiplash The headline is no accident, The Tax Foundation is a center-right, fiscally conservative organization, generally critical of tax increases.

cliftonk 5y ago

Families with kids w/ under 200k combined income pay > 10% of their income in health insurance. Premiums for a decent plan with 2 adults + 1 kid is $20k a year.

texasbigdata 5y ago
So $7k per person per year.
coolspot 5y ago
SoCal Kaiser HMO 30 ($30 copay) for 2 adults and 2 kids is like $1k/month, paid before taxes.

dillondoyle 5y ago

It goes beyond deductions too. Though maybe you're referring to total costs of premiums or company pays costs that probably come out of your comp. I was shocked to learn how much my parent's insurance costs. Even though ostensibly employed by a huge multi-national, my dad technically operates as his own S-corp so they have to buy on the market. That seems to be a trend in the gig economy which is worse for low 'wage' earners. I also am on private market as I own my business. Mine is $500 a month at 32 and healthy. Theirs is 2k ish and increases significantly each year (65 and 62). That is really hard for almost all older Americans to afford. By the time they are 75 or even older the cost would be insane if this continues. I agree that messaging is what's holding back reform. The messaging is so easy to short circuit. Just look at the headline of this post. No one wants their taxes to double.

ENOTTY 5y ago
The messaging on this article likely comes from the Tax Foundation's political viewpoint, which is generally anti-tax
sokoloff 5y ago
> By the time they are 75 or even older the cost would be insane if this continues. That's more or less why Medicare exists.
- dillondoyle 5y ago
  Yeah it does look helpful and pretty good for what it does cover. But still a lot of out of pocket costs and premiums if you want drug coverage and more. Correct me if I'm wrong but it doesn't really cover if you need long term care which is insanely expensive.

eat_veggies 5y ago

Another thing that people are missing is that a net zero change, or even a small loss would be worth it in terms of freedom. You're no longer compelled to stay at your current job just to keep your healthcare, and if you lose your job then you only have one problem rather than two -- especially in the middle of a pandemic, when lots of people are getting laid off and needing to go to the hospital due to covid

jdashg 5y ago
HN and VCs ought to be extremely interested in single-payer for this reason. Healthcare (for themselves and their families) is a big reason why, in practice, people stick around at stable employers. Also, private stock valuation can't simply pay health insurance bills.
- 1991g 5y ago
  I certainly couldn't ever seriously consider early stage startups, as my spouse is unfortunately heavily dependent on my healthcare. It'd be cool if that was no longer a blocker.
RickJWagner 5y ago
Yes. I imagine many homeless or underemployed people would love this. Then again, with many wage-earners already leaving the state, this may turn toxic.

jobu 5y ago

Yeah, the headline could easily be flipped with the subheading and most people's reaction would be drastically different. Overall I think a single-payer system is for the best. Having healthcare tied to your job creates another anchor to keep people tied to large, stable companies instead of taking risks with startups or small businesses. The main downside is that companies have started doing tiered healthcare costs based on things like smoking or health indicators. Having income tax based on your weight or smoking status is probably a non-starter, so it removes some of the incentives for people to make good choices (and reduce healthcare costs).

Fatnino 5y ago
Some system to earn tax credits if you can prove that you lead a healthy lifestyle. Maybe verified by the doctors in the unified health system.
- Maarten88 5y ago
  A sugar tax will accomplish a lot and is much easier.
  - jimbob45 5y ago
    Yeah I was going to say this. If you want smokers and the obese to partially fund their own healthcare, you can very easily slap taxes on cigarettes and soft drinks, earmark that money to go to insurance, and call it a day.
    - fortran77 5y ago
      I think the obese should pay for their externalities directly. Also, if the best treatment for something is “lose weight” then that should be tried first and no other treatments given until the weight is lost. 80% of people with Type II diabetes who are also overweight or obese would be asymptomatic if they lost weight. Why spend public money if there exists a free treatment? Save the public resources for right-weight type IIs and type Is.

