
Cost of universal health care in California bigger than state's budget - mudil
http://www.sacbee.com/news/politics-government/capitol-alert/article151960182.html
======
sologoub
TLDR; $400 billion total, $200 billion is currently spent on subsidies and
medi-cal, $150 billion is already spent by employers.

The state would need to "find" ~$50 billion or ~$1,300 per resident more to
fully fund this.

Personally, this seems like a relative bargain and some modest extra taxes
should offset the difference. Article reads pretty poorly and sensationalist.

Not to mention that the missing amount is less than most people have in
various deductables and co-pays already.

EDIT: Turns out in 2015, per capita health spending was $9,990 already, which
translates to ~$390 billion for 39 million Californians. So $400 Billion is
cheaper than what we already spend in 2017, assuming modest growth since 2015.

Further, if we assume that this money already gets spent, just not very
evenly, we'll end up with a much fairer system and a lot smaller downside for
people if/when they get sick.

Personally, I'll gladly trade some immediate savings for long term protection
from not having insurance when I need it most. The data seems to imply that I
won't even have to pay all that much more.

~~~
mtgx
Indeed. An alternative view on this:

> _The state would pay for almost all of its residents’ medical expenses —
> inpatient, outpatient, emergency services, dental, vision, mental health,
> and nursing home care — under the plan, and Californians would not have any
> premiums, copays, or deductibles._

> That’s an incredible deal for just 15% of GDP, which again is lower than the
> US as a whole already spends on health care.

[http://mattbruenig.com/2017/05/22/californias-
surprisingly-c...](http://mattbruenig.com/2017/05/22/californias-surprisingly-
cheap-single-payer-plan/)

~~~
laurencerowe
Single payer would be a great improvement on the current nightmare of American
healthcare, but let's not kid ourselves that this is an incredible deal. The
UK spent 8.5% of GDP on healthcare in 2013 (life expectancy in the UK is
marginally higher than in California.) Most European countries spend around
11%.

~~~
dogma1138
Single payer != universal health care.

Single payer is likely no not work in the US, but there are plenty of other
solutions out there.

Europe has universal health care, not every country has single payer the UK
and France do, NL and Germany do not.

Also in all honesty unless you have cancer or something else which completely
degenerative the NHS is garbage that no one outside of the low income brackets
wants to deal with.

~~~
DanBC
> the NHS is garbage that no one outside of the low income brackets wants to
> deal with.

The various patient surveys and patient satisfaction scores disagree with you.

The fact that almost no-one uses private insurance is also proof that most
people like and will use the NHS, even with all the problems it has. And the
numbers of people with private health insurance has reduced, not increased,
since 2011.

------
carsongross
Few know this:

The United States _currently_ spends more money per capita on socialized
medicine than any other country except Norway:

[https://en.wikipedia.org/wiki/List_of_countries_by_total_hea...](https://en.wikipedia.org/wiki/List_of_countries_by_total_health_expenditure_per_capita#/media/File:OECD_health_expenditure_per_capita_by_country.svg)

In fact, the US spends more on socialized medicine than Japan, the UK and
Finland spend _in total_ , private and public spending.

The US healthcare system is totally out of control. Nothing will fix it until
there is a collapse.

~~~
therealmarv
Wow, I'm surprised. So doctors/hospitals are extremely expensive in USA? What
is spend monthly very roughly on health care in USA (if you're have one)? I'm
originally from Germany and I always assumed we pay more for health care
generally.

~~~
curun1r
One aspect that makes care in the US cost more is our culture of being highly
litigious. We seem to believe that if doctors make honest mistakes, it
entitles the patient or their heirs to a large settlement. So
doctors/hospitals need expensive malpractice insurance and that cost gets
bundled in with the cost of care. To add to that, settlements encompass both
medical costs and compensation for pain and suffering, which is usually a
multiple of the medical costs. So the cost of lawsuits increases the cost of
care which, in turn, increases the size of settlements which, in turn,
increases the cost of malpractice insurance which increases the cost of care.
It's a feedback loop.

