# 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:** 3
**Author:** ![Ludovic](https://avatars.discourse-cdn.com/v4/letter/l/7ab992/32.png) [@Ludovic](https://boards.straightdope.com/u/Ludovic)\ **Post date:** [June 2, 2017, 9:05pm UTC](https://boards.straightdope.com/t/ca-single-payer-costs/787240/41 "2017-06-02T21:05:31Z")
According to what I’ve read, CA will have to get permission to roll their federal health dollars into their system which will require permission from the administration. I wonder what the chance that they will get it will be. The simplest take on that would be that they won’t get permission because the administration doesn’t want the liberals to have any victories, and it will cause governmental health care to continue to be seen as getting worse. On the other hand, if you think that it will fail, you might want to approve it just to watch it crash and burn but I don’t think the administration looks that far forward. ---
**Author:** ![Yllaria](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/yllaria/32/3452_2.png) [@Yllaria](https://boards.straightdope.com/u/Yllaria)\ **Post date:** [June 2, 2017, 9:32pm UTC](https://boards.straightdope.com/t/ca-single-payer-costs/787240/42 "2017-06-02T21:32:54Z")
> [@Typo\_Negative](#): > > [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) . . . Does it define Californians? Is there a residency requirement? Are chronically ill people going to be flocking to California? NPR was saying today that the vote just “kept the conversation alive”. Even if everything got ironed out, they guessed it would be a year or more before single payer actually happened. And funding is still not specified, not even a little. As to the residency requirement, I’m guessing it will be like the residency requirement for college/university. If you’ve lived in California for more than a year, you don’t have to pay the out-of-state fees. ---
**Author:** ![adaher](https://avatars.discourse-cdn.com/v4/letter/a/dec6dc/32.png) [@adaher](https://boards.straightdope.com/u/adaher)\ **Post date:** [June 3, 2017, 3:13am UTC](https://boards.straightdope.com/t/ca-single-payer-costs/787240/43 "2017-06-03T03:13:18Z")
> [@Ludovic](#): > > According to what I’ve read, CA will have to get permission to roll their federal health dollars into their system which will require permission from the administration. I wonder what the chance that they will get it will be. The simplest take on that would be that they won’t get permission because the administration doesn’t want the liberals to have any victories, and it will cause governmental health care to continue to be seen as getting worse. On the other hand, if you think that it will fail, you might want to approve it just to watch it crash and burn but I don’t think the administration looks that far forward. If it was me I’d be very eager to let them try it and thus kill the idea off once and for all, but I don’t know if the Trumpists are that smart. ---
**Author:** ![DrDeth](https://avatars.discourse-cdn.com/v4/letter/d/b487fb/32.png) [@DrDeth](https://boards.straightdope.com/u/DrDeth)\ **Post date:** [June 3, 2017, 3:33am UTC](https://boards.straightdope.com/t/ca-single-payer-costs/787240/44 "2017-06-03T03:33:41Z")
> [@wolfpup](#): > > 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. . Actually very few have single payer. [https://www.forbes.com/sites/timworstall/2017/03/26/its-surprising-how-few-countries-have-national-single-payer-health-care-systems/2/](https://www.forbes.com/sites/timworstall/2017/03/26/its-surprising-how-few-countries-have-national-single-payer-health-care-systems/2/) ---
**Author:** ![Tee](https://avatars.discourse-cdn.com/v4/letter/t/73ab20/32.png) [@Tee](https://boards.straightdope.com/u/Tee)\ **Post date:** [June 3, 2017, 3:43am UTC](https://boards.straightdope.com/t/ca-single-payer-costs/787240/45 "2017-06-03T03:43:38Z")
> [@Yllaria](#): > > NPR was saying today that the vote just “kept the conversation alive”. That was my impression of the bill; it’s more like a conversation right now. I don’t see a sane way to fund all medical treatments without any limits, so my guess is there are a lot of proposals yet to come. But the intent is there. ---
