# CA single-payer costs **URL:** \ **Category:** Great Debates\ **Created:** [May 22, 2017, 10:07pm UTC](https://boards.straightdope.com/t/ca-single-payer-costs/787240 "2017-05-22T22:07:40Z")\ **Posts on this page:** 20\ **Page:** 2
**Author:** ![Caldazar](https://avatars.discourse-cdn.com/v4/letter/c/8e8cbc/32.png) [@Caldazar](https://boards.straightdope.com/u/Caldazar)\ **Post date:** [May 23, 2017, 2:23am UTC](https://boards.straightdope.com/t/ca-single-payer-costs/787240/21 "2017-05-23T02:23:41Z")
> [@Grim\_Render](#): > > 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. Sure, but that is not what is being proposed in the California bill. The bill proposes a single-payer system, but without many of the regulations and cost controls other systems contain. So it really is the state government just picking up the tab in many cases so as to guarantee healthcare for all residents. The proposed bill is here: [Bill Text - SB-562 The Healthy California Act.](https://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201720180SB562) . Some excerpts: Section 1(e) “It is the intent of the Legislature that neither health information technology nor clinical practice guidelines limit the effective exercise of the professional judgment of physicians and registered nurses. **Physicians and registered nurses shall be free to override health information technology and clinical practice guidelines if, in their professional judgment, it is in the best interest of the patient and consistent with the patient’s wishes**.” (bolding mine) Section 2, Chapter 4, 100630 “(a) Covered health care benefits under the program include all medical care determined to be medically appropriate by the member’s health care provider.” Section 2, Chapter 5, 100639 “(b) Health care services provided to members under the program, except for care coordination, shall be paid for on a fee-for-service basis unless and until another payment methodology is established by the board.” “(c) Notwithstanding subdivision (b), integrated health care delivery systems, essential community providers, and group medical practices that provide comprehensive, coordinated services may choose to be reimbursed on the basis of a capitated system operating budget or a noncapitated system operating budget that covers all costs of providing health care services.” It does outline collective bargaining rights between providers and the state-run insurance system. But there’s a limit to how far the state-run system can push this to drive down prices in this framework. ---
**Author:** ![wolfpup](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/wolfpup/32/10618_2.png) [@wolfpup](https://boards.straightdope.com/u/wolfpup)\ **Post date:** [May 23, 2017, 7:47am UTC](https://boards.straightdope.com/t/ca-single-payer-costs/787240/22 "2017-05-23T07:47:08Z")
> [@Okrahoma](#): > > So - to implement “single payer” in California … Yet another post to “prove” that single-payer or equivalent form of UHC can’t work, despite the fact that it works in every civilized country on earth, and it does so at a mere fraction of the per-capita cost in the US. A good comparison is Canada which is socioeconomically very similar to the US and where total per-capita health care costs are around half of what they are in the US. **Half.** Once you figure out why this is, you will understand why the rest of your post is moot and absurd from the big-picture perspective of a properly managed health care system executed in partnership with the federal government. The _ **reasons** _ for this I have repeated in these forums seemingly about ten million times, and the _ **plain fact of it** _ is obvious in any international comparison of health care costs. I am truly sick and tired of these debates that serve only to put on display conservative Americans’ apparent total ignorance of health care economics. > [@HurricaneDitka](#): > > 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? I am not **Oredigger77** but let me introduce you to how single-payer works in the real world. Health care in single-payer or equivalent UHC systems is paid for through the patient’s health care card in exactly the same manner as a credit card, and in order to get a health care card you need to present a number of documents establishing residency in the state or province and, more importantly, proof of citizenship or legal residency. The latter requires the appropriate official federal document and is enforced as strictly as it would be for a passport application – no exceptions. ---
