So - to implement “single payer” in California (and that’s without taking into account the dreaded “medical migration” costs that posters here like to mention whenever single-state single payer solutions are mentioned) - here is the estimate by the CA Senate Apropriations committee. Keep in mind that CA initial government estimates for things are notoriously low (for example, the estimate for the high-speed rail system when it was approved was $40B. Today the estimate is $64B and still growing).
$400B/year.
“The estimate assumes the state would retain the existing $200 billion in local, state and federal funding it currently receives to offset the total $400 billion price tag.” - I am not sure what the “local and state” funding part here is, but ok. So need to find $200B more.
The article says that currently employers spend $100-150B/year. Let’s say CA manages to get that money from employers instead - that leaves $50B to $100B. And knowing how bad government estimates are, really, it’s going to be $100B+. At least.
CA annual income tax revenue is about $65B. CA annual sales tax revenue is about $20B. And CA corporate tax revenue is around $8B.
So - to implement the “single payer”, CA has to
somehow get the $ that employers pay currently for medical insurance
and
triple its income tax or more than double its total taxation
I can’t speak to the hypothetical experience of California. (I’m tired of debates and really don’t want to get into this, so I will withhold any specific comments.)
I will point out that Vermont was unable to even start the process after passing a law to do so. Vermont isn’t one of the wealthiest states per capita, but it’s still quite rich compared to many countries that do have single-payer.
Single payer is virtually impossible on a state by state basis unless there is a way to prevent health vacation from other states. Ultimately, there good reason for the anti-immigration people to work with the single payer folks since they need each other.
“(and that’s without taking into account the dreaded “medical migration” costs that posters here like to mention whenever single-state single payer solutions are mentioned)”
A question for the Oredigger77’s of the world: If health vacations are a concern in a state-level UHC plan, do our rather lax immigration enforcement efforts concern you at all for a national-level UHC?
Shouldn’t this take into account the money that 40 odd million Californians are already paying for healthcare? If you’re telling me that they’re going to raise my taxes by $8,000 but, in return, I won’t have to pay $10,000 in insurance costs, then I’m surprisingly okay with that.
“Vacation” implies the person comes just for the healthcare then leaves. “Immigration” implies they come to wherever to become a productive member of that society.
It does. From my OP: “The article says that currently employers spend $100-150B/year. Let’s say CA manages to get that money from employers instead.”
The vast majority of medical spending comes from the employers. If you’re employed and your employer provides medical benefits, you’re not paying $10,000 in insurance costs. According to this average annual employee contribution to the medical insurance in California is $1116.
It’s talking about employers. I’m talking about employees. I’m employed (engineer). My employer provides medical benefits. I pay over $10,000 per annum for the family.
Even if it was $3,000 and only half the people paid it per year, that’s still $60B which would more than cover the low end of your scary numbers.
I work in California and my medical insurance is currently a little over $1,100/month for a single person. I pay $220 of that. If I want to retire before medicare kicks in, or if I have to work somewhere else, that’s all on me. So if the program can get under $1,000/month, I’m pretty sure we’d work something out.
Ok - so the employer pays $900. That will be taken by the state from the employer (see the OP). To cover the rest - instead of the $220, just take whatever income tax you’re paying to the state monthly and triple it. How much does that come to?
This seems like a silly bill. It seems to adopt a single-payer method of insurance/reimbursement but does not implement the cost controls and rationing typically associated with such systems. Under the proposal, provider reimbursement would remain fee-for-service. Providers largely retaining decision-making power as to what care to provide to patients. Providers can collectively bargain. They’re basically just taking the $10,000 per person per year that would be paid through private insurers and instead funneling those payments to the single-payer insurance system via taxation; California has a population of about 39 million, hence the $400 billion estimated price tag.
It does provide for public recording of costs and patient outcomes, which I think is a good thing. But that’s a regulatory matter; you can enforce this piece if you want regardless of insurance scheme.
I wonder what the cost estimates would be with Medicare reimbursement levels? Would physicians and hospitals move out of state or figure out how to operate in a lower price world?
Awful, awful!! The idea that everyone can see a doctor is discussing! We should spend that money on weapons, walls and jails instead!! Being poor is not at all related to larger, societal influences, its because people are lazy! Let them die on the streets! Oh yeah, and every single legislative push should have something about making guns easier to get too!
Maybe physicians will sacrifice and stay in CA even if their income is cut by 10-20% for family doctors and 40-50% for specialists. Or maybe they will move. After all, they definitely have the means to do so.
Well, that seems rather an easy calculation. Currenlty, US healthcare costs are 3.2 trillion, or about 10 000 per person. California has 40 million people, so 400 billion.
Basically, all this does is assume that the government will be picking up the tab of all healthcare in California. That seems like it was a pretty easy job to calculate. Frankly, I’m getting the same feeling of “woo for the credulous” that I get from the argument that accidents and violence significantly lowers US life expectancy, or that US infant mortality stats are due to differences in registration.
UHC is not a mysterious think. It is the default in the developed world and some of the rest of it. Its been going for a very long time. We know how it works and what it costs.
If you could run the German system at german costs in California, it’d cost 216 billion, down from todays spending of 400 billion. The French system, 200 billion. The UKs system, 160 billion. (5400, 5000 and 4000 x 40 million people respectively)
The US is not such a special snowflake that it has different economic laws from everywhere else.
This does admittedly assume that California is not the only state with UHC. A big fraction of the US problem is the large number of systems, payers coverage and providers, and all the extra work and duplication of error that ensues. Adding an extra system on top of that isn’t going to save anything. Youd need to replace rather than top up.