apendleton 5y ago

> my actual change is net zero, in most cases It's designed to be a progressive system, unlike current health insurance, so almost nobody's change will be net zero, even assuming the cost of providing the service is the same (which, who knows). Low-income earners can probably expect to pay considerably less, and high-income earners can expect to pay considerably more; only people right at the crossover point would expect no change.

bryanlarsen 5y ago
Even better, on average it will be net zero. Since some high earners skew the average considerably, it will be net positive for a significant majority of taxpayers.
- thrill 5y ago
  Well sure it's better for most taxpayers, since it'll be a proportion of income the higher paid person will be paying for their own and a dozen others' healthcare.

TheMagicHorsey 5y ago

This is not taking into account CA government efficiency. I've lived here for 30 years. I'm not putting my family health into the hands of a government that has zero successful large scale projects under its belt and can't even run a parental benefits system where people can get their checks sent to the right address. No thanks. We're moving. More real estate and jobs for the rest of you true believers. Enjoy the weather. I will miss it.

hourislate 5y ago

Typical the argument is that a single payer system is to avoid waste. California Government would be the perfect candidate for this since they are so fiscally responsible and do such an amazing job managing their finances. God Speed.

_moof 5y ago
California had a $75 billion surplus last year.
- verdverm 5y ago
  That in itself is not a signal of responsibility. You could have increased revenues or cut the wrong programs.
- kyboren 5y ago
  That's thanks to the Federal Congress and Jerome Powell, not to California's supposed fiscal prudence. California has benefited from the Federal spending bonanza and also has famously high tax rates, treats capital gains as ordinary income, and has a lot of rich people. The FTB seems to have screwed up the links[1] and I can't find later data for a complete fiscal year, but check out "Ordinary Dividends" and "Capital Gain" in exhibit A9 for FY2019[2] to get a sense of how important that is to the state budget. [1]: https://data.ftb.ca.gov/stories/s/Other-Tax-Data/sgxz-494k#department-of-finance-exhibits https://data.ftb.ca.gov/stories/s/Other-Tax-Data/sgxz-494k#d... [2]: https://data.ftb.ca.gov/download/d6s8-gyup/application%2Fpdf https://data.ftb.ca.gov/download/d6s8-gyup/application%2Fpdf
- quartesixte 5y ago
  That surplus was on made on extra taxes collected, and not on lean government spending. I love this state’s geography and food scene, but the various governments here (local, county, state) aren’t exactly the pinnacle of smart governance.

_moof 5y ago

The way this headline is written reminds me of a recent article that asked if you would rather have a treatment with a 10% chance of death or one with a 90% chance of success. This is from an advocacy organization that is more or less anti-tax. There are probably much more balanced takes on this proposal from other sources.

parkingrift 5y ago

>I think it’s worth doing the math on how much it costs you in healthcare coverage before really judging a book by its cover here. If my compound deductions are the same who cares if it’s just taxes? Have you done this analysis? Most employers cover a portion of your employer sponsored health insurance. Are you expecting that your employer will just add this amount back to your salary? At no point in my career, going back to fast food in college, have I ever spent 5-10% of my income on insurance. I would have to include the employer portion to even get close to that.

conanbatt 5y ago

Unless it sucks, and then you just pay it twice.

Justin_K 5y ago

Except anybody you consider to be a "good" doctor won't take this insurance because the payouts are too low. So, your employer will still buy "aftermarket" plans to provide better care. Now you'll be paying both for a plan you won't use and a plan you will use.

dragonwriter 5y ago
> Except anybody you consider to be a "good" doctor won't take this insurance because the payouts are too low When you are the single payer for the entire state, yes, I think the doctors in the state will take it.
rapind 5y ago
FWIW, as a Canadian, I don’t have any health insurance beyond what my government provides and I don’t think or worry about it. I have a lot of complaints about my government (like most people), but the idea of universal healthcare isn’t one.