**Author:** ![adaher](https://avatars.discourse-cdn.com/v4/letter/a/dec6dc/32.png) [@adaher](https://boards.straightdope.com/u/adaher)\ **Post date:** [June 3, 2017, 5:31am UTC](https://boards.straightdope.com/t/ca-single-payer-costs/787240/46 "2017-06-03T05:31:56Z")
> [@DrDeth](#): > > Actually very few have single payer. > > [https://www.forbes.com/sites/timworstall/2017/03/26/its-surprising-how-few-countries-have-national-single-payer-health-care-systems/2/](https://www.forbes.com/sites/timworstall/2017/03/26/its-surprising-how-few-countries-have-national-single-payer-health-care-systems/2/) Plus the fact that single payer works through rationing. While rationing is not a necessary component of universal health care, it is a necessary component of the single payer version. The lack of competition enables the government to hold down costs, both through price controls, since providers have no other options but to deal with the government, and through denial of “excess” care, like “unnecessary testing” and “elective procedures”. I use scare quotes because while single payer systems base their findings on sound science, the data they use is only useful when looking at groups. Some individuals will inevitably be served poorly. For example, our own government recently said that women shouldn’t get annual mammograms until 50. While that will achieve better results for the population as a whole, those few women who get breast cancer before 50 will have worse outcomes. As for elective procedures, if you’re merely in agonizing pain and can’t live a productive life, but won’t die, your government believes you can wait. The reason that system won’t work in California is because Californians won’t tolerate it. They want the same level of care they get now through their employer plans, and that’s really, really expensive. There will be some cost reduction due to California’s bargaining position as the sole payer, but that is always limited by free movement across borders. Good doctors can always just practice elsewhere, and hospitals will invest less in modern equipment if they aren’t likely to make any money off it. ---
**Author:** ![ataraxy22](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/ataraxy22/32/307_2.png) [@ataraxy22](https://boards.straightdope.com/u/ataraxy22)\ **Post date:** [June 3, 2017, 9:04am UTC](https://boards.straightdope.com/t/ca-single-payer-costs/787240/47 "2017-06-03T09:04:05Z")
Um, the way it usually works as that single payer is optionally supplemented with insurance for those who want a higher level of service. Sent from my SM-G930V using Tapatalk ---
**Author:** ![adaher](https://avatars.discourse-cdn.com/v4/letter/a/dec6dc/32.png) [@adaher](https://boards.straightdope.com/u/adaher)\ **Post date:** [June 3, 2017, 9:22am UTC](https://boards.straightdope.com/t/ca-single-payer-costs/787240/48 "2017-06-03T09:22:54Z")
California’s ambition is for single payer to replace all private insurance. They might want to set their sites lower. ---
**Author:** ![Ravenman](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/ravenman/32/2929_2.png) [@Ravenman](https://boards.straightdope.com/u/Ravenman)\ **Post date:** [June 3, 2017, 10:30am UTC](https://boards.straightdope.com/t/ca-single-payer-costs/787240/49 "2017-06-03T10:30:24Z")
> [@Okrahoma](#): > > [http://www.sacbee.com/news/politics-government/capitol-alert/article151960182.html](http://www.sacbee.com/news/politics-government/capitol-alert/article151960182.html) > > 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). CBO: “We estimate this bill will result in 23 million more uninsured Americans.” Conservatives: “Sqwaaaaaak! No! You haven’t been 100% correct in the past, so everything you say should be ignored!” CaSAC: “We estimate this bill will cost $400 billion per year.” Conservatives: “Ahhh… finally a health care cost estimate we can trust! Your past mistakes are absolved.” I get so confused as to whether Republicans are for or against policy analysis on any given day. ---
**Author:** ![adaher](https://avatars.discourse-cdn.com/v4/letter/a/dec6dc/32.png) [@adaher](https://boards.straightdope.com/u/adaher)\ **Post date:** [June 3, 2017, 10:33am UTC](https://boards.straightdope.com/t/ca-single-payer-costs/787240/50 "2017-06-03T10:33:13Z")
This quasi-Republican says the CBO and other neutral budget analysts are essential and their word should be taken as gospel, even if they aren’t always accurate. Their educated estimates are a heck of a lot better than any alternatives. ---
