California's Single-Payer Health Care Plan Would Cost More Than the State's Whole Budget

Like in Colorado, New York, and Vermont, California is learning that a single-payer plan would be prohibitively expensive.



Stop me if you've heard this one before. A state considers implementing a single-payer health care system, then learns it would have to use its entire annual budget, plus some, to fund the idea.

The latest stop on this magical mystery tour of progressive health care plans is California, where U.S. Sen. Bernie Sanders (I-Vermont) has been campaigning on behalf of a proposed state-run single-payer system. On Monday, state lawmakers in Sacramento got their first look at the price tag for the proposal, which rings in at a whopping $400 billion annually.

The Sacramento Bee notes that, even after accounting for an estimated $200 billion that could be saved by replacing current state-run health programs with the single-payer program, the state would still need to come up with $200 billion annually.

This year's state budget in California, by the way, is about $180 billion. That means that implementing a single-payer health care system would require doubling (at least) the state's current tax burden. The analysis of the health care proposal presented to lawmakers on Monday suggests a 15 percent increase to the state's payroll tax to provide the necessary revenue.

The cost analysis is seen as "the biggest hurdle to creating a universal system," the Bee reports.

If this sounds familiar, that's because it is. Just last week, we reported on a similar single-payer proposal in New York State, which would require doubling (and possibly quadrupling, depending on which projection you believe) the state's tax burden. Vermont's attempt to implement a single-payer health care system collapsed in 2014 because the costs were too high. Colorado voters rejected a proposed single-payer system in 2016 when faced with the prospect of increasing payroll taxes by 10 percent to meet the estimated $25 billion annual price tag.

The list of states that have tried to go single-payer is still a small sample size, but a fairly wide ranging one. It includes states with large populations and small ones. States with a variety of economies and tax systems. States that are growing quickly and those that aren't.

Despite that range of variables, one thing remains constant: state-level single-payer health plans would require massive increases in tax revenue, equal or larger than the amount of revenue consumed by every other state-level program in a single year.

California's proposal is particularly expensive because it's not just a single-payer proposal, but a generous one. As Vox details, "the state would pay for almost all of its residents' medical expenses—inpatient, outpatient, emergency services, dental, vision, mental health, and nursing home care—and Californians would not have any premiums, copays, or deductibles." Undocumented immigrants would be covered too.

Even in the state that spends the most money each year, the $200 billion increase is asking for a lot. Californians pay an average of 11 percent of their income in state and local taxes, the sixth highest of any state, according to the Tax Foundation, a Washington, D.C.,-based think tank that favors lower tax rates, and the state's top income tax rate of 13.3 percent is already the nation's highest.

"Needless to say, doubling California's tax burden would give them the highest taxes in the country by far," Joe Henchman, vice president of state projects for the Tax Foundation, told Reason on Tuesday.

The proposal "will cost employers and taxpayers billions of dollars and result in significant loss of jobs in the state," warns the California Chamber of Commerce.

A single-payer system at the federal level would have the same fiscal problems, of course, but unlike state governments that are required to balance their budgets annually, a nationally single-payer system would just be added to the federal government's ever-growing tab. That's not necessarily better, but it would offer something of a solution to the problem of how to pay for a hugely expensive new entitlement. Until Democrats control the federal government, though, state-level efforts like the ones in New York and California are likely to continue percolating.

There's one other thing that's fairly consistent among the states that have proposed single-payer systems in recent years: When voters find out how much a single-payer system will cost, they are much less likely to support one.

Single-payer advocates learned that lesson last year in Colorado at the ballot box, as the state turned blue for Hillary Clinton even as 79 percent of voters said "no" to single-payer health care.

Other polling bears out that relationship. A recent poll commissioned by the California Association of Health Underwriters, found that 66 percent of California residents are opposed to single-payer health care. Opposition increased to 75 percent when those polled were told the price tag for the system is $179 billion annually—which is actually lower than what the legislative analysis suggests.

There's also this analysis from the Kaiser Family Foundation, which shows how support for single-payer health care declines when there is a price tag attached to the idea.

Kaiser Family Foundation

When free health care provided by the state government isn't free, it's a much more difficult sell. Progressives in California have their work cut out for them.

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  1. Billion, sparky.

    1. Indeed. This shit will bankrupt those assholes.

      I love California. I just hate the Californians.

    2. It’s been fixed it seems, and yeah if California’s entire budget is 170 million than they are the literal kings of small government. ^_-

  2. $400 million? So $10 per resident? Doesn’t sound that bad. Think you might be off by a few orders of magnitude….