It's not the only reason why our health care costs are spiraling out of
control, but it is a reason that will naturally continue to increase over time
unless we cap malpractice claims.

~~~
brownbat
Allow me to play devil's advocate...

Medical negligence is the third leading cause of death in the United States.
We have an epidemic of "honest mistakes" like scalpels left in patients after
surgeries,[0] often leading to deaths, or amputations of the wrong limb[1]
leading to enormous harms to the patient. Something as innocent as 'forgetting
to wash your hands' has outsized consequences in this industry, forgiving
'honest mistakes' is not a safe standard.

It's also not generally true that plaintiffs in tort cases receive exorbitant
damages, this is a popular myth because there are a few outlandish examples.
The most popular examples, such as the "Stella awards," are completely made
up.[1][2]

States that have capped medical malpractice have seen no difference in medical
costs, and it has not been found to be a significant contribution to costs in
the industry.[3] Meanwhile, capping costs hurts patients - some mistakes end
up costing millions in additional medical costs throughout an injured
patient's life, and most importantly for getting improved care over time, it
lightens incentives for billion dollar hospitals to actually correct
underlying procedures that make harms more likely.

[0]
[https://en.wikipedia.org/wiki/Retained_surgical_instruments](https://en.wikipedia.org/wiki/Retained_surgical_instruments)

[1]
[http://www.hotcoffeethemovie.com/default.asp?pg=mcdonalds_ca...](http://www.hotcoffeethemovie.com/default.asp?pg=mcdonalds_case)

[2]
[http://www.snopes.com/legal/lawsuits.asp](http://www.snopes.com/legal/lawsuits.asp)

[3] [http://www.decof.com/decof/wp-
content/uploads/2015/12/five-m...](http://www.decof.com/decof/wp-
content/uploads/2015/12/five-myths-about-medical-negligence.pdf)

[4] More on handwashing as a challenge to health in hospitals:
[http://annals.org/aim/article/712481/compliance-
handwashing-...](http://annals.org/aim/article/712481/compliance-handwashing-
teaching-hospital)

~~~
DanBC
> We have an epidemic of "honest mistakes" like scalpels left in patients
> after surgeries,[0] often leading to deaths, or amputations of the wrong
> limb[1] leading to enormous harms to the patient.

I thought "wrong site surgery" was rare.

[https://www.ecri.org/components/HRCAlerts/Pages/HRCAlerts111...](https://www.ecri.org/components/HRCAlerts/Pages/HRCAlerts111815_Joint.aspx)

> Wrong-site, wrong-patient, and wrong-procedure surgery continues to be the
> sentinel event most frequently reported to the Joint Commission, with 1,196
> such events reported through September 30, 2015, according to recently
> updated statistics provided by the accreditor. The next most frequently
> reported events include unintended retention of a foreign object (1,072),
> delays in treatment (1,035), suicide (932), and operative or postoperative
> complications (904).

That's way too many, but in 2009 there were 48 million inpatient surgical
procedures carried out in the US.

[https://stanfordhealthcare.org/medical-clinics/surgery-
clini...](https://stanfordhealthcare.org/medical-clinics/surgery-
clinic/patient-resources/surgery-statistics.html)

I don't think you can call 0.007% an "epidemic".

~~~
brownbat
> I thought "wrong site surgery" was rare.

It is, but that wasn't the entire sentence, nor really representative of the
total harm from medical errors.

------
a3n
Separate from the cost debate, the bill is labeled a "job killer," I assume
because of all the insurance and related jobs lost.

Which would be bad for the people losing their jobs, but they're only employed
because they work for an arguably unnecessary middle-man industry. There's no
"right" to those jobs, and if we can find a way to deliver health _care_ , as
opposed to health _insurance_ , to close to everyone, we should figure that
out, regardless of insurance jobs.

