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Cost of universal health care in California bigger than state's budget (sacbee.com)
30 points by mudil on May 23, 2017 | hide | past | web | favorite | 82 comments



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.


In addition, they don't provide a figure for the amount of money that individuals put toward health care, only the amount that their employers contribute.

Considering that most employers don't fully cover health insurance (relying on employee payroll deductions to make up the difference) and that many people pay directly out of their own pockets for insurance, I wonder if there'd be a shortfall at all.


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...


I like seeing dental included (per the parent comment). Increasingly discovered to be the genesis of numerous systemic problems (e.g. cardiovascular, for one) when not cared for. A really big opportunity for the kind of up front, preventative maintenance that saves big money / expense, down the road.

Dental care needs to be wrapped into the fold of overall healthcare. Its exclusion creates far more trouble than just bad teeth.


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%.


http://visual.ons.gov.uk/how-does-uk-healthcare-spending-com...

> ONS’s new internationally-comparable “health accounts“1 show that the UK’s total healthcare spending in 2014 was £179 billion, or 9.9% of GDP.

> As a percentage of GDP, the UK spent less on healthcare than USA, Japan, France and Germany and a similar percentage to Canada. The USA spent the most on healthcare as a percentage of GDP at 16.6%.

And it's not all private insurance for the US. In 2014 the US government spent more than 8% GDP, compared to UKs just under 8%.

> Despite less than half of the USA’s total healthcare expenditure coming from government expenditure or compulsory insurance schemes, it still spends more per person on these financing schemes than the UK- £3,111 in the USA in 2014, compared with £2,210 in the UK. In the USA spending on privately-funded healthcare is over five times more per person than in the UK.

The US government spends more per person on healthcare than the UK, Canada, Italy, or the OECD average, and gets worse outcomes across a range of measures.


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.


> 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.


Thanks for the edit. You did the math. The headline is basically opposite of what it should be.

'California cuts overall health spending by almost 50% by going Universal'


Yeah, the headline is sensationalist. With the current spending factored in, it's really not that bad.

A big enough tax on fast food could probably cover it, with the added bonus of decreasing the amount needed.

If that doesn't work, then there are a lot of programs they can cut that are less important than healthcare.


> A big enough tax on fast food could probably cover it

Exactly this kind of statement is what worries some about universal healthcare. I highly support single payer, universal healthcare. But statements like this undermine the cause by feeding fuel to the idea universal healthcare will inherently lead to more government intrusion into your personal decisions.


> But statements like this undermine the cause by feeding fuel to the idea universal healthcare will inherently lead to more government intrusion into your personal decisions.

Is that worse than corporate intrusion? Does your health insurance not factor these things in already?


"Is that worse than corporate intrusion?"

Yes. You sometimes have a choice about which corporation you deal with. You don't get a choice when it comes to the government.


> You don't get a choice when it comes to the government.

But you do get a vote, you don't get that with a corporation.


Sure you do. You can vote to not give them your money.

Try that with taxes.


> inherently lead to more government intrusion into your personal decisions

People wouldn't care except that your "personal" decision affects them.

(1) Everyone pays for the public health care system e.g. hospitals. So if you're increased risk of serious disease results in increased visits or treatments then that's my problem as well.

(2) Everyone pays for insurance. So if you're making premiums more expensive then that affects me too.


> People wouldn't care except that your "personal" decision affects them.

Yes it's perfectly logical under a single payer, universal healthcare system. So the reaction by some is: this is exactly why we should not have universal healthcare.

> Everyone pays for insurance. So if you're making premiums more expensive then that affects me too.

It muddies the water quite a bit by having a marketplace of different private insurance companies. If you see me doing something risky you have no clue whether or not I'm even covered under the same insurance company as you. So maybe I am, maybe I'm not affecting your premiums. Single payer universal healthcare removes all doubt.


Like it or not, it's already done with cigarettes, alcohol, marijuana, gasoline, and a ton of other stuff.