    1. possible 200 billion per year divided by 40 mil people comes to $5000.00 tax on everyone every year and since kids don’t pay taxes we adults will pay far more. I’ll pay less since I’ll quit working and get free meds anyway.

      1. So cheaper than insurance?
        Why don’t you quit working now to live on welfare? If you need healthcare that would probably make you qualified for free meds as it is. Or is that a Libertarian idea of how things work like saying Pharma will close up shop if they’re limited to $4B in profits but a free market will magically get them to limit their profits to $4B and be happy?

        1. How much is the Federal subsidy? I believe the 400 billion is net of the Federal subsidy for Medicare and Medicaid.

        2. when you take out kids and those who don’t pay in Cali you end up with $8 to $10k a year. Not cheaper and thats if it makes the min $200 billion a year

          1. My +1 insurance is $12K/yr in a state that’s slightly cheaper than CA, the family plan is even more. So I’m betting $8K-$10K for a family would still be a lot cheaper. I’m on a $0ded/PPO so that should be comparable to what most think of when they think single payer, with co-pays I probably have more medical costs than what they have planned unless they’re going to have a co-pay assistance.

            The handwaving over costs of government run healthcare makes no sense. We already pay in a very inefficient system and we don’t and won’t deny care to the point of killing people we bankrupt them (the basis of our inefficiency).

        3. The free market does limit their profits.

          It’s government regulation that allows the corporatocracy the profits you quot at the expense of the competition which is shut out of the market.

          I can tell you’ve never run a business.

          1. Me? I presently have a business. What you said has nothing to do with what I said. I actually agree with what you said.
            I was pointing out the hypocrisy of libertarian idealism. If $4B isn’t enough to stay in business it’s not enough to stay in business no matter what is causing that limit.
            I was also pointing out the lie that anyone who’s already not scamming for welfare would scam for welfare, if they’re not willing to be that poor for medicaid they’re not going to be willing to be that poor so they could avoid paying less than they presently do for a single payer system. If that’s how they were willing to live they would already be doing it.

  3. Is that graphic correct? It looks like oppose and support are flipped.

  4. The communistas don’t understand the economics all that great.

    And why should they? There are no repercussions for political profligacy. until citizens start demanding accountability and prosecution for wasteful spending, spend on you devilish crooks and assholes.

  5. Progressives believe that even if single-payer is impossible in every state due to cost problems, it’s still possible at the Federal level. That’s because they are functionally retarded, but I sincerely wish them the best of luck in getting these measures passed in California regardless of the cost. That way, the entire rest of the nation can witness the truth first or second hand.

    1. We need to lower the number of progressives to a more manageable level. Anybody got suggestions on what to do with them?

      1. Well, if you’re a Progressive you would forcibly sterilize them as three generations of imbeciles is enough?

        Thanks, Teddy Roosevelt.

      2. You could start by burning down Washington DC.

        I guess next you could induce millions of coronaries at once if you told them that all of the developing nations of the world will continue to use fossil fuel for as long as they don’t want to toil in misery.

    2. “We take a loss on every one we sell, but we make it up in volume!”

      1. Dammit. Something something refresh…

    3. Progressives believe that even if single-payer is impossible in every state due to cost problems, it’s still possible at the Federal level.

      “We lose money on each unit we sell, but we make up for it in volume!”

      1. California Dairy Price supports.

    4. I hope the Californians come to their senses because their are already to many left coasters and damn yankees who have immigrated to Texas. I think Texas should build a wall, or something.

      1. Just shoot everyone in a Prius who gets near the border.

        1. Too funny!

          I don’t have a Prius. But I do have one of Toyota’s other hybrids.

          Still made me laugh out loud.

        2. Lol my wife and I both own a Prius but I still found this hilarious.

      2. At some point Austin is going to try and separate and become a California territory

    5. >I sincerely wish them the best of luck in getting these measures passed in California regardless of the cost. That way, the entire rest of the nation can witness the truth first or second hand.

      Sadly, a LOT of regular folks who are not progtards will suffer in this experiment.

      I for one will definitely move to Nevada if this passes. All the rest of the progtardian foolishness I’ve been able to abide but I’ll be damned if I’m going to let Sacramento make health care decisions for my family.

      1. There are a lot of people who will suffer as a result, but I have faith that good intentions last precisely as long as they don’t have tangible effects upon the person who claims to have them in most cases.

        1. Ox gored and all that?

      2. You can checkout anytime you like , but you can never leave.

      3. Why just wish. California would appear to have rather expansive notions of who gets to vote there.

        You can help make it a reality.