**Author:** ![Tee](https://avatars.discourse-cdn.com/v4/letter/t/73ab20/32.png) [@Tee](https://boards.straightdope.com/u/Tee)\ **Post date:** [June 3, 2017, 1:53pm UTC](https://boards.straightdope.com/t/ca-single-payer-costs/787240/51 "2017-06-03T13:53:22Z")
> [@adaher](#): > > The reason that system won’t work in California is because Californians won’t tolerate it. They want the same level of care they get now through their employer plans, and that’s really, really expensive. There will be some cost reduction due to California’s bargaining position as the sole payer, but that is always limited by free movement across borders. Good doctors can always just practice elsewhere, and hospitals will invest less in modern equipment if they aren’t likely to make any money off it. They would get cheaper doctors, foreign doctors, and people who aren’t doctors to fill the holes. The ones who want to leave can funnel themselves into the other 49 states that are having the same trouble with health care spending, I’m sure they’ll be fine. ---
**Author:** ![eschereal](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/eschereal/32/18939_2.png) [@eschereal](https://boards.straightdope.com/u/eschereal)\ **Post date:** [June 3, 2017, 4:38pm UTC](https://boards.straightdope.com/t/ca-single-payer-costs/787240/52 "2017-06-03T16:38:22Z")
> [@adaher](#): > > California’s ambition is for single payer to replace all private insurance. They might want to set their sites lower. Are there single-payer systems that have completely replaced all private insurance? Because I think I have heard that it is possible to obtain private insurance in countries like Canada and the UK. If that is the case, why do you think would California be different? Why do you think their ambition is to replace _all_ private insurance? (And if single-payer is more cost-effective, why _not_ replace inefficient private insurance with it?) ---
**Author:** ![adaher](https://avatars.discourse-cdn.com/v4/letter/a/dec6dc/32.png) [@adaher](https://boards.straightdope.com/u/adaher)\ **Post date:** [June 4, 2017, 2:05am UTC](https://boards.straightdope.com/t/ca-single-payer-costs/787240/53 "2017-06-04T02:05:44Z")
You can get supplemental insurance and California doesn’t have any plans to ban private insurance. But the costs of single payer are taking into account what Californians get now through their employer insurance, which is just impossible. The cost speaks for itself: double California’s current already bloated budget. And then they think they can pay for it through a poorly hidden tax on employers? And cover illegals? They are out of their minds. Now if they make it more like Medicaid and cover only legal residents, then they might have something. ---
**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:** [June 4, 2017, 2:20am UTC](https://boards.straightdope.com/t/ca-single-payer-costs/787240/54 "2017-06-04T02:20:55Z")
> [@ataraxy22](#): > > Um, the way it usually works as that single payer is optionally supplemented with insurance for those who want a higher level of service. Except in Canada. The only additional insurance is dental, scripts, optical. Hence why so many Canadians visit the USA for medical needs. ---
**Author:** ![adaher](https://avatars.discourse-cdn.com/v4/letter/a/dec6dc/32.png) [@adaher](https://boards.straightdope.com/u/adaher)\ **Post date:** [June 4, 2017, 3:04am UTC](https://boards.straightdope.com/t/ca-single-payer-costs/787240/55 "2017-06-04T03:04:22Z")
Also, at least in single payer systems, the supplemental insurance doesn’t apply to the stuff you need. It doesn’t let you jump the line. ---
**Author:** ![eschereal](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/eschereal/32/18939_2.png) [@eschereal](https://boards.straightdope.com/u/eschereal)\ **Post date:** [June 4, 2017, 3:46am UTC](https://boards.straightdope.com/t/ca-single-payer-costs/787240/56 "2017-06-04T03:46:19Z")
> [@Balthisar](#): > > Except in Canada. The only additional insurance is dental, scripts, optical. Hence why so many Canadians visit the USA for medical needs. > [@"\[wa-po](#): > > ([https://www.washingtonpost.com/news/fact-checker/wp/2016/10/11/trumps-claim-about-canadians-traveling-to-the-united-states-for-medical-care/?utm\_term=.570ab3da27dd](https://www.washingtonpost.com/news/fact-checker/wp/2016/10/11/trumps-claim-about-canadians-traveling-to-the-united-states-for-medical-care/?utm_term=.570ab3da27dd))"]… the right-leaning Canadian think tank Fraser Institute, which found that in 2014, more than 52,513 Canadians received non-emergency medical treatment outside of Canada … a 