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.
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.
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.
> 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.
Dental care needs to be wrapped into the fold of overall healthcare. Its exclusion creates far more trouble than just bad teeth.
> 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 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 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.
'California cuts overall health spending by almost 50% by going Universal'
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.
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.
Is that worse than corporate intrusion? Does your health insurance not factor these things in already?
Yes. You sometimes have a choice about which corporation you deal with. 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.
Try that with taxes.
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.
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.
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.
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, 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.
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.
Otherwise I feel that there's a loaded gun pointed at my head and any random statement is likely to set it off.
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.
Probably not; it would take a huge chunk of US fast food revenue, and probably more than California's.
> 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.)
The United States currently spends more money per capita on socialized medicine than any other country except Norway:
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.
The U.S. healthcare system _is_ totally out of control.
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.
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, often leading to deaths, or amputations of the wrong limb 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.
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. 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.
 More on handwashing as a challenge to health in hospitals: http://annals.org/aim/article/712481/compliance-handwashing-...
I thought "wrong site surgery" was rare.
> 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.
I don't think you can call 0.007% an "epidemic".
It is, but that wasn't the entire sentence, nor really representative of the total harm from medical errors.
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.
(the first couple simple doctor appointments would be $20 or something, there is some basic care built into the monthly payments)
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.
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.
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.
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.
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.
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.
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.
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 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.
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.
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.
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?
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.
WWI killed 38 million.
WWII killed 60 million.
That doesn't look like a downward trend to me.
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...
As an individual you're just a sucker, a sitting duck to be plucked one feather at a time
Essentially you are just writing a check to the government rather than a private company.
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.
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.
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.
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."
The entire rest of the western world would indicate that it's cheaper than the current system, better too.
If you don't pay for private health insurance you get public coverage (but you have to pay an increased tax).
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.
Which California—Democratic majority notwithstanding—is hardly short on.
And those are exactly the people this Sac Bee headline is aimed at.
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.