    6. It’s worth noting that California’s GDP is the same as France. This isn’t the economy of Wyoming and the notion that economies of scale aren’t there is absurd. Actually, come to think of it, single payer would probably work better in Wyoming than in California. Not that it would work in either case.

      Of course, France doesn’t have single payer, and they do have the ability to print money (so long as Germany gives them permission).

    7. They would say that the federal government would just be able to negotiate the prices down or something.

      1. Much like the government used to ‘negotiate down’ the cost of harvesting cotton.

        1. Now, there’s a thought as to how to enact effect health care reform making it a “right” for everyone.

          California needs a constitutional amendment that makes all CA health care workers slaves.

          Yeah, that’s the ticket.

    8. It would be entertaining, until California insists on a federal bailout. It’s too big to fail, you know. Then, we can all pay for their reckless endeavors.

    9. The feds can just print more money.

  6. Health care is too expensive for each of us individually but if we pool our money we’ll have enough for all of us collectively.

    Forget healthcare, the failure of the public school system to teach fundamentals of math is the real problem here. These people seriously believe that two people can run twice as fast as one person.

    1. A valid point, although the way they’re thinking about it is that they’re going to loot places like Silicon Valley for all their ‘profits’ so they can get finally not worry about complicated things like how to survive as an adult. It’s failed public education all the way down.

      1. Somehow I think that the entertainment and tech industries will get a pass.

        1. I think the days of their most profitable industries ‘getting a pass’ with tax breaks will need to come to an end if they plan on financing such a massive program. If nothing else, the voters will demand that the government loot Silicon Valley and Hollywood. Sure, that will mean the entire industry will just move to Texas but I’m all for that, personally.

          Moonbeam has already admitted that he doesn’t give a shit what happens to the economy as long as people keep voting him into office. Frankly, that’s almost respectable since that’s literally his job. If only there weren’t so many contrary examples I’d say ‘good on him’ for helping to expose all of the California rules as bullshit.

          1. Silicon Valley could do well in Texas, but Hollywood would have to move to Austin.

            1. Hollywood would have to move to Austin.

              Why Austin? Isn’t like half the programming I watch filmed in Canada, acted by Canadians, or both anyway?

            2. Silicon Valley is already doing well in Texas it seems, but your implication that Austin isn’t in Texas is an apt one. ^_^

              1. Yeah Austin stinks…

          2. Jerry’s MO is to rail about how the rich need to pay their fair share, while quietly nickel-and-diming the poor. He was just the same as Mayor of Oakland.

          3. I had to attend his news conference in Concord where he was trying to rally support for SB1 – the increase in the fuel tax and auto registrations. He did say almost that at the end of his speech. In answer to one of the questions that was asked with an obviously anti tone, “They shouldn’t pass this if they don’t like it. The roads won’t get fixed. I won’t care because I’m termed out. I’ll be gone by then on my ranch working.”

            Which led to the inevitable question of whether he’d remain in politics. To which he gave the coy answer of “you never know where I might pop up.”

            They’re all the same. I know that term limits are unlibertarian but I find myself supporting them for this very reason. They just make careers out of sucking off the government teat. They only have to change teats every once in a while.

          4. Keep your silicon valley assholes out of my suburbs. Fucking housing in Dallas is already going up too much and if you don’t put a contract in on a house the day it comes to the market you won’t get it. See ya down in Arizona Bay.

      2. Yep. Took 100 years to get this bad. Stands to reason, a massive upheaval is the only thing that can start the trend back the other direction. Still that will take……100 years.

        At least I hope kids born today will be convinced not to go to college. That waste of time really costs the individual money. The public high schools is the total collective failure.

        Communism is awesome when you call it community and service.

    2. That is also where we get project managers who believe nine women can have a baby in one month.

    3. The heavier an object is, the faster it will fall.

    4. They’re all just farmers at heart. When their farm begins to fail because the crop prices won’t support their production, they just go to the bank to borrow more money for next year when they plan to plant twice as much and make up the difference on volume.

  7. Expensive ideas are great, unless you’re paying.

  8. If the current budget is $180M, I don’t understand how we can save $200M from existing programs.

    1. Billion, that is.

    2. FTA: The estimate assumes the state would retain the existing $200 billion in local, state and federal funding it currently receives to offset the total $400 billion price tag.