25.5 percent increase over the 2013 estimate of 41,838 people. For context, 52,513 people represent 0.15 percent of the country’s population of 35.5 million in 2014. Big numbers, there. Reminds me of the guy who said, with a straight face, that since UHC, 90% of Canadians have moved within 100 miles (160km) of the US border. > [@](#): > > The study does not look specifically at Canadians traveling to the United States. The survey asks physicians to estimate the percentage of their patients who received non-emergency medical treatment outside of Canada, rather than asking the question of patients. So maybe start looking for a more useful example than Canada. ---
**Author:** ![manila](https://avatars.discourse-cdn.com/v4/letter/m/e5b9ba/32.png) [@manila](https://boards.straightdope.com/u/manila)\ **Post date:** [June 4, 2017, 5:41am UTC](https://boards.straightdope.com/t/ca-single-payer-costs/787240/57 "2017-06-04T05:41:53Z")
How much is medical malpractice insurance for doctors in California? Presumably under UHC this would be underwritten by the state. How does it work currently? Do doctors personally pay this? Also does vehicle insurance cover medical costs? Home insurance cover public liability? I can’t help feeling that the health of one country’s citizens should be a major priority for any government and is too important for a for profit insurance company ---
**Author:** ![race\_to\_the\_bottom](https://avatars.discourse-cdn.com/v4/letter/r/c4cdca/32.png) [@race\_to\_the\_bottom](https://boards.straightdope.com/u/race_to_the_bottom)\ **Post date:** [June 4, 2017, 5:50am UTC](https://boards.straightdope.com/t/ca-single-payer-costs/787240/58 "2017-06-04T05:50:12Z")
One factor always missing in these debates about single payer is that a big chunk of your auto insurance is the part of liability coverage which would cover medical expenses of accident victims. I don’t have any numbers, but shouldn’t auto insurance premiums decline under single payer which would objectively lower the cost? ---
**Author:** ![adaher](https://avatars.discourse-cdn.com/v4/letter/a/dec6dc/32.png) [@adaher](https://boards.straightdope.com/u/adaher)\ **Post date:** [June 4, 2017, 6:31am UTC](https://boards.straightdope.com/t/ca-single-payer-costs/787240/59 "2017-06-04T06:31:54Z")
Sounds like it should. As for malpractice, single payer systems don’t allow massive malpractice suits. But single payer systems also don’t allow illegal residents full benefits either. California probably won’t cross the trial lawyers lobby, so they’d probably put taxpayers on the hook for big settlements as well. THey really haven’t thought this out. ---
**Author:** ![eschereal](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/eschereal/32/18939_2.png) [@eschereal](https://boards.straightdope.com/u/eschereal)\ **Post date:** [June 4, 2017, 6:50am UTC](https://boards.straightdope.com/t/ca-single-payer-costs/787240/60 "2017-06-04T06:50:09Z")
> [@"\[pnhp](#): > > ([$375 billion wasted on billing and health insurance-related paperwork annually: study - PNHP](http://www.pnhp.org/news/2015/january/375-billion-wasted-on-billing-and-health-insurance-related-paperwork-annually-stud))"]Private insurers spent $198 billion on (billing and insurance-related costs), whereas public insurers, e.g. Medicare and other government-sponsored programs, spent $35 billion on such activities. The insurance marketplace is a nightmare for healthcare providers. There is one corner of the expense picture that is poorly calculated. If the state is the primary or sole payer, doctors and hospitals can cut back drastically on this expense. Which means the various bean counters will be forced to find worthwhile jobs. Medicare’s operational overhead is something like 0.5% of its revenue stream, which means the $400B cost estimate is nonsensical, because it is based on the more expensive, less efficient profit-driven system. I suspect the biggest fear about UHC is that the government will seek ways to reduce costs – like raising taxes on products and activities that are deemed to compromise healthiness. Twinkies, booze, tobacco, Disneyland, sasquatch hunting, whatever they decide is contributing to negative outcomes. Which might be a good thing, as long as they refrain from outright bans. [Previous page](https://boards.straightdope.com/t/ca-single-payer-costs/787240.md?page=2) [Next page](https://boards.straightdope.com/t/ca-single-payer-costs/787240.md?page=4)