These type of taxes are the only way I'm in favor of government healthcare programs. Cigarettes, alcohol, and junk food directly increase medical costs, and people who indulge (and over indulge) in those things should be partly responsible for those increased costs.


> Cigarettes, alcohol, and junk food directly increase medical costs

Actually, all those things you listed _decrease_ lifetime medical costs. From a purely economic sense, people who drink, smoke, and eat junk food are _ideal_. They're reasonably healthy during their most productive years, and then mortality rate spikes just before retirement (a time when most people are least productive).

So if the logic is that we tax things based solely on economic externalities, then we should encourage drinking, smoking, and obesity. We should subsidize all those activities.

Check Google for numbers that back this up; usually the analysis is done against the U.K. health care system/NHS.


> Actually, all those things you listed _decrease_ lifetime medical costs. From a purely economic sense, people who drink, smoke, and eat junk food are _ideal_. They're reasonably healthy during their most productive years, and then mortality rate spikes just before retirement (a time when most people are least productive).

Actually, the numbers don't back that up. A person doesn't get diabetes and die the next day with no medical costs. A smoker doesn't get lung cancer and die tomorrow. They might not live as long, but their medical costs are higher the entire time, and the older they get, the higher the costs become. Eating poorly is especially costly because it doesn't kill people quickly, but causes significant health problems.

> So if the logic is that we tax things based solely on economic externalities, then we should encourage drinking, smoking, and obesity. We should subsidize all those activities.

No, the logic is that we provide healthcare to everybody so that they can have longer, healthier lives. Makes no sense to waste money on the people actively working against that goal, so if smokers/drinkers/fatties want to take part then they need to cover the extra costs they've created for themselves.


[flagged]


Are you really trotting out the tired old taxation equals violence argument?


We've asked you countless times not to post these ideological talking points here. We ban accounts that continue, so please stop.


sctb, I honestly don't understand why you are threatening to ban me.

It's not an ideological talking point that people who die earlier due to health problems don't cost extra in pension funds. It's just a fact: if someone dies at 55, he won't cost a pension system which starts paying out at 65 a penny. fpgaminer posted much the same thing.

Nor, I think, was my aside about taxes being enforced with violence an ideological talking point: it's a fact that any law is ultimately enforced with violence. I honestly don't see how mentioning a social cost in the context of cost-benefit analyses could be considered a violation of any of the HN guidelines.

I'm not trying to derail or be argumentative; I'm honestly trying to understand how a fair moderator could threaten me with a ban for my comment.


The issue is the same as before: https://news.ycombinator.com/item?id=13911550. I appreciate that it's not your intention to derail, but the effect of these comments is predictable and we need commenters to be mindful of that so that we can have the kinds of discussions—thoughtful, informative—that we're after here.


Would you please be so kind as to update https://news.ycombinator.com/newsguidelines.html to indicate 'ideological talking points' the staff believe prevent thoughtful & informative discussion?

Otherwise I feel that there's a loaded gun pointed at my head and any random statement is likely to set it off.


The scientists and public policy professionals who formulate these policies aren't doing this for a laugh. There are significant benefits to taxing things that make people sick.

And these policies have been pioneered in other countries e.g. Australia first where they have been wildly successful in reducing overall health care cost.


I'm not arguing that they don't reduce health costs: I'm arguing that a) they increase other costs (e.g. old-age pensions, since people would live longer) and b) they are an unjust imposition of force in order to change private behaviour.


> A big enough tax on fast food could probably cover it, with the added bonus of decreasing the amount needed.

Probably not; it would take a huge chunk of US fast food revenue, and probably more than California's.

https://www.franchisehelp.com/industry-reports/fast-food-ind...

> If that doesn't work, then there are a lot of programs they can cut that are less important than healthcare.

The amount that would need to be cut is pretty much all the non-healthcare spending in the state budget (including the spending that directly produces revenue, yet it requires that the revenue come in anyway.)