      My guess is the “budget” they’re referring to is the General Fund, discretionary spending, the stuff that gets hammered out by the lege on a year-to-year basis, and pretending entitlement spending and mandated funds and federal revenue sharing and reimbursements and various sub-divisions of the government aren’t part of the budget. Last time I checked a few years back, Georgia’s real total budget was well over $40b while the newspaper was referring to it as $18b. There’s several streams of revenue that don’t pass through the GF – those aren’t budget items as far as the government is concerned and most of the press seems to be either ignorant of the real tax load or willing to go along with the lie that the government’s only half as expensive as it really is. IIRC, by law the motor fuels tax in Georgia goes straight to the DOT and since the pols can’t get their grubby paws on that cash to fund whatever pet “transportation infrastructure” projects they dream up (which is exactly why the motor fuels tax goes straight to the DOT) they just pretend it doesn’t exist.

  9. Thanks for catching the billions/millions screw-up, folks!

    1. You forgot the second bear head on the NCR flag, too. ^_-

  10. If Governor Brown thinks he has a freeloading…

    1. Governor brown thinks freeloading is how the trucking industry should work.

    2. Moonbeam has free-loaded his entire life; why would he see it as a problem?

      1. As a native Californian, my hat is off to your understanding of the underlying problem with Governor Moonbeam.

        Like a bad penny, he just keeps coming back. And spending and spending.

        What did we expect from an “almost priest”. Having been schooled in a Catholic High School, I would expect no less than giveaways of OPM. To them, taxes are just alms for the poor.

        Priests are famous for it. Only requiring the occasional alter boy as payment.

  11. And this while the state and local governments in CA are currently struggling just managing subsidized care, let alone actual state-run hospitals.

    There was a county-run hospital in Contra Costa County (Doctor’s Medical Center in San Pablo) that recently shut down because it was hemorrhaging money at such an alarming rate and the County simply found it expeditious to kick some money to privately run critical care facilities to make up the gap.

    Likewise, in Alameda County, the county hospital also ran itself into the ground and is now essentially being leased to a subsidized private provider who also can’t seem to stop running at an enormous loss.

    While the actual boots-on-the-ground facilities are exploring various methods of privatization in order to achieve basic functionality, the legislature is actively working to put all medical facilities in the state back into the hands of the very system that is frantically trying to divest itself of those facilities due to its inability to run them.

    Left hand, meet right hand.

    1. What’s telling about the broken system in your example Square = Circle, is how much money the “non-profit” hospitals kicked in to try and keep DMC open. Why would other, competing hospitals, non-profit no less, throw their precious revenues over to a loser run by the County?

      There was a reason. Broken system.

  12. If the current total budget is $180 billion, where is the $200 billion offset from current state health care programs coming from?

    1. The rich will finally pay their fair share. Duh. Doy.

      1. California will just tax them 110%. They won’t even notice.

    2. federal Medicaid payments I’d guess

  13. Do it. I wanna see it happen.

  14. I noticed from the infographic that one of the pros listed for single-payer is reducing administrative overhead. I have seen this mentioned in several places as a benefit of single-payer. I don’t understand why that is. I associate centralization like that with more overhead in most cases.

    Anyone know why that is?

    1. because politicians lie.

      1. See just below for lying regarding costs.

    2. Because the state believes that it is efficient, despite all of the millions of examples where that is the opposite of reality.

    3. It’s deductive logic that assumes the truth of its conclusion.

      I’ve heard the argument stated thusly:

      Obviously, if you have two companies providing the same service, they’re doubling functions that wouldn’t need to be doubled if there were only one. This is because when I choose one over the other, one is getting my business, while the other is just people sitting there disappointing and hoping the next guy will choose them.

      Therefore, if there’s only one company, obviously you streamline the whole thing and you save on those redundancies.

      Of course, you have to guard against the negatives of having a monopoly by having the government run it, otherwise you would be subject to price-gouging.

      The fact that in practice neither monopolies nor the government lead to reduced costs in contrast to free competition is just noise, given the airtight logic of the basic argument.

      1. There is the argument that there is only one set of forms to fill out, since you are only dealing with one “insurance company”. Of course, Square hits the nail on the head. The number of different forms goes down, but the huge offices of state workers getting paid to surf internet pron more than offsets that.

        1. And empirical evidence suggests single payer systems raise administrative costs.

          1. There’s no incentive to keep them down.

    4. I had a debate with a person years ago about single payer systems. His argument was that Medicare only had a 5 percent overhead. He stubbornly held onto this point even though I questioned it with facts like 3 percent goes to finance residencies at hospitals. The major problem is that thanks to the AMA’s lobbying during the 90’s the residencies were limited to 100,000 doctors per year. Until that changes, with an increasing population, health care is doomed to get worse.

      1. Thank you for pointing out one of the many reasons why Americans spend so much on health care.

  15. “…The cost analysis is seen as “the biggest hurdle to creating a universal system,” the Bee reports….”

