I worry about reimbursement rates. Here in FL, right now Medicare pays the most for psychologists (PHD, PSYD) then any of the insurance panels. Recently, Tricare and BC/FL announced plans to reduce benefits by 30%, which is lower than I received 30 years ago. Their rates are about half of Medicare rates.
@busdriver11 “your company would not have to provide you health care, but they would not pay you extra because of this. I wonder what motivation someone who already has employer paid healthcare would have to desire this program?”–I didn’t think of this, but you’re right. For someone with employer paid (tax free) healthcare, this would not be a good thing.
I wonder how would Tricare (the military health insurance) be handled? There are a large number of military families both active duty and retirees living in California. I don’t see them being covered.
One concern I have if CA tries to go this alone is that we’ll see an exodus of top physicians. None of the UC teaching hospitals accept Medi-Cal. If they are mandated to accept lower payments they may be compelled to join a concierge practice or leave the state.
I also wonder how the insurance industry is going to handle the costs of breakthrough medications based on individual gene therapy. The costs are going to be astronomical and it’s hard to envision a system that provides equal access to all.
@momsquad I agree. Why would doctors take a significant pay cut if they can move to a neighboring state?
“I also wonder how the insurance industry is going to handle the costs of breakthrough medications based on individual gene therapy.”
Gene therapy has not been yet fruitful, so we are talking about something years from now.
I am just trying to understand how the redundant programs – like medicare – would play into this proposed new bill. Medicare is taxed at a federal level, yet Medicare services would not be utilized by California residents under the new single payer system, so how would the taxes be worked out to prevent residents from paying for something they have no intention of using?
It sounds like you are saying Medicare taxes collected from California residents would be re-purposed and used to pay for the single payer system instead. Is that correct?
This type of “no questions asked” first dollar coverage seems like a recipe for encouraging overuse by patients and overtreatment by providers. Or would “medically necessary” be enforced by the kind of insurance limitations and restrictions currently practiced by government and private insurance companies?
@BunsenBurner , Gene therapy, as in introducing a cloned gene into a person, is yielding some of the most promising results for cancer treatment ever observed. Here is one example but there are many more:
http://www.cbsnews.com/news/blood-cancer-multiple-myeloma-gene-therapy-all-study-patients-responded/
Many of the single payer systems do have copays. Even for those on Medicaid, a small copay is required in many states. To discourage overuse or for financial stability, you should have a copay. You can adjust them for low income individuals.
It’ll be hard to do on the state level without a VAT.
Genetic based therapies already exist in cancer treatment. They will test the tumor and if certain genetic markers are found, certain drugs are preferred.
I’m saying the federal government would collect the taxes for Medicare as it does now. California would get a waiver, so that instead of the feds paying Medicare claims, the feds would just take all the money that otherwise would have been paid for all Californians that got Medicaid services, and instead write one giant check to the California Healthy California Board.
The same would be true, in theory, for Tricare. Healthy California would get all the money that would have been used to provide services to military families.
BTW, I’m trying to give the best, fairest explanation of this proposal that I can. I’m against it, though. If it passes the legislature and is signed either by Jerry Brown or his successor, I believe the attempt to implement it will drag on for years and then fail.
california single payer costs http://sanfrancisco.cbslocal.com/2017/05/22/california-single-payer-healthcare-400-billion-price-tag/.
We’re CA…we know we can tax our way out of any problem and into nirvana…
“Genetic based therapies already exist in cancer treatment. They will test the tumor and if certain genetic markers are found, certain drugs are preferred.”
^^This has nothing to do with gene therapy. This is personalized medicine. Gene therapy involves much more than simply testing for markers.
That CAR-T tech is also not what would be considered pure “gene therapy.” It is immunotherapy. Show me a treatment that works in solid tumors, and I will show you the next Bill Gates of biotech.
Re: #31
Presumably, the 15% payroll tax or other tax would be at least partially offset by the reduced private spending on medical costs or medical insurance.
Of course, whether overall costs go up or down depends on such matters as what is covered and what copayments etc. there are, and what incentives end up being built into the system to avoid wasteful medical spending. First dollar coverage for everything would likely be the opposite, in that it will encourage medical spending, some of which may be wasteful.
“Various analyses say that this system would cost, overall, a little bit more than what Californians now pay (I do not believe this, btw; I think the estimates are rosy.)”
Experience in other countries are that single payer systems generally end up costing more than the original estimate. I travel to Canada frequently, and the UK less often, and it is very common to see discussions about the cost of medical care, and in some cases discussions regarding delays overall and non-availability of some advanced care. There are obvious offsetting advantages, the most obvious of which might be (i) people get some health care (after some delay); (ii) chronically ill patients might have to worry about being sick and dying, but don’t have to worry about bankrupting their families in the process; (iii) depending upon details, it might be a simpler system; For example small businesses might pay through the nose in taxes, but at least they know what they have to pay.
“I’m not sure how many doctors will want to sign up for a program that reimburses at the Medicare rate.”
I have heard that some small health organizations generally lose money at the Medicare rate, and try to make it up on the other patients. Of course this doesn’t work if everyone is paying the Medicare rate. I am not familiar with the economics of large hospitals, so hopefully someone who is familiar can comment.
There does seem to be some advantage in trying this at the state level before the federal level. For example, if it turns out to be a disaster, there is less to undo. Doing it at the state level does lead to the obvious risk that companies might just decide to leave the state.
“everyone in California would be covered, including undocumented residents.”
A very good reason to slip into California when you get sick.
However, it does seem that the US has been by far the worst at controlling the cost of health care, compared to other rich countries like Canada and the UK. The reasons for that may be more varied and diffuse than whether the system is single payer or not.
I think I read that Jerry Brown thinks it is highly impracticle. Kaiser said it would not be able to operate. Kaiser is a big employer and you can be sure doctors would leave the state. The cost would be double the current entire state budget. This has disaster written all over it.
I think I read that Jerry Brown thinks it is highly impracticle. Kaiser said it would not be able to operate. Kaiser is a big employer and you can be sure doctors would leave the state. The cost would be double the current entire state budget. This has disaster written all over it.
I believe the people trying to put this in place still don’t understand that this is exactly the reason we are in the situation we are in now. How could we end up with the person we have now leading the country? Exactly this kind of mentality.
Let’s just give everyone any possible benefit for free. Let’s be generous and compassionate. Let’s attract anyone with a medical problem and every last illegal immigrant. Come on over, it’s all free. Except…the wealthy will still do okay because they have money to spare (or they’ll move away or retire because they have the ability to do so). The poor might be affected as more illegal immigrants move in to do their jobs for a lesser salary and companies move out, but at least they’ll have free health care. But the middle class who are barely hanging on, can’t afford to move and can’t afford to keep paying more in taxes will get even more resentful that they are once again, paying for others and getting less for their money.
They still don’t seem to understand why they lost. THIS IS WHY. You can’t keep piling everyone else’s costs on the shoulders of people who can’t afford it. California will end up being the land of the ultra rich and the poor, nothing in between.
Meanwhile in Nevada…
https://www.vox.com/policy-and-politics/2017/6/6/15731622/nevada-medicaid-for-all
This is currently sitting on Gov. Brian Sandoval’s desk. Will be interesting to see if he signs it and if he does, how the current administration will react. The western states do seem to be leading the charge here when it comes to a public option for healthcare…I think this looks promising…