~~~
jernfrost
How is this supposed to kill jobs? Total money spent should be no different.
It just shifts from out of pocket to taxes.

~~~
adt2bt
If you read the other parent comment in this thread, total expenditures on
health care would actually drop by close to 50% overall (with a few fraught
assumptions, of course). In the best/worst case, that's a $350B economic blow
to those who rely on insurers for their employment. Given the complexity of
the health care system around the US, I'm sure any move to universal health
care will be extremely economically disruptive and render quite a few people
jobless without competitive skills.

------
jernfrost
Really weird talking about how expensive this is. Whether you pay through it
out of pocket or through taxes what difference does it make? Why do Americans
think there is somethink inherently more difficult with paying taxes than
paying other expenses.

Weird how these people talk about health care as unaffordable but somehow
there are always money for wasting trillions in wars like Iraq and Vietnam.

~~~
ryanx435
You should look into how much the federal and state governments pay to
Medicare and Medicaid and other medical programs than compare it to the budget
for the various military expenditures.

Also, although iraq and Vietnam were failures on the surface, I challenge you
to put a dollar value on the pax Americana that American military spending has
enabled in the last 70 years, a dollar value on the various technologies
developed through military funding over the years, and a dollar value on a
thriving capitalistic economy that was saved from fascist and communist
takeovers by military spending.

Than maybe it won't be so strange to you why the us spends so much on the
military.

~~~
threeseed
No one is disputing that the US needs a military. What everyone is questioning
(and rightly so) is whether the levels of investment are warranted. Especially
when the US has such a pitiful social safety net compared to other Western
countries.

And let's be serious here. The rest of the world has done more to save the
world from fascism and communism than the US has. And entrepreneurship has
done far more for innovation than military spending has.

~~~
ryanx435
The other western nations can afford to spend more on their safety net because
of the military strength of america and the protection it provides against
foreign invaders.

America defeated japan essentially by itself while providing enough food and
supplied to keep the russian army alive while also providing the majority of
the military strength to the western front, essentially being the primary
factor in the defeat of fascism.

As for communism, it was the us vs ussr while Europe and China and japan
rebuilt after the destruction of world War 2, again, the us provided the bulk
of the force against communism.

Your statement about the rest of the world doing more to save the world from
fascism and communism is blatantly false.

~~~
flukus
> America defeated japan essentially by itself while providing enough food and
> supplied to keep the russian army alive while also providing the majority of
> the military strength to the western front, essentially being the primary
> factor in the defeat of fascism.

Where to start? The US did most of the work in beating Japan but they also got
a lot of help from Russia toward the end. Once Japan had lost Manchuria to the
Russians they gave up on a conditional surrender, they had nothing to bargain
for.

And the primary factor in defeating fascism? If it wasn't for the British
holding out in the west that front would have been lost before you guys even
got involved. But more importantly on the Eastern front, the tide had already
turned before lend lease to Russia made any difference. It sped the war up but
it didn't decide it.

~~~
Turing_Machine
"Once Japan had lost Manchuria to the Russians they gave up on a conditional
surrender, they had nothing to bargain for."

Most people think that nuking Hiroshima and Nagasaki was what made Japan
surrender unconditionally, not the loss of Manchuria.

"But more importantly on the Eastern front, the tide had already turned before
lend lease to Russia made any difference."