    Naah. It was the paperwork that killed ’em.
    BTW, any gov’t cost estimate of a gov’t program is off. And the correct number is some hole number multiplication of that guess; addition is not the correct operation in these cases. See, oh, the SF Bay Bridge:…..ented-cost

  16. Looking for Tony and the remaining lefty retards to tell us how the gov’t is overestimating the costs. With historical examples, of course.

    1. Tony doesn’t pop up when actual numbers are in play. Too hard to refute by making shit up.

      Global warming “belief” and racist “colored folks need government protection from whitey” feelz are more his bailiwick.

      1. Lol I’m barely here and even I know that’s his m.o.

  17. The difference between the New York plan and the California plan is that California has a stupid ass initiative system. The legislature punts all the “difficult” problems to the ballot, which is one reason the state is so fucked up.

    If they put this on the ballot, and it gets 50.05% of the vote, it becomes inviolable law. Doesn’t matter if it’s fiscally impossible, it’s still the law. Doesn’t matter if the state goes bankrupt, it’s still the law. Can’t balance the budget? No problem, no one gets paid. It’s still the law.

    This state is literally one bad initiative away from Venezuela. Only the Federal government keeps the state in check. Which is why the progtards were masturbating over the prospect of a Calexit.

    I guarantee you if this passes everything east of Interstate 5 will quit and form their own state.

    1. California is a case study in the folly of direct democracy.

    2. Everything east of the 1 except in the Bay Area and LA.

      1. Yeah sure, we’ll take Atascadero. But not Oxnard!

    3. Progtards weren’t the only ones masturbating over Calexit.

    4. Under the Constitution, you cannot form a new state out of an old one without the consent of the old one.

      Yes, I know West Virginia exists. IIRC that was justified on the basis that the Virginia state legislature consisted of the legislators who remained part of the one loyal to the Union. Which was pretty much all people from West Virginia.

    5. Only the Federal government keeps the state in check.

      This makes the FedGov sound exceedingly reasonable and competent. The FedGov supplies them with gatorade and vitamin E to keep them from collapsing and occasionally distributes rain coats to keep their socialist-derp bukkake from splashing all over observers and bystanders.

      1. No, the Feds are not reasonable and competent. But they do jealously guard their privileges, some of which California would dearly love to have. Stuff like… printing your own money.

    6. Include Orange County west of the 5 or at least Knott’s and Huntington Beach.

  18. It’s Cali. Don’ they have a bunch of wealthy celebrities just chomping at the bit to pay for the healthcare of their fellow (poorer) men? //rhetorical

    1. Government run healthcare is a wrong.

  19. This proves my earliest predictions about any American-style single-payer system. Americans who demand single-payer want much more comprehensive systems than they have in Europe and Canada. The people pushing for single payer are going to have to learn to live with the more spartan European systems if they ever want to get something that doesn’t consume 500% of all the money printed in the US.

    1. ^ This.

      This is one of the great follies of this debate – like Marx’s “bourgeois socialists,” Americans seem to think they can have all the benefits of a capitalist system, but without the capitalism.

    2. That’s just a negotiating position. Everyone will be glad to double the budget if they think the alternative is to triple it.

  20. It’s mainly because your starting from the bloated, overpriced, fascist-crony system we have now. Prices are driven up by restrictions on the market and simply socializing the payment of these exorbitant prices does nothing to solve core problem, the high prices. In fact, it makes it worse.

  21. They want us to deficit spend our way to Utopia. Idiots.
    Cut the Fed government back to bare bones, actually follow the Constitution (all powers not stated are reserved for the States and the People), and let us keep the $ that the Fed currently sucks out of the economy.

    Oh, and let California go ahead a secede, PLEASE! Get all those communistic voters out of our republic!

    1. “Oh, and let California go ahead a secede, PLEASE”

      The proposal died; not nearly enough support.

  22. FYI, California is the best reason for the application of borders and their recognition that ever existed.

    1. Also, they’ve been influencing our candidates and elections for years.

  23. Hmmm … wandering mind ….

    Suppose any state were to implement single-payer, no questions asked, illegal immigrants and everybody. There’d be a lot of freeloaders from neighboring states, more for more serious matters (cancer), less for minor stuff (vaccinations).

    I wonder how much the state would benefit from competition from neighboring states? The usual way any government program fails is lack of accountability and competition. But as a single payer state’s costs kept climbing and gathering cobwebs and cruft and inefficiency, neighboring states would come off better and better. Would that be enough to inject a dose of reality (however small) once in a while and keep the waste down to a dull roar?