**Author:** ![PatrickLondon](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/patricklondon/32/4422_2.png) [@PatrickLondon](https://boards.straightdope.com/u/PatrickLondon)\ **Post date:** [May 23, 2017, 8:12am UTC](https://boards.straightdope.com/t/ca-single-payer-costs/787240/23 "2017-05-23T08:12:00Z")
Politically, introducing such a scheme involves persuading enough people that most of the healthy need to spend more either as a support for others in the same community, and/or as a transfer from their fit and healthy selves to their older and sicker selves in future, and for the resulting system to be good enough to get enough cross-community use that it’s not seen as emergency charity for the poor but a service for everyone. You’ve got an issue of a priori values and emotions as much as, and probably before, you’ve got an issue of economic calculations. Is there a professionally authoritative source for a public exchange of transparent benchmark information on costs, clinical effectiveness and value-for-money on individual treatments, as well as standards of provision? Both public and private systems need that, and it might inform the values debate as well. ---
**Author:** ![puddleglum](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/puddleglum/32/137_2.png) [@puddleglum](https://boards.straightdope.com/u/puddleglum)\ **Post date:** [May 23, 2017, 6:15pm UTC](https://boards.straightdope.com/t/ca-single-payer-costs/787240/24 "2017-05-23T18:15:56Z")
> [@Okrahoma](#): > > 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](http://kff.org/other/state-indicator/single-coverage/?currentTimeframe=0&sortModel=%7B%22colId%22:%22Location%22,%22sort%22:%22asc%22%7D) average annual employee contribution to the medical insurance in California is $1116. The incidence of the health insurance all falls on the employee and not the employer. So what is important is not the employee portion but the total costs. The employee pays the cost along with the federal government since employee health insurance costs are tax deductible. ---
**Author:** ![Okrahoma](https://avatars.discourse-cdn.com/v4/letter/o/90db22/32.png) [@Okrahoma](https://boards.straightdope.com/u/Okrahoma)\ **Post date:** [May 23, 2017, 6:17pm UTC](https://boards.straightdope.com/t/ca-single-payer-costs/787240/25 "2017-05-23T18:17:54Z")
> [@puddleglum](#): > > The incidence of the health insurance all falls on the employee and not the employer. So what is important is not the employee portion but the total costs. The employee pays the cost along with the federal government since employee health insurance costs are tax deductible. Which is completely irrelevant to the OP’s cost calculations and what was taken into account when doing so. Whatever portion today comes from the employer will continue to be paid, if not to the insurance companies, then to the CA government. It will not be paid to the employees. ---
**Author:** ![puddleglum](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/puddleglum/32/137_2.png) [@puddleglum](https://boards.straightdope.com/u/puddleglum)\ **Post date:** [May 23, 2017, 6:27pm UTC](https://boards.straightdope.com/t/ca-single-payer-costs/787240/26 "2017-05-23T18:27:41Z")
> [@Grim\_Render](#): > > 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. It is not true that you can take another countries health insurance system and just plop it into California and expect it to work just as well. For instance to get doctors salaries the same as in the UK would mean a 26% pay cut for GPs and a 35% pay cut for specialists. Nurses salaries would have to be cut by 25% as well. The weather in California is nice but I bet if you tried to give people a cut in pay of 25-35% a bunch of them would leave to other states. In order to make up the difference California would have to import thousands of doctors and nurses from third world countries and California does not control immigration laws. ---
**Author:** ![Icarus](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/icarus/32/72_2.png) [@Icarus](https://boards.straightdope.com/u/Icarus)\ **Post date:** [May 23, 2017, 6:47pm UTC](https://boards.straightdope.com/t/ca-single-payer-costs/787240/27 "2017-05-23T18:47:17Z")
> [@puddleglum](#): > > For instance to get doctors salaries the same as in the UK would mean a 26% pay cut for GPs and a 35% pay cut for specialists. Nurses salaries would have to be cut by 25% as well. The weather in California is nice but I bet if you tried to give people a cut in pay of 25-35% a bunch of them would leave to other states. In order to make up the difference California would have to import thousands of doctors and nurses from third world countries and California does not control immigration laws. As I’ve stated in other threads on this subject, a fundamental aspect of our entire health care system is wealth creation. Any large scale changes would have to address this - people up and down the chain would make less money. There would have to be something in place to address this to incentivize people to stay in their roles - tax breaks? Tuition forgiveness? Something. ---