I'm sorry, that is simply not correct. The Lend-Lease pipeline was in full
operation by early 1942, well before the tide turned at the Battle of
Stalingrad in early 1943. In fact, the Germans moved on Stalingrad
_specifically to disrupt_ the Persian Corridor portion of the Lend Lease
operation.

~~~
flukus
> Most people think that nuking Hiroshima and Nagasaki was what made Japan
> surrender unconditionally, not the loss of Manchuria.

Most people have never even heard of the battle of Manchuria. Japan were
already putting out feelers for a peace before either, they new they couldn't
win by then. They'd already had cities destroyed by conventional weapons, the
nukes weren't that big a deal.

> I'm sorry, that is simply not correct. The Lend-Lease pipeline was in full
> operation by early 1942, well before the tide turned at the Battle of
> Stalingrad in early 1943. In fact, the Germans moved on Stalingrad
> specifically to disrupt the Persian Corridor portion of the Lend Lease
> operation.

First of all, much of the early contribution was british and Canadian rather
than American ([http://www.historynet.com/did-russia-really-go-it-alone-
how-...](http://www.historynet.com/did-russia-really-go-it-alone-how-lend-
lease-helped-the-soviets-defeat-the-germans.htm)).

Lend lease was under way but no where near the total contributions
([https://www.ibiblio.org/hyperwar/USA/BigL/BigL-5.html](https://www.ibiblio.org/hyperwar/USA/BigL/BigL-5.html)),
chart 6 has a yearly breakdown. The biggest effect was that it allowed the
USSR to counter attack after Stalingrad because they didn't have to throw
everything into defending the city.

------
eecc
Well, signle player, universal health care provider also means one powerful
actor with the weight and leverage to aggressively pursue economies of scale
and optimizations and preventive care.

As an individual you're just a sucker, a sitting duck to be plucked one
feather at a time

------
curtis
If your universal health care system is some variant of "single payer", which
is what I think is proposed here, then the fact that it is really expensive is
largely irrelevant, and for a really obvious reason: You may be paying a lot
of money for government funded health insurance, but you are _not_ paying all
that money to a private health insurer like you are now.

Essentially you are just writing a check to the government rather than a
private company.

------
anovikov
Why all discussions about healthcare reform revolve around money to pay for
it? I am sure this is the wrong side of it. Whatever money you pay, you have a
limited supply of doctors. So in the end, more money just raises prices,
redistributing who gets which care, anyway.

Why not start with supply side? Automatically recognize diploma of doctors
from all developed countries (you may start with a limited list - very rich
countries with life expectancy higher than U.S. - start with UK, France and
Germany, add a few more if it's not enough - no one can say that their doctors
are not 'good enough') - and make them instant immigration papers - literally,
hand out green cards right at the airport on arrival. Millions will flock and
quickly saturate the market. Then you will not have a problem with either new
single-payer, or old system.

------
GiorgioG
As much as I'm a proponent for free markets & lower taxes, I want universal
healthcare in the US. When big pharma companies & hospital systems are forced
to negotiate with the government for rates, costs will go down. My 5 year
old's type 1 diabetes quarterly supplies are billed at $6,000 per shipment.
Looking at what's in the box, I'm hard pressed to guess there's more than $100
of material costs. The technology has been around forever, and yet these
companies continue to extort these exorbitant prices because nobody had said
'Enough!' Same story with a friend's Gleevec. $14,000 per month. It's time to
put cost controls in place. If universal care is how that's achieved, then so
be it.

------
chipperyman573
Isn't that a given? I mean, do people not realize that the money has to come
from somewhere? Of course it's going to be _insanely_ expensive to insure
everybody.

Edit: I'm not arguing against Single Payer, I'm just surprised that this is
something so shocking an article was written (and then upvoted) about.

~~~
jernfrost
If you pay 200 dollars today per month for health insurance but instead have
to pay 200 dollars in extra taxes tomorrow for health insurance, what
difference does it make?

~~~
DrScump
Can you name an Obamacare-compliant plan (even just bronze) with a total
(unsubsidized) $200 premium for the median or mean adult? One?

------
aphextron
This headline is really misleading and clickbaity. It makes it seem as if the
state is facing a budget shortfall. The cost they are referring to is a
hypothetical number crunching of possible future healthcare systems.

~~~
gzuki
And even further, they are misrepresenting that somewhat. They admit further
down the article that after offsetting from the existing employer based tax
that "total new spending to implement the system would be between $50 billion
and $100 billion per year". They make it sound like it's $400b more, rather
than total.

There is also no discussion of the kind of external savings this might create.
Usually that kind of thing is included in budget office analysis.

~~~
tanderson92
More good analysis here too: [http://mattbruenig.com/2017/05/22/californias-
surprisingly-c...](http://mattbruenig.com/2017/05/22/californias-surprisingly-
cheap-single-payer-plan/)

------
stmfreak
It will also provide excellent cover for California's pension shortfalls.

------
ChuckMcM
These discussions rarely include a discussion about existing extortionate
pricing models do to distort the discussion.

------
teekert
Perhaps they should not accept healthcare cost as is? Wages of physicians are
insane in the US (because the price of the education is insane?), as are the
prices of medcine. Just think of what Pharma has to spend on commercials in
the US. All that money is a big waste.

