New Single-Payer Bill Intensifies Newsom’s Political Peril

[Allan]

So you also have a gigantic WELFARE system just like the U.S.?

Whatever. See ya.

 

[Luther]

The tax bracket is a base for initial calculation of taxes (and yours is dated btw), but the poorest get federal and provincial credits that get them to a net of less than zero taxes.

The tax bracket is a base for initial calculation of taxes

A lot of our poor pay NOTHING at all at all times (WINK)

 

[Luther]

Whatever. See ya.

I know

It gets HOT in the kitchen

 

[Greenbeard]

The article you cite says that the prior single payer bill that failed in 2017 would have cost an estimated $400 billion in taxes per year. Or, roughly $10,000.00 per resident per year. Who exactly is going to be paying that? Because mind you, California’s budget is presently $200 billion, and we have the highest taxes in the nation, with only property taxes remaining somewhat sane. We have a high state sales tax, high state income tax and Capital gains tax. Even if the cost is over-inflated, and would only be half as much ($200 billion per year), we would have to double California’s tax revenues.

Left, right or center, Californians are not clamoring for being taxed more. Especially not when the Californian state governmental bureaucracies have demonstrated themselves to be sluggish morasses of ineptness, even when lives are on the line.

As of 2019, the American health care system costs $11,582 per person. How do you finance a system that expensive? Well, we're already doing it! That $200 billion may be net new spending by the state government, but it's not net new health spending in California. Those hundreds of billions of dollars are already being poured into the health system in that state, financed by the same households, businesses, and government entities that would be financing the state's single-payer program.

State-level health spending numbers haven't come out in a while, but let's take the latest national health spending numbers (from 2019) and imagine California's corner of the American health system more or less mirrors the national numbers.

So if total health spending is a dollar, households are financing 28 cents of it and businesses are financing 19 cents of it directly through premiums and out-of-pocket spending. Another 45 cents of that spending is being financed by various levels of government, which of course in a deficit-less world ultimately derives from households and businesses again via their tax contributions.

Those entities are all collectively pooling their funds and passing them through private insurers, programs like Medicare and Medicaid, and sometimes (for households) just paying directly out-of-pocket. Those payers in turn are taking that money and cutting the checks that represent the revenue stream to health care providers, like hospitals and medical professionals, with about 7 cents of the health care dollar siphoned off along the way by insurance and government administrative costs.

If California were to pursue single-payer, the entities pooling their money to purchase health care are the same. The same households, businesses, and levels of government will still ultimately be the ones purchasing health care. But instead of filtering through a variety of different payers, all of their contributions instead get collected as tax revenue by the state government and turned over to the state single payer (significantly oversimplifying, as for instance out-of-pocket spending is unlikely to disappear entirely and I imagine the federal contribution would still be collected from households and businesses by the feds but would then be transferred to the state single-payer entity).

So in principle you can imagine a California single-payer system in which everyone pays the same thing they do now, the only change being who they pay it to, and the same revenue flows into health care providers from the single-payer entity.

Obviously the reality is complicated, since there will be various distributional effects; there are a thousand technical, operational, and policy details to address; and the transition is likely to be incredibly challenging (precisely why I'd like to see a state experiment with this model). But to a first approximation, the answer to questions about who pays and where the money comes from is: the same people and entities pay, and the money is already there.

 

[mrjurrs]

*cough*


New Census Bureau estimates, released in late December, reveal that California actually saw a population loss in the year that ended on July 1 of about 69,000 residents, which translates into just a 5.7% gain since the 2010 census, much lower than the nation as a whole.Jan 4, 2021

California’s population may be declining

California’s 170 years of strong population growth have ended and the state may be in decline, with powerful economic and political effects,

www.mercurynews.com

Yes CA population declined almost .0017%. That may break us.

 

[Luther]

Yes CA population declined almost .0017%. That may break us.

What will break you is the fast growing poor immigrant population

Keep up the good work

 

[Luther]

Yes CA population declined almost .0017%. That may break us.

But... but....(LOL)

I guess people that like the beach, like to ski, love nature, prefer a Mediterranean climate, like people that care about other people, own a convertible, want an educated workforce.

 

[mrjurrs]

What will break you is the fast growing poor immigrant population

Keep up the good work

Based on your economic expertise? Back it up.

 

[Patriotic Voter]

Yep, and only one of them pays anything for it. I’m sure that many would prefer to have Medicaid coverage (no monthly premiums, annual deductibles or co-pays) than Medicare coverage, but that form of ‘public option’ is not currently offered.

Nobody wants Medicaid coverage. To qualify, you must have no more than $1,500 in your name at all times. That is impossible if you don't; quit your job. Believe me, I tried. I could not become eligible.

 

[Patriotic Voter]

If just one of the 50 states had single payer, a lot of sick people would move there to take advantage of it.

Not if it is the most expensive state to live in. The danger is someone driving from southern Oregon, western Nevada, or western Arizona to get medical care in northern or eastern California. The solution is self-explanatory: Make all patients show their state ID cards or driver's licenses. And of course do not accept any Mexico passports or visas for identification along the southern border.

 

[Allan]

Make all patients show their state ID cards or driver's licenses.

In Canada (and I assume other countries with health coverage) you get a health insurance card, similar in size to a credit card. They are issued by each province.

 

[Luther]

Based on your economic expertise? Back it up.

Speaking of economics?

Oh shit...(LOL)

Companies Are Fleeing California. Blame Bad Government.