    If I were running the simulation, I’d be all over things like this. What’s a few million virtual livs matter when you can game the system and see what happens?

    1. Scarecrow said “I wonder how much the state would benefit from competition from neighboring states? The usual way any government program fails is lack of accountability and competition. But as a single payer state’s costs kept climbing and gathering cobwebs and cruft and inefficiency, neighboring states would come off better and better. Would that be enough to inject a dose of reality (however small) once in a while and keep the waste down to a dull roar?”

      Well, you don’t see Massachusetts trying to act like New Hampshire, do you?

      1. Nah. But I think there must be some small benefit, just from the cost comparisons. The same thing applies to all laws, like cigaret and booze and other sin taxes. States usually eventually notice when their tax revenue goes down because of people smuggling in their sin, or goes up from people smuggling out their sin.

        I expect it’s pretty small. But I wonder if anyone has ever attempted to measure it.

  24. Golly. Looks like Reason can run at least 50 more articles about how expensive medical spending is if run by ‘the state’. Maybe 10,000 more if municipalities can get in on the game. All of which is totally pointless and basically dishonest.

    Total medical spending in the US currently – $3.5 trillion
    Total state govt spending in the US currently – $1.8 trillion
    Total municipal govt spending in the US currently – $1.6 trillion

    Yes – single-payer progs are dishonest to pretend that states/locals/feds can just assume financial responsibility for the spending and use debt issuance to disguise the spending, institute some intergenerational thievery, and avoid actual reform of anything. But so are ‘market advocates’ who want to ignore everything about current reality cuz hey boobjobs prove everything can work out well.

    1. Markets are indeed credible devices to reduce costs. One need not look far to find examples of deregulation dropping prices on some of the most technical fields around. Look at how much airline prices dropped with competition. Look at oil. Shipping. You can ship a container full of, what, 10,000 t-shirts, for just a couple thousand dollars – add in port fees and handling, 25 or 50 cents per t-shirt. Look at how much cars have improved even while governments lard on safety features that do nothing but add weight and confusion.

      Only a fool would think medicine is immune to market magic.

      1. Which hospital offers the best deal on a tonsillectomy there near you? Which Doctor is trying to grow their business by offering a “First Visit Free.” Got a price list from the local Urgency Clinic?

        We do not have a free market medical system. What we have is a twisted up crap system that does not compare well with nearly any other industrialized nation.

        It is time for change to a single-payer system!

        1. ??? Can’t discern which way you are swinging.

        2. Or the opposite.

        3. Well, I was actually about to call several ophthamologists for price quotes on a LipiFlow treatment (Dry eye treatment not covered by Medicare).

          I guess that means:
          –Consumers only will shop if they have to pay out of pocket
          –If it’s covered by insurance they won’t shop, no price competition
          –Whether there are multiple insurance companies following the same government regulations or single payer is irrelevant; if the consumer doesn’t pay, he won’t shop and there will be no price competition
          –If insurance companies have different coverage options and different formularies, there will be competition among insurance companies and pharmacies.

        4. “It is time for change to a single-payer system!”

          1. Not sarc.

            “a twisted up crap system that does not compare well with nearly any other industrialized nation.” Was the kool-aid filled tell.

      2. Only a fool would think medicine is immune to market magic.

        The only people who think the current healthcare market is working are those who – have someone else making all the economic decisions to provide them with access to the medical system. IOW – they are as ignorant and entitlement-driven as children who think food appears on the table by magic. And they are the ones chanting boobjobs – that’s the ticket.

        Anyone who actually has to make their own economic decisions in this healthcare market thinks our system is a complete clusterfuck and has been for a couple decades. The reality is that when markets fail people will tend to look for a solution outside the market. ‘Market advocates’ are incapable of acknowledging that markets can fail – so they become useless – just chanting boobjobs – that’s the ticket.

        1. Except those ‘market failure’ aren’t really market failures, they’re the product of direct controls and subsidies imposed by the state. If the government would get out of the way and let insurers and providers compete, stop dictating what services have to be covered/are allowed to be covered, how they can be paid for/how they have to be paid for, and eliminate unnecessary barriers to providing care, then prices will decline and and quality improve.

          This is what makes your repeated complaints about ‘market failures’ so laughable. It’s standard socialist recipe: government fucks up market, blames flaws created by government on market failure, uses it to justify more government involvement in market, and on the cycle goes until that market has been nationalized.

          Just like with every other industry subject to extensive price and production controls and effective government sanctioned monopolies, there is no reason at all why socializing health care would either reduce costs or increase supply. Eo ipsi, it would just amount to rationing the same limited supply of healthcare we have now.

