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Re: Single-Payer Health Care in California: Here’s What It Would Take

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Message 11 of 16

@rker321 wrote:

No single payer system will ever work unless is driven Nationally.  and not by any state independently

I wish it did. 


Well, some are trying it anyway - it will be a very tough road for a state - but if they can do it and their citizen approve it in all the details - more power to them.

* * * * It's Always Something . . . Roseanne Roseannadanna
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Re: Single-Payer Health Care in California: Here’s What It Would Take

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Message 12 of 16

@Richva wrote:

I am trying to understand yoru point. Are you saying it is too hard to provide single payer or just too hard for conservatives? 

 

You might look at Maryland since they are headed that way

 

And while states do need federal waivers to incorporate programs like Medicare into a state-run program, Maryland is the only state to already hold a Medicare waiver. It enables a unique system known as all-payer rate setting, which serves as the basis for universal health care in several industrialized nations. In other words, while other states would have to begin from scratch to overhaul their health care systems, Maryland has a head start.

 

 


Just posting what is happening as a current event and asking some questions of people here.

 

The Maryland "all payer system" has been around for a very long time ( the 70's).  CMS applied the waiver ceiling to them in 2016 - to really test this experiment.

 

https://innovation.cms.gov/initiatives/Maryland-All-Payer-Model/

 

Since then, the MD numbers look good based on this CMS ceiling but it is only one part of the whole in getting to a single payer system.

 

Just like in CA, there are lots of hurdles to overcome - NO state can get from what they have now to some sort of single payer system without all the details hashed out. 

 

This Md. all pay system is a good start in ONE part of these details.  They have had 37 years to perfect it.

 

The devil is in these complete details and even candidates in MD. for governor have not rules out an increase in sales or income taxes to pay for the universal coverage which some invisions.

 

I thought the NYT article was good because it highlighted all the different changes that will have to take place to move this state, or any state, to a single payer system..

 

 

* * * * It's Always Something . . . Roseanne Roseannadanna
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Re: Single-Payer Health Care in California: Here’s What It Would Take

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Message 13 of 16

"Single payer" does not mean only one INSURER, its big advantage is the INDIVIDUAL never has to get involved in the billing from the providers for any covered service.

 

The problem is this requires a single set of "fees" that are agreed to by all the providers, which if its a requirement for doing business in the State should be possible to arrange. The State would reimburse the provider according to the fee, and then collect from the insurance company, and the patient for (co-pays that are essential to prevent the service from being abused), or if the patient has "better" insurance, the copay would be collected from the insurer.

 

They'll need to eliminate the Republican parasites by making coverage mandatory, possibly via an additional employment tax where the employer does not provide insurance, basically expanding Obamacare without the freeloader feature so dear to Republicans who want to revert to the system we had before Obamacare - no insurance for pre-existing conditions, cancellations for making claims, life-time caps, etc etc.

 

California has the sixth largest economy in the World, so unless Congressional GOPers torpedo the deal, there's no reason they can't do at least as well as, say, France, which has a SLIGHTLY smaller economy/GDP AND no uninsured citizens.

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Re: Single-Payer Health Care in California: Here’s What It Would Take

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Message 14 of 16

No single payer system will ever work unless is driven Nationally.  and not by any state independently

I wish it did. 

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Re: Single-Payer Health Care in California: Here’s What It Would Take

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Message 15 of 16

I am trying to understand yoru point. Are you saying it is too hard to provide single payer or just too hard for conservatives? 

 

You might look at Maryland since they are headed that way

 

And while states do need federal waivers to incorporate programs like Medicare into a state-run program, Maryland is the only state to already hold a Medicare waiver. It enables a unique system known as all-payer rate setting, which serves as the basis for universal health care in several industrialized nations. In other words, while other states would have to begin from scratch to overhaul their health care systems, Maryland has a head start.

 

 

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Single-Payer Health Care in California: Here’s What It Would Take

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Message 16 of 16

From:  NYT 05.25.2018 - Single-Payer Health Care in California: Here’s What It Would Take

 

It would take ALOT - law changes at the federal and state level and money.

 

If you live in CA, are you as a Medicare beneficiary ready to be a member of a state-run program?

 

It is the details which are important to people and if they feel they might be losing something even if it is for the supposedly "greater good" - they will decline the vision. 

 

Not to mention how providers of healthcare would feel about getting a pay cut - would they stick around????

 

Excerpts from the link:

All the leading Democratic contenders (governors race) in the June 5 primary have pledged support for a single-payer system run by the state. . . . .

 

. . . . .“Voters are thinking about the fundamental values associated with single-payer,” said Kelly Hall, an independent health consultant who works with the Service Employees International Union-United Healthcare Workers in California, which has endorsed Mr. Newsom. “Almost zero voters have thought about the policy implications.”