Silicon Valley remains the world’s preeminent tech hub. But that won’t last if lawmakers there keep antagonizing businesses.

www.bloomberg.com

 

[Patriotic Voter]

In Canada (and I assume other countries with health coverage) you get a health insurance card, similar in size to a credit card. They are issued by each province.

We are talking about limiting California medical services to California residents so they will not be overrun with the wrong patients.

Private health insurance companies give people cards that can be used anywhere. The only way to make sure people are not illegally doctor shopping is ask for a state ID card.

Do you think a single-payer system can work for 330 million people?

 

[Luther]

Based on your economic expertise? Back it up.

"California was not a part of this nation when it's history began, but we are clearly now the keeper of its future." CA Rising

Huh?

Companies Are Fleeing California. Blame Bad Government.

Silicon Valley remains the world’s preeminent tech hub. But that won’t last if lawmakers there keep antagonizing businesses.

www.bloomberg.com

 

[Allan]

We are talking about limiting California medical services to California residents so they will not be overrun with the wrong patients.

I know that's what you are talking about.

Private health insurance companies give people cards that can be used anywhere. The only way to make sure people are not doctor shopping is ask for a state ID card.

A State issued medical card will provide the same protection. In addition it makes electronic healthcare recordkeeping smoother because the card can be scanned and records accessed.

 

[Patriotic Voter]

A State issued medical card will provide the same protection. In addition it makes electronic healthcare recordkeeping smoother because the card can be scanned and records accessed.

So the receptionist does not need a keyboard and mouse to bring it up on her computer screen? That is weird.

 

[Allan]

So the receptionist does not need a keyboard and mouse to bring it up on her computer screen? That is weird.

They just scan the card and my coverage is confirmed and medical records come up. The card works in pharmacies as well to bring up my prescription history (but not medical records as they remain confidential).

 

[ttwtt78640]

Nobody wants Medicaid coverage. To qualify, you must have no more than $1,500 in your name at all times. That is impossible if you don't; quit your job. Believe me, I tried. I could not become eligible.

See expanded Medicaid which is available in many states.

The Affordable Care Act established a new methodology for determining income eligibility for Medicaid, which is based on Modified Adjusted Gross Income (MAGI). MAGI is used to determine financial eligibility for Medicaid, CHIP, and premium tax credits and cost sharing reductions available through the health insurance marketplace. By using one set of income counting rules and a single application across programs, the Affordable Care Act made it easier for people to apply and enroll in the appropriate program.

MAGI is the basis for determining Medicaid income eligibility for most children, pregnant women, parents, and adults. The MAGI-based methodology considers taxable income and tax filing relationships to determine financial eligibility for Medicaid. MAGI replaced the former process for calculating Medicaid eligibility, which was based on the methodologies of the Aid to Families with Dependent Children program that ended in 1996. The MAGI-based methodology does not allow for income disregards that vary by state or by eligibility group and does not allow for an asset or resource test.

Medicaid Eligibility | Medicaid

Medicaid is a joint federal and state program that, together with the Children’s Health Insurance Program (CHIP), provides health coverage to over 72.5 million Americans, including children, pregnant women, parents, seniors, and individuals with disabilities. Medicaid is the single largest...

www.medicaid.gov

 

[ALiberalModerate]

Roughly a third of the state of California is covered under Kaiser Permanente. What happens to Kaiser Permanente with single payer?

 

[Allan]

Roughly a third of the state of California is covered under Kaiser Permanente. What happens to Kaiser Permanente with single payer?

They'll offer services not covered by universal coverage. Things like ambulance, travel, dental etc. Private insurance exists in Canada and those are the types of services they cover.

 

[ALiberalModerate]

They'll offer services not covered by universal coverage. Things like ambulance, travel, dental etc. Private insurance exists in Canada and those are the types of services they cover.

Kaiser Permanente is an HMO that owns its own providers, so it's different than insurance. Members go to Kaiser Permanente doctors, specialists, hospitals and so on. It's like a private version of the U.K.'s national health service.

 

[Greenbeard]

Roughly a third of the state of California is covered under Kaiser Permanente. What happens to Kaiser Permanente with single payer?

You could argue that the prevalence of the KP model in California makes it better suited than many places to implement a single-payer experiment. The California bill, like lots of single-payer proposals, would put large/institutional health care providers on global budgets, which is probably closer to KP's business model than it is to those of other hospital/health systems.

 

[Allan]

Kaiser Permanente is an HMO that owns its own providers, so it's different than insurance. Members go to Kaiser Permanente doctors, specialists, hospitals and so on. It's like a private version of the U.K.'s national health service.

I see. So in Canada doctors and medical clinics are private, but Hospitals are provincially run. I would suspect the difference would be that the single payer would pay Kaiser on a fee-based remuneration for services provided.

 

[aociswundumho]

Not if it is the most expensive state to live in. The danger is someone driving from southern Oregon, western Nevada, or western Arizona to get medical care in northern or eastern California. The solution is self-explanatory: Make all patients show their state ID cards or driver's licenses. And of course do not accept any Mexico passports or visas for identification along the southern border.

Wait, I thought healthcare was a human right?

Human rights do not depend upon your street address.

 

[aociswundumho]

They'll offer services not covered by universal coverage. Things like ambulance, travel, dental etc. Private insurance exists in Canada and those are the types of services they cover.

I don't understand the point of having single payer if it doesn't cover everything. If I recall correctly, single payer in Canada doesn't even cover prescription drugs.