          1. If the government would get out of the way and let insurers and providers compete…

            Govt isn’t stopping a free market. The EXISTENCE of insurance prevents a free market. ‘the insured’ will NEVER be a rational buyer as long as insurance is paying for it. And providers will never be focused on consumers as long as insurance is the actual paying customer. PERIOD.

            And govt has ALWAYS been in the healthcare system. Hospitals wouldn’t have been built without tax deductions and top marginal tax rates well over 50%. Muni hospitals grew in the 1920’s because charitable hospitals preferred leaving beds empty than accepting all the sick patients who couldn’t pay. Which is rational but it proves that ‘medical care’ is an upper-middle class good/service not a ‘mass market’ thang. Before that the lower half drank alcohol to self-medicate. Unfortunately market advocates are not at all honest about that. They are selling the same bs siren song that socialists are.

            there is no reason at all why socializing health care would either reduce costs or increase supply.

            Except for the tetchy little FACT that EVERYWHERE on earth has lower costs – and every industrialized country has more supply of both doctors and hospitals (though not diagnostic equipment) and better outcomes – and most are actually structured to implement market reforms better than we are too. We are nothing but a fat clusterfuck with stupid entitled ideologues on all sides.

            1. Of course doctors are plentiful in single payer countries. Like Canada which is short about 20,000 doctors. We have a shortage here because the Feds limit the number of residencies. That’s thanks to the AMA which lobbied Congress and HHS because the AMA was afraid of an oversupply of doctors and lower fees.

              1. Oh for fucks sake. Americans are just completely fucking dishonest or stupid. Yes it is a FACT that the US is EASILY the worst performing industrialized country re the supply of doctors. Further, our system is completely skewed against supplying the doctors that 90% of the population actually needs for most of their life.

                We have specialists – but not primary care doctors. Here in Denver there are 350 or so true general practice primary care doctors. Most of the doctors who are called ‘family/general practice’ are actually internal medicine specialists (500 of them in the county). 340 of them are not open for new patients. Of those 10: 2 are over-65 (when will they retire?), 2 are Vietnamese in a Vietnamese part of town (not near me), and 5 of the remaining 6 are directly part of a hospital (so not independent). Good luck finding a primary care doctor if you are just a family moving to Denver. I can get an appointment with a primary care doctor in Thailand faster than one here. And Denver County has one of the better supplies of doctors in the US.

                And it ain’t the gummint that is restricting residencies. That is a PRIVATE non-profit (ACGME) run/owned by all the professional guild groups and med schools and providers. If you think they would just go away – or be competed away – if gummint were to simply disappear tomorrow, then you are deluded.

                1. As an aside – our entire medical training system is based on the Flexner Report – issued in 1910. The AMA and the Carnegie Foundation drove that. The federal govt has essentially done nothing to restructure any part of that. In large part because of opposition from those provider/cronies.

                  Hell govt doesn’t even structure medical training for that part of the population that is EXCLUSIVELY covered by Medicare. The US has as many geriatricians as Denmark (population – 6 million) – and their number is DROPPING each year while the number of retirees grows.

                  1. +1 to both Ride ‘Em and JFree

      3. hey I love safety features….as long as they are optional 😀

    2. “But so are ‘market advocates’ who want to ignore everything about current reality cuz hey boobjobs prove everything can work out well.”

      So showing the market works pisses you off?

  25. How much do Californians spend on insurance and healthcare now? Shouldn’t this be considered? If the state took what is currently spend in the form of taxes and set up a single-payer system, would the efficiencies of new system enable full coverage for all Californians. It seems the article left out obvious considerations.

    1. Eric didn’t make this terribly clear, but the analysis showed that a single payer system would cost $400B annually, and that California currently spends about $200B annually of public money (federal, state, and local) on health insurance service, meaning they’d need to come up with an additional $200B in revenue. This would be offset somewhat by saving employer the $100B to $150B they currently spend on insurance for their employees. Net total healthcare spending up $50B to $100B.

      1. And assuming the total cost estimate is remotely accurate.

        BTW isn’t Cali sniffing around DC looking for a bailout with their ‘light rail’ project? Something about running way over budget….

    2. There will not be any ‘efficiencies’. That is nothing more than the propagandizing of ‘no actual reforms are necessary’.

      Either make a case for exactly how the medical system needs to be reformed – or you are part of the problem.

      1. “Either make a case for exactly how the medical system needs to be reformed – or you are part of the problem.”
        Of course, if those reforms proposed don’t involve expanding the state’s responsibility for regulating and paying for medical services, you’ll probably just ignore them.

