
ACA repeal could cost California more than 200,000 jobs - devinp
http://sciencebulletin.org/archives/8417.html
======
labster
This is all kind of a joke, because California would never go back to the way
it was before Obamacare. At the very least, we would increase taxes to pay for
it within our own state. But I wouldn't be surprised if we went to a single
payer health insurance system here. Right now, we're supporting the ACA
because it was Obama's signature issue, but if it's gone people will want to
switch to something better.

Democrats will have a supermajority in California come January. It will be
interesting to see what happens.

~~~
edblarney
Thee's no way on earth Cali will go single payer.

Something that gives 'essentially universal coverage' \- sure. But single
payer, no way.

'Single payer' often means that Steve Jobs waits 12 months for his knee
replacement, in behind a lot of unemployed folks, immigrants, many
undocumented migrants etc. which is the objective of socialized medicine.

In Canada, it's illegal to pay a doctor to fix you. Granted, we're the only
country where this is the case.

I could be wrong, but a UK friend indicated that if you 'go outside the NHS'
then you have to basically stay outside of it.

The 'real challenge' is to try to find the right balance and make it fair, but
still allow people to have choice etc..

Probably for 2/3rds of people, 'single payer' is best, but for a not-
insignificant-minority it's definitely not.

It's tricky because I'm not sure anyone in the world has the solution.

~~~
labster
I think I meant single-payer in the way that Medicare works in the U.S. There
can be companies who manage it, or supplemental policies, but the primary
payer remains the U.S. Government.

So the approach would be to extend Medicare to everyone (or in our case,
MediCal). Increase payroll taxes to pay for it; remove the requirement that
employers provide health insurance. All other laws remain the same.

~~~
edblarney
I agree that a medicare extension to 'everyone' might help.

But that won't work, it will blow up healthcare.

Why?

Because young people just won't buy coverage. They'll all just use Medicare.
:)

Most people will = destruction of the industry.

So, yes, 'getting everyone covered somehow by nudging in Medicare' sure ...
but it can't just be done by simply extending it.

------
gozur88
200k jobs? What kind of jobs? If these are paper shufflers adding overhead to
health care, then I'm all for it.

~~~
viraptor
The looked research explains:

"The majority (135,000) of these lost jobs would be in the healthcare
industry, including at hospitals, doctor offices, labs, outpatient and
ambulatory care centers, nursing homes, dentist offices, other healthcare
settings, and insurers. But jobs would also be lost in other industries.
Suppliers of the healthcare industry, such as food service, janitorial, and
accounting firms, would experience reduced demand, leading to job loss. The
lost jobs also include those lost due to the “induced effect” of healthcare
workers spending less at restaurants, retail stores, and other local
businesses."

~~~
gozur88
>The majority (135,000) of these lost jobs would be in the healthcare
industry, including at hospitals, doctor offices, labs, outpatient and
ambulatory care centers, nursing homes, dentist offices, other healthcare
settings, and insurers.

Yes, I see we know where they work but not what they do.

~~~
viraptor
Any reason not to understand this as "across the board"? High costs and few
insured mean fewer people actually going to the doctor. Lower volume would
affect everyone from receptionists to specialist doctors, any supporting
staff, and management.

Maybe apart from the ER staff. They'll get more people who didn't handle
simple problems early. (Or couldn't afford to)

~~~
gozur88
>Any reason not to understand this as "across the board"?

Is there any reason to assume it? It's not like people didn't get care before
the ACA - they used Medicaid or went to the ER. We were told the ACA would
make things more efficient as people would be able to use primary care instead
of ERs for non-emergency problems.

And yet somehow we have 200k extra jobs. That's not a sign of efficiency.

------
sharemywin
Maybe they should adjust their state tax base and if the rest of the country
is subsidizing CA than that's a problem.

~~~
ideonexus
California's federal taxes subsidize the rest of the country, not the other
way around:

[http://www.theatlantic.com/business/archive/2014/05/which-
st...](http://www.theatlantic.com/business/archive/2014/05/which-states-are-
givers-and-which-are-takers/361668/)

------
rebootthesystem
Keeping a bad system just to save jobs that should not exist in the first
place is the height of stupidity.

We need 200K jobs in California to run the ACA? I live in a town with a
population of about 40,000 people. It takes five towns like mine to run this
abomination?

Good riddance. On all fronts.

~~~
TheCoelacanth
No, it takes 200K jobs to provide healthcare for the millions of previously
uninsured people in CA.

~~~
rebootthesystem
That's really funny. I guess before Obamacare we were living in the Dark Ages
and nobody was able to receive any form of health care in CA.

Please.

~~~
TheCoelacanth
I never claimed that no one had insurance previously. About 32 million people
did. Obamacare added a few million more to that number, hence the new
healthcare jobs.

~~~
rebootthesystem
You are looking for justification where it does not exist. California did not
need another 200K jobs. Please. We have more than enough bandwidth to handle
medical care.

The part you might not see is what Obamacare has done and is doing to the
medical industry, from providers on up.

