Comment by sologoub | Hacker News Reader

Comment by sologoub | Hacker News Reader

TLDR; $400 billion total, $200 billion is currently spent on subsidies and medi-cal, $150 billion is already spent by employers.

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.

EDIT: 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.

In addition, they don't provide a figure for the amount of money that individuals put toward health care, only the amount that their employers contribute.

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.

Indeed. An alternative view on this:

> 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.

http://mattbruenig.com/2017/05/22/californias-surprisingly-c...

I like seeing dental included (per the parent comment). Increasingly discovered to be the genesis of numerous systemic problems (e.g. cardiovascular, for one) when not cared for. A really big opportunity for the kind of up front, preventative maintenance that saves big money / expense, down the road.

Dental care needs to be wrapped into the fold of overall healthcare. Its exclusion creates far more trouble than just bad teeth.

Single payer would be a great improvement on the current nightmare of American healthcare, but let's not kid ourselves that this is an incredible deal. The UK spent 8.5% of GDP on healthcare in 2013 (life expectancy in the UK is marginally higher than in California.) Most European countries spend around 11%.

Single payer != universal health care.

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 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.

http://visual.ons.gov.uk/how-does-uk-healthcare-spending-com...

> 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.

Thanks for the edit. You did the math. The headline is basically opposite of what it should be.

'California cuts overall health spending by almost 50% by going Universal'

Yeah, the headline is sensationalist. With the current spending factored in, it's really not that bad.

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.

> A big enough tax on fast food could probably cover it

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.

Like it or not, it's already done with cigarettes, alcohol, marijuana, gasoline, and a ton of other stuff.

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.

> Cigarettes, alcohol, and junk food directly increase medical 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, 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).

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.

> 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?

"Is that worse than corporate intrusion?"

Yes. You sometimes have a choice about which corporation you deal with. You don't get a choice when it comes to the government.

> 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.

Sure you do. You can vote to not give them your money.

Try that with taxes.

> inherently lead to more government intrusion into your personal decisions

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.

> People wouldn't care except that your "personal" decision affects them.

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.

> A big enough tax on fast food could probably cover it, with the added bonus of decreasing the amount needed.

Probably not; it would take a huge chunk of US fast food revenue, and probably more than California's.

https://www.franchisehelp.com/industry-reports/fast-food-ind...

> 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.)

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