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...

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.


My friend has dual U.S.-Swedish citizenship. It's crazy to think, but a few times now he's actually flown out to Sweden to have a medical procedure performed, because it's _cheaper_ to get an international round-trip ticket to Sweden then it would be to just have the procedure done in the U.S. (where he lives). And it's never been anything big; just outpatient type stuff.

The U.S. healthcare system _is_ totally out of control.


He should have just flown to Oklahoma instead: http://reason.com/blog/2017/01/27/what-happens-when-doctors-...


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.


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.


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

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

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

[3] http://www.decof.com/decof/wp-content/uploads/2015/12/five-m...

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


> 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...

> 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...

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


> 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.


These sorts of incidents are terrible and we should do everything to avoid them going forward. But, given their prevalence, it would seem that the medical industry hasn't done a particularly good job of dealing with them. The current system, which is more interested in assigning blame and providing restitution, is the free market approach that believes that capital incentives are the only ones needed and seem, to me, to be a failure. If you contrast the way that the medical industry handles incidents with the way that the aviation industry handles incidents, you'll see that pilot incidents are handled through a process that is much more interested in preventing future problems than it is in assigning blame. This leads to less defensiveness and more cooperation in finding processes and equipment that prevent future problems.

Also, if you want to make the case that malpractice settlements don't significantly contribute to the cost of health care, it's probably good to cite a source that isn't an association of trial lawyers. Among their failures in logic...arguing that insurance premiums are more tied to market performance than payouts completely disregards the fact that premiums wouldn't be necessary at all without the kind of payouts we currently have. There's an entire insurance industry making billions of dollars per year that is essentially unnecessary overhead that could be eliminated. And the trial lawyers themselves are making significant amounts of money off our broken health care system too.

These types of overhead can be eliminated in a single-payer system. Malpractice can be handled by panels of doctors who's sole goals are to push out habitually negligent doctors and reduce the incidence of mistakes for the vast majority who are quality doctors. And, since single-payer covers all future medical costs, there's no need to compensate patients for future costs that result from malpractice. Such a system completely eliminates all the inefficiency of dealing with medical incidents using the judicial system.


A young single person can get insurance for about $300 a month but it won't cover much until they have spent about $8000. This varies by state of course.

(the first couple simple doctor appointments would be $20 or something, there is some basic care built into the monthly payments)


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.


Yep, health care administrators--this century's buggy whip makers, telephone sanitizers, ...


Both the military and the private health insurance industry are Keynesian jobs programs first, their stated purposes second.


They call it a job killer because of all the extra taxes needed. More than doubling taxes in a state that already has very high taxes will have an impact.


How many are in state anyway? I'd of thought most of the middle men would be parts of large companies located in cheaper states.


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


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.


It actually drops spending significantly; there's lots of friction in healthcare caused by the maze of different payers and their different requirements and processes.

But it's not a job killer; reducing the total cost drag from healthcare and the associated personal uncertainty resulting from the gaps in the status quo system ought to spur pretty much every other industry.


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.


Yea, nobody seems to talk about it that way for some reason. If we 'save' on health care, it's either from making the system more efficient, or not providing care to people who need it. Maybe it's too complicated for a sound byte, I'm not sure.


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.


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.


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.


> 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.


"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.


> 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-...).

Lend lease was under way but no where near the total contributions (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.


> I challenge you to put a dollar value on the pax Americana

It's been near constant actual war with an entirely constant internal war footing and national security state limiting basic freedoms justified by the war footing. There is no pax Americana.


The number of people who have died in armed conflicts throughout the entirety of the globe as a percentage of the population is the lowest it has ever been in human history. The number of wars between nations is at the lowest rate in all of human history. Yes, wars occur and will continue to occur, but to assert that the last 70 years of human history is not in a relatively peaceful time is historically disengenious.

Edit to add: the last 70 years have been the first in human history where no major conflicts occured on the European continent. Same with the north American continent.