**Author:** ![CarnalK](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/carnalk/32/486_2.png) [@CarnalK](https://boards.straightdope.com/u/CarnalK)\ **Post date:** [May 23, 2017, 6:48pm UTC](https://boards.straightdope.com/t/ca-single-payer-costs/787240/28 "2017-05-23T18:48:52Z")
> [@puddleglum](#): > > It is not true that you can take another countries health insurance system and just plop it into California and expect it to work just as well. For instance to get doctors salaries the same as in the UK would mean a 26% pay cut for GPs and a 35% pay cut for specialists. Nurses salaries would have to be cut by 25% as well. The weather in California is nice but I bet if you tried to give people a cut in pay of 25-35% a bunch of them would leave to other states. In order to make up the difference California would have to import thousands of doctors and nurses from third world countries and California does not control immigration laws. Doctors in a bunch of states earn about 25% less than California doctors. There’s cost of living to consider but you wouldn’t necessarily need to import Pakistani doctors. Doctors’ business costs would likely go down under a UNC system due to administrative savings and more reliable payment schedules. ---
**Author:** ![puddleglum](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/puddleglum/32/137_2.png) [@puddleglum](https://boards.straightdope.com/u/puddleglum)\ **Post date:** [May 23, 2017, 8:11pm UTC](https://boards.straightdope.com/t/ca-single-payer-costs/787240/29 "2017-05-23T20:11:31Z")
> [@CarnalK](#): > > Doctors in a bunch of states earn about 25% less than California doctors. There’s cost of living to consider but you wouldn’t necessarily need to import Pakistani doctors. Doctors’ business costs would likely go down under a UNC system due to administrative savings and more reliable payment schedules. California has the second highest cost of living in the country, so doctors must be paid more in order to work there. If you cut everyone’s salary by 25% then those people can get a better lifestyle by moving out of state. The business costs would only go down for doctor’s who own their own business, not for those who work as employees, and would not affect nurses. ---
**Author:** ![iamthewalrus\_3](https://avatars.discourse-cdn.com/v4/letter/i/258eb7/32.png) [@iamthewalrus\_3](https://boards.straightdope.com/u/iamthewalrus_3)\ **Post date:** [May 23, 2017, 9:44pm UTC](https://boards.straightdope.com/t/ca-single-payer-costs/787240/30 "2017-05-23T21:44:14Z")
> [@snfaulkner](#): > > “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. Either way, there are plenty of people whose healthcare costs far more than the economic value they reasonably can or do produce for society. What happens if all those people make the rational choice to move to California? Even if they want to be productive, they won’t cover their own costs. ---
**Author:** ![Balthisar](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/balthisar/32/2825_2.png) [@Balthisar](https://boards.straightdope.com/u/Balthisar)\ **Post date:** [May 24, 2017, 11:55am UTC](https://boards.straightdope.com/t/ca-single-payer-costs/787240/31 "2017-05-24T11:55:15Z")
> [@iamthewalrus\_3](#): > > Either way, there are plenty of people whose healthcare costs far more than the economic value they reasonably can or do produce for society. > > What happens if all those people make the rational choice to move to California? Even if they want to be productive, they won’t cover their own costs. Retirees. In any case, aren’t we missing co-pays and deductibles from the equation? Presumably, they would disappear, and so they would count towards the available pool of funds. ---
**Author:** ![puddleglum](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/puddleglum/32/137_2.png) [@puddleglum](https://boards.straightdope.com/u/puddleglum)\ **Post date:** [May 24, 2017, 2:21pm UTC](https://boards.straightdope.com/t/ca-single-payer-costs/787240/32 "2017-05-24T14:21:35Z")
> [@iamthewalrus\_3](#): > > Either way, there are plenty of people whose healthcare costs far more than the economic value they reasonably can or do produce for society. > > What happens if all those people make the rational choice to move to California? Even if they want to be productive, they won’t cover their own costs. It is not just the sick, this will be true of everyone who makes less than the average income. Since the price of health insurance will no longer be per person but a percentage of income, it will be a good deal for everyone who makes less than the average income and a bad deal for those who make more than the average. Since the cost of living is so high, the very poor are probably the only ones who will benefit, but for the richer residents it would be a huge raise to move out of state. ---
**Author:** ![CarnalK](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/carnalk/32/486_2.png) [@CarnalK](https://boards.straightdope.com/u/CarnalK)\ **Post date:** [May 24, 2017, 3:07pm UTC](https://boards.straightdope.com/t/ca-single-payer-costs/787240/33 "2017-05-24T15:07:47Z")
Well, since this is such a straightforward math question, why haven’t all the doctors moved to Arkansas? It has one of the lowest costs of living in the country but is top ten for doctors’ salaries. It’s almost like other factors are involved. ---