 

In this case, “implications” could be another word for booby traps. Even a state as big, wealthy and liberal as California — with the world’s fifth-largest economy and nearly 40 million people — would find itself hamstrung by money, a legal and regulatory thicket, and highly motivated opposition.

 

“You’re talking 20 percent of California’s economy,” said Dana Goldman, the director of the Schaeffer Center for Health Policy and Economics at the University of Southern California. “The savings you’re going to get are going to come out of someone’s pockets.”

 

Even Mr. Newsom sounded a cautious note recently, conceding it could take years to erect such a system: “It is not an act that would occur by the signature of the next governor.”

 

Visionary thinking is needed to create an independent, state-run system that’s responsible for every resident’s health care and prescription drugs — but so is getting the authority, financing and political support.

Start with who’s in charge.

. . . . . California cannot simply decide to divert health care money spent in the state to a single-payer insurance plan of its own. Federal rules govern nearly all health-insurance coverage.

 

Medi-Cal — the state’s version of Medicaid, the health insurance program for low-income Americans — covers about a third of the population. Here, the state has lots of leeway to experiment, and the federal government has tended to let that happen.

 

But almost everyone else gets coverage through an employer, Medicare or the individual marketplace. And in these arenas, the state has less authority.

 

To redirect Medicare funds, California would require a federal waiver — something unlikely to be granted by any administration.

 

Medicare is popular, and federal officials are unlikely to allow a state to engineer a wholesale Medicare takeover. Californians might not be too happy, either. Once California — and not the federal government — were to be the single payer, then the current Medicare program would no longer be an option. If would be replaced by a new California version.

 

A bigger stumbling block comes from employer plans, which cover roughly 43 percent of Californians. Federal law, in effect, prohibits states and localities from dictating how private employers that self-insure should structure their plans. So employers unwilling to take part in a California-run insurance system wouldn’t have to.

 

Officials could try to persuade them by offering cheaper coverage and fewer administrative headaches. But if, say, Google and Disney want to stick with the coverage they have, they can. Changing that law would require an act of Congress.

 

The phrase ‘higher taxes’ is less popular than ‘single payer.’

Let’s, for the moment, magically eliminate the legal and regulatory roadblocks: Poof! California transfers its share of Medicaid and Medicare money to its own single-payer system, and it convinces every private employer to drop its existing coverage and join.

 

Where is the rest of the money to cover the uninsured going to come from? The state could look to cut costs: eliminate intermediaries, including insurance companies; reduce administrative costs; negotiate lower prices for drugs; and pay hospitals and doctors Medicare rates rather than higher private-plan prices.

 

Broader health coverage could also help reduce pricey emergency-room visits and improve preventive care, which could head off more serious illnesses and higher costs down the road.

 

Still, expanding coverage costs more for a reason: When people have it, they use it. The total price tag would depend on what’s covered, but eliminating deductibles and co-payments, as a recent California bill proposed, further raises costs. A legislative analysis of that bill, which offered free medical care for every resident including undocumented immigrants, estimated the final tally would be about $400 billion a year — more than double the state’s budget.

 

About half that sum could come from existing Medicare and Medicaid dollars, according to the analysis. What employees and employers currently spend would cover another $100 billion to $150 billion. But the remaining $50 billion to $100 billion would require new taxes — such as a 15 percent payroll tax on earned income.

 

A separate analysis put the bill’s cost at $331 billion, accounting for savings achieved through efficiencies and preventive care, among other things. Whatever the figure, even supporters concede that it would require a higher sales tax and increased taxes on large businesses.. . . .

‘Single-payer’ has no single definition.

Democrats overwhelmingly favor single-payer plans in polls, but the phrase means different things to different people. To some, “single-payer” is just a way of saying coverage for everyone. To others, it means eliminating the profit motive from health care. Or it represents simplicity — an end to paperwork, deductibles, co-payments and preapprovals.

 

. . . . When asked if he would still support single-payer if it meant higher taxes, however, Mr. Cohen ( a Medicare beneficiary) said no: “Raising taxes to offset the cost of health insurance is not the best approach.” And he is unwilling to trade his Medicare coverage for a state-based version, “unless it changes for the better.”

 

A nationwide Kaiser Family Foundation survey last September found similar sentiments. A majority favored the idea of a single-payer national health plan. But when those surveyed were told that the role of employers in health care would be ended, that governmental control would grow, or that people would have to trade in their existing coverage, support fell below 40 percent.

 

Consider what happened in Colorado. In 2016, surveys showed wide support for a single-payer plan, but when an initiative was put on the ballot, it got just 21 percent of the vote.

 

Of course, changing the message — and the details — can similarly drum up support, or flop those who previously flipped, but the variability shows how quickly voters can turn.

* * * * It's Always Something . . . Roseanne Roseannadanna
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