All of this has been under the blanket of American military dominance and the threat of mutually assured destruction.


Not to argue one way or the other because I don't know. But I think that the overall trend comes from way before American military hegemony. And the European Community-now-Union is usually acknowledged by historians for the peace in Europe.


The peace in Europe today is a direct result of nato and the threat of invasion from the soviets during the 50s through early 90s. You gotta remember that the Americans occupied western Germany up until reunification (we still have huge military bases in germany) and provided finances to pretty much every european country during their reconstruction periods after the devastation of the world under thr conditions of alliance against communism . Europe hasn't been in a place to fight eachother again because of threat of Soviet invasion and forced alliances with eachother under the American umbrella.

Edit: also how can European peace have come from before American hegemony when American hegemony was a direct result of the European powers destroying eachother in a world war?


You misunderstand: the overall trend of deaths around the globe due to armed conflict.

About Europe, I said I wouldn't argue because I don't have the knowledge to assess those claims. Just saying what is usually acknowledged by historians as the main cause.


"You misunderstand: the overall trend of deaths around the globe due to armed conflict."

WWI killed 38 million. WWII killed 60 million.

That doesn't look like a downward trend to me.


This is where I got it from: https://ourworldindata.org/war-and-peace/

The downward trend since the middle ages is actually in wars between the major powers. War mortality seems more or less the same over the long term. The number of smaller conflicts goes up, though.

The decreasing long-term trend in all violence, not just war, is stronger: https://ourworldindata.org/slides/war-and-violence/#/title-s...


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


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.


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.


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.


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.


Right, it adds an insane cost. You then need to raise that same amount of money.

However, when you consider that people are no longer paying for health insurance there's a large pool of money available.

CA needs somewhere between $50-100B to fund this project. The population of CA is around 39M (https://www.google.com/publicdata/explore?ds=kf7tgg1uo9ude_&...). That means, you need about $2,564/person/year. Or about $214/person/month.

If you compare that figure to the average health insurance cost for people in CA everything starts to look possible or reasonable.

Of course, there's still some massive political hurdles to get over. But the money is out there.


You forgot to account for two significant factors: that 40% of Californians pay no state income tax, and that California dramatically skews toward higher brackets paying for the state's expenditures - the top 1% already pay an absurdly massive 48% of state income tax.

Per person numbers like the ones you included are basically meaningless, given they bear almost no reflection of the actual fiscal implementation and unique issues it would create.

Alexander Tyler nailed the broader issue of 'democracy' long ago:

“A democracy cannot exist as a permanent form of government. It can only exist until the voters discover that they can vote themselves money from the public treasure. From that moment on the majority always votes for the candidates promising the most money from the public treasury, with the result that a democracy always collapses over loose fiscal policy followed by a dictatorship."


> Of course it's going to be insanely expensive to insure everybody.

The entire rest of the western world would indicate that it's cheaper than the current system, better too.


Actually let's be clear here. The rest of the Western world does not have a pure single payer system. In fact almost all of them don't. What we have e.g. in Australia is a mixed system closer to Obamacare.

If you don't pay for private health insurance you get public coverage (but you have to pay an increased tax).


The increased tax is our governments attempt to copy the American system.


> I mean, do people not realize that the money has to come from somewhere?

If You read some of the above comments, you'll see that the money is already coming from "somewhere", that Medicare and Medicaid already cost more than what Japan spend per capita, or that $400bln may be half of what is currently being collectively.

https://news.ycombinator.com/item?id=14398948 https://news.ycombinator.com/item?id=14398974


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?


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


Quite a lot to people who are ideologically opposed to taxes and/or government spending irrespective of the cost-effectiveness of the programs they find compared to alternatives.

Which California—Democratic majority notwithstanding—is hardly short on.

And those are exactly the people this Sac Bee headline is aimed at.


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.


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.



The state is facing a budget shortfall, per Brown administration estimates.


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


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


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.




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