**Author:** ![watchwolf49](https://avatars.discourse-cdn.com/v4/letter/w/e9c0ed/32.png) [@watchwolf49](https://boards.straightdope.com/u/watchwolf49)\ **Post date:** [May 24, 2017, 3:27pm UTC](https://boards.straightdope.com/t/ca-single-payer-costs/787240/34 "2017-05-24T15:27:17Z")
> [@Icarus](#): > > As I’ve stated in other threads on this subject, a fundamental aspect of our entire health care system is wealth creation. Any large scale changes would have to address this - people up and down the chain would make less money. There would have to be something in place to address this to incentivize people to stay in their roles - tax breaks? Tuition forgiveness? Something. There a point almost always ignored in these debates … the health care system in the United States works wonderfully … stock prices are escalating, dividends are robust … whoever finds the cure for Alzheimer’s isn’t going to get rich selling in Germany/France/United Kingdom … they’ll be getting rich selling in the United States … If California implements this what happens to the commercial insurance companies operating in there? … or more importantly, what happens to the pension trusts that rely on those dividend payments … What happens when, in a given year, the medical expenses exceed revenue … does California borrow the money to pay the hospitals? … is that even legal for California to borrow the money (other than issuing bonds)? … > [@iamthewalrus\_3](#): > > Either way, there are plenty of people whose healthcare costs far more than the economic value they reasonably can or do produce for society. > > What happens if all those people make the rational choice to move to California? Even if they want to be productive, they won’t cover their own costs. If it looks like an economic bubble, if it smells like an economic bubble, if it sounds like an economic bubble, if it feels like an economic bubble and if it tastes like an economic bubble … maybe it’s an economic bubble … just saying … The good news is that socialism used to be a filthy word in American politics … but today we know a major political party candidate can make it to the convention running on a socialist platform … so when that bubble bursts, the Federal Government can step in and take over the whole operation and we all know how much better Congress is at running things than the open market … ---
**Author:** ![Oredigger77](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/oredigger77/32/3181_2.png) [@Oredigger77](https://boards.straightdope.com/u/Oredigger77)\ **Post date:** [May 24, 2017, 4:35pm UTC](https://boards.straightdope.com/t/ca-single-payer-costs/787240/35 "2017-05-24T16:35:03Z")
> [@HurricaneDitka](#): > > 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? I’m probably not the right person to answer this because I’m fairly extreme when it comes to immigration, I want open borders. To answer your question I don’t think that the rate of travel from the other 49 states to California as a percent of the population is remotely comparable to the rate of travel from outside the US into the country especially if you eliminated the people who already had single payer in their home country. If nothing else there isn’t a constitutionally protected right to travel into the country while there is between states. As far as my ideal we would provide an UBI and single payer insurance to all us citizens from birth to death and then invite the rest of the world to come work and live here so they could help pay for the benefits of being a citizen. We could abolish all safety nets beside those two and give nothing to the non-citizens. ---
**Author:** ![iamthewalrus\_3](https://avatars.discourse-cdn.com/v4/letter/i/258eb7/32.png) [@iamthewalrus\_3](https://boards.straightdope.com/u/iamthewalrus_3)\ **Post date:** [May 24, 2017, 7:31pm UTC](https://boards.straightdope.com/t/ca-single-payer-costs/787240/36 "2017-05-24T19:31:37Z")
> [@CarnalK](#): > > Well, since this is such a straightforward math question, why haven’t all the doctors moved to Arkansas? It has one of the lowest costs of living in the country but is top ten for doctors’ salaries. It’s almost like other factors are involved. Ok, although I said “what happens if all those people”, I didn’t really mean “every single person”. I meant “a lot of people.” Apologies for misspeaking. Presumably, some doctors _do_ move to Arkansas for just those reasons. If, say, Arkansas were considering paying for more and more expensive medical care for its residents, that would probably result in some _more_ doctors moving to Arkansas. Similarly, a change like this is going to incentivize people who have higher than average health costs and lower than average income to move to California. Not _everyone_, but some. Possibly quite a lot. So if you’re considering the change, you have to figure out how big that effect will be, and if it’s still a feasible plan. Pointing out that people have many different factors that they consider in where to live doesn’t change the reality that financial incentives exist, and changing them will change people’s behavior. ---
