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Comment by labster | Hacker News Reader

This is all kind of a joke, because California would never go back to the way it was before Obamacare. At the very least, we would increase taxes to pay for it within our own state. But I wouldn't be surprised if we went to a single payer health insurance system here. Right now, we're supporting the ACA because it was Obama's signature issue, but if it's gone people will want to switch to something better.

Democrats will have a supermajority in California come January. It will be interesting to see what happens.

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Not all universal health insurance systems are created equal. Read up on Molina Healthcare. Some of the Medi-Cal heavy provider networks in Southern California are so bad that they are effectively inaccessible.

Oh, I'm aware of the MediCal providers, because my friends have to use them. That's what Obamacare coverage gets you -- access to the cheapest doctors, or the ones who are willing to essentially donate their time.

The only reason I'm against "repeal and replace" is because I expect the end result will be worse than the ACA. The system is fundamentally broken, but still getting stuff done. In the way that many major software projects are. If the Congress was willing to write their own code instead of outsourcing it to lobbyists, I might be a little more confident in the results.

Thee's no way on earth Cali will go single payer.

Something that gives 'essentially universal coverage' - sure. But single payer, no way.

'Single payer' often means that Steve Jobs waits 12 months for his knee replacement, in behind a lot of unemployed folks, immigrants, many undocumented migrants etc. which is the objective of socialized medicine.

In Canada, it's illegal to pay a doctor to fix you. Granted, we're the only country where this is the case.

I could be wrong, but a UK friend indicated that if you 'go outside the NHS' then you have to basically stay outside of it.

The 'real challenge' is to try to find the right balance and make it fair, but still allow people to have choice etc..

Probably for 2/3rds of people, 'single payer' is best, but for a not-insignificant-minority it's definitely not.

It's tricky because I'm not sure anyone in the world has the solution.

I would say that France may have it right.

I think I meant single-payer in the way that Medicare works in the U.S. There can be companies who manage it, or supplemental policies, but the primary payer remains the U.S. Government.

So the approach would be to extend Medicare to everyone (or in our case, MediCal). Increase payroll taxes to pay for it; remove the requirement that employers provide health insurance. All other laws remain the same.

I agree that a medicare extension to 'everyone' might help.

But that won't work, it will blow up healthcare.

Why?

Because young people just won't buy coverage. They'll all just use Medicare. :)

Most people will = destruction of the industry.

So, yes, 'getting everyone covered somehow by nudging in Medicare' sure ... but it can't just be done by simply extending it.

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