Beyond the fact that we have personally gotten royally screwed by Obamacare,
my wife is a doctor and I see and hear everything that's going on. Only one
way to put it:

Carnage.

Doctors are quitting. Care is horrible or compromised due to forced cost
reductions. Some patients are not seen because they are not worth the effort
or the doctors are not going to get paid enough, etc.

Having more people who can be claimed to have insurance isn't a good metric at
all. You have to look at what they have and how much it is costing.

Most of people who now have insurance thanks to Obamacare have no clue that
they've signed a deal with the devil. What I mean by this is that they have,
effectively, signed-over their estate to the government. They are LIABLE for
every dollar spent in their care from now until eternity.

Yup. Forget about leaving the family home to your kids. If you get sick and
need care the government will own your home and your kids might get nothing
after you pass.

This is because they've been shoved into Medicaid and that means the
government has to, by law, recover all costs and this means they got their
hooks into your estate.

They can even file liens on your home to pay for your care.

Bullshit?

OK, how about we get the truth from the horse's mouth:

[https://www.medicaid.gov/medicaid/eligibility/estate-
recover...](https://www.medicaid.gov/medicaid/eligibility/estate-
recovery/index.html)

What do you think about Obamacare now? And how about those bullshit 200K
workers? Their salaries surely will be added in some form to the money owed by
these poor saps who are shoved into Medicaid and now have "insurance".

Obamacare might easily be the largest theft of personal property by a
government in the history of humanity. And I don't think I am exaggerating
here. I think there are over twenty million people on Medicaid. Every single
one of the estates could be in danger of being sold off by the government to
pay for medical care.

This is truly revolting. Yet all of these Obama/Obamacare supporters are so
ignorant of the facts that they actually think he did a good thing for the
country and that Obamacare has helped poor people. Unbelievable.

~~~
TheCoelacanth
For anyone who dies after January 1, California's Medicaid estate recovery
only applies to money spent putting you in a nursing home or similar, not for
all health care as you stated.

There are also more people with new private insurance coverage in CA than new
Medicaid recipients, so that part of your rant is also false.

~~~
rebootthesystem
Oh, and that makes it better? Do you have any idea how many people are in
nursing homes? My wife happens to be a doctor and she happens to have a lot of
experience with nursing homes.

How about nationwide?

Also, could you provide a link to verify what you are claiming will start on
January 1st?

Please don't try to put lipstick on a pig. It's still a pig. The personal
estate grab by the government is without precedent.

And, for what? The care people get at the kinds of plans that shove you into
Medicaid isn't anything to boast about.

Obamacare is a disaster. Thankfully the new administration seems poised to
tackle this head-on. I hope they do a good job while still providing for a
reasonable path to healthcare for those who have financial limitations.

It is society's obligation to help them. Yet the way this happens can't take a
form that makes it insanely worst for the rest of us and, at the same time,
has the government make a grab for people's estates. This is just wrong
whether it happens in one state or all of them.

~~~
TheCoelacanth
I'm all for getting rid of Medicaid estate recovery, but blaming it on
Obamacare is just wrong. It has been around since 1993.

Here [http://www.mercurynews.com/2016/06/27/californias-seizure-
of...](http://www.mercurynews.com/2016/06/27/californias-seizure-of-medi-cal-
patients-assets-is-limited-by-new-law/) is info about the change to
California's laws on estate recovery. They now recover the minimum allowed by
federal law.

~~~
rebootthesystem
You are missing a very important point.

Obamacare is a complete farce on many points.

First, it claims million of people who didn't have insurance are now insured.
The truth is they were shoved into Medicaid.

Second, this is NOT health insurance! This is you incurring a debt with the
State and one they are obligated by law to collect on by grabbing your estate.

Third, NOBODY is forewarned when they sign on the dotted line that the family
home and their entire estate is at risk of being appropriated by the
government and that nothing whatsoever might remain for the kids to inherit.

Given healthcare costs it isn't too much of a stretch to conclude that getting
sick with anything that requires hospitalization, surgery or extended care
will result in a bill so large that most people's estates will be depleted
before heirs can see a dime of inheritance.

To me this is sick underhanded government robbery. If a private enterprise
swindled people into contracts with such consequences people would end-up in
jail. Yet in government you can do this, you can lie, cheat and steal from
people and suffer no consequences whatsoever.

This is way past wrong.

~~~
TheCoelacanth
You are very wrong on the first two points.

First, millions of people who didn't have health insurance now do. Not
Medicaid, private insurance. There are also millions of new Medicaid
recipients.

Second, most of the Medicaid coverage is not debt. Only coverage of one
specific thing is debt; all the other coverage is not taken from the estate.

------
cylinder
Enough with this job counting nonsense.

------
boona
> ACA repeal could cost California more than 200,000 jobs

My god, 200,000 jobs in CA alone?! It's worst than I thought. That's 200,000
people who are not only costing the economy, but aren't contributing to the
economy themselves.

~~~
stuaxo
Is this missing a sarcasm tag? I don't really get it - but then am tired.