**Author:** ![adaher](https://avatars.discourse-cdn.com/v4/letter/a/dec6dc/32.png) [@adaher](https://boards.straightdope.com/u/adaher)\ **Post date:** [May 25, 2017, 4:35am UTC](https://boards.straightdope.com/t/ca-single-payer-costs/787240/37 "2017-05-25T04:35:33Z")
If California wasn’t so obsessed with treating undocumented immigrants the same as citizens they’d be able to pull this off cost-wise. Including illegals makes the whole scheme impossible and would turn California into a magnet for illegal immigration, while also taking the pressure off other border states. Why go to Texas when you can get free health care in California? They could also get a lower price tag by not making all health care free. Co-pays are a necessary component of keeping costs down. Even if they do get the costs in order, they still have to convince Californians with insurance that they should give that up and go on the government plan. Good luck with that. ---
**Author:** ![wolfpup](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/wolfpup/32/10618_2.png) [@wolfpup](https://boards.straightdope.com/u/wolfpup)\ **Post date:** [May 25, 2017, 4:52am UTC](https://boards.straightdope.com/t/ca-single-payer-costs/787240/38 "2017-05-25T04:52:56Z")
> [@adaher](#): > > Co-pays are a necessary component of keeping costs down. Some think so, I don’t. There are no co-pays in the single-payer system where I live, and the system works fine, without any over-utilization problems or unusual cost problems. No one goes to the doctor for fun, much less to a hospital. Co-pays act as a disincentive that discourages seeking health care for those who have difficulty affording them, introducing delays that may lead to expensive health complications, and waiving co-pays for the poor adds an unnecessary level of administration to support something that serves no real purpose. But I agree with you that UHC must be restricted to citizens and legal residents, and that requirement must be strictly enforced. If California is planning on covering undocumented immigrants in their health care plan they must be nuts. Open borders to free public health care makes about as much sense as trying to run a bank with an open vault. ---
**Author:** ![adaher](https://avatars.discourse-cdn.com/v4/letter/a/dec6dc/32.png) [@adaher](https://boards.straightdope.com/u/adaher)\ **Post date:** [May 25, 2017, 5:37am UTC](https://boards.straightdope.com/t/ca-single-payer-costs/787240/39 "2017-05-25T05:37:14Z")
Be great for Abbott though in Texas, his poverty rate will drop sharply in a very short time. Of course, another issue is the funding mechanism. Universal health care in almost all countries that have it is paid for by the recipients for the most part through things like VATs or social insurance taxes. Employers usually pay a portion of it as well. California wants to put it ALL on employers, thus hiding the direct cost but creating a much bigger problem: as people rush in to get health care, employers will rush out, and even those that remain will pay lower wages, which is not good in a place as expensive as California. ---
**Author:** ![Typo\_Negative](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/typo_negative/32/484_2.png) [@Typo\_Negative](https://boards.straightdope.com/u/Typo_Negative)\ **Post date:** [June 2, 2017, 4:56pm UTC](https://boards.straightdope.com/t/ca-single-payer-costs/787240/40 "2017-06-02T16:56:39Z")
[Single payer passes California Senate](http://www.msn.com/en-us/news/us/single-payer-health-care-bill-passes-california-senate-heads-to-assembly/ar-BBBNFtd?li=BBnb7Kz) > [@](#): > > “How do we possibly pay for this thing?” asked Sen. Tom Berryhill, R-Modesto, ahead of Thursday’s vote. “This seems to me to be like what we did originally with Covered California and we are going to just figure it out as we go. … We don’t have the money to pay for this.” I think Single Payer is the way to go, but this is exactly the question that comes to my mind. It especially troubling if it just California and not the nation. > [@](#): > > It would also eliminate premiums, co-payments and deductibles and allow Californians to get health care from any willing provider without referrals. Does it define Californians? Is there a residency requirement? Are chronically ill people going to be flocking to California? [Previous page](https://boards.straightdope.com/t/ca-single-payer-costs/787240.md?page=1) [Next page](https://boards.straightdope.com/t/ca-single-payer-costs/787240.md?page=3)