    3. Per capita healthcare spending in the US is over $10,000. $400 billion to cover 40 million is $10,000 per capita. Based on the limited information I have the cost of California’s single payer plan is not significantly different from what we currently spend.

      The thing is that it doesn’t really matter if we reshuffle the paper trails or not. What we really want are for Americans to have access to the healthcare we need at a lower cost. I would gladly pay more taxes if, at the end of the day, single-payer was showing that I have more money to spend on things that aren’t healthcare, assuming service levels are similar of course. Total costs don’t change noticeably so, at the individual level, there is no reason to want to see this system.

      The major benefit to this plan is that the 8% of Californians that don’t currently have health insurance now have access to medical care. If the cost estimates are correct I see no reason why we wouldn’t want to expand the number of people who have access to healthcare by nearly 3 million. The trouble is that government cost estimates are far too low, far too often. I could easily see the per capita cost jumping to $15,000. We don’t want that.

      Our primary problem with per capita healthcare costs is not the payment system though. Our real issue is a supply shortage. I would much rather focus on removing the trade guild inspired market restrictions that created this shortage.

  26. the analysis of the health care proposal presented to lawmakers on Monday suggests a 15 percent increase to the state’s payroll tax to provide the necessary revenue.

    Colorado voters rejected a proposed single-payer system in 2016 when faced with the prospect of increasing payroll taxes by 10 percent to meet the estimated $25 billion annual price tag.

    the Colorado payroll tax increase was more than 200% and it looks like the California proposal is 150%.

  27. I applaud this move. This will finally push out the employers out of this state and then I will be able to move to someplace else.

  28. How does this compare with how much is spent on insurance?

    How long are the lines going to be with no copay?

    1. Per capita spending is roughly the same as the current mess. Almost 3 million more people are projected to be covered so, for total care provided, we should get roughly a 10% drop in costs.

      To my knowledge nothing is being done to address our severe doctor shortage. 8% more patients means that waiting times should increase by at least 8%. As most of the uninsured with have complications from untreated injuries or illnesses we expect that wait times will increase by far more until those issues have been dealt with.

      This assumes the cost projections are accurate which is a big IF. There are far bigger cost reductions to be had by regulatory reform. One of these includes ensuring more doctors are trained. I prefer to wait to expand coverage until we have more doctors to provide the care.

  29. Pretty slanted article here.
    1. This article makes no mention of how much the private health insurance companies suck out of California and the fact that this would be a savings that would counterbalance the expense of single-payer.
    2. So single-payer works in every other major wealthy industrial country but it can’t work in the richest of all the wealthy industrial countries?
    I call BS !

    1. Your second point’s first portion is a fact not in evidence.

    2. Single payer works in other countries for a myriad of reasons, not just because one entity pays the bills. It would never work here, because those who oppose it still have powerful political power. And those who favor it actively oppose the other factors that cause it to work.

      Article isn’t slanted, it showed what states would have to pay and they decided not to pay it. Bing bang boom.

    3. “Single-payer” doesn’t exist except in Canada and the UK. But like all American progs, you are too fucking stupid to know how other systems actually work – and too dishonest to give a shit since the purpose here is to buy votes not fix healthcare.

    4. “So single-payer works in every other major wealthy industrial country…”
      That’s debatable. Most of the countries you think have single payer systems don’t, and what makes you think the ones that do actually ‘work?’ People love to cite life expectancy as though it were actually reflective of quality of medical care in a country. But it isn’t. It’s more reflective of how fat your citizens are and how much they drive cars and kill each other and commit suicide.

      1. Life expectancy data easily corrects for ‘non-medical’ type deaths – and can also separate the easy stuff (reduce childhood deaths) from the difficult (extend life for adults).

        And – for adults – life expectancy is highly correlated with availability of PRIMARY CARE doctors/treatments. Specialists are, generally, useless for life expectancy but highly correlated with spending. And the US system is geared towards driving primary care into irrelevance while giving specialists free rein to leech. THAT is why we spend so much, overutilize irrelevant stuff, and have the same adult life expectancy for most of our population as the better-off Third World.

    5. 2. So single-payer works in every other major wealthy industrial country but it can’t work in the richest of all the wealthy industrial countries? I call BS !

      We could have universal health care like “every other major wealthy industrial country” does: a basic health care system for all with limited coverage, limited payments, limited service, and long wait times, with mandatory contributions from the middle class to meet costs. We could have that today by reforming Medicare/Medicaid and reusing its current budget more effectively.

      What California and the Democrats propose is luxurious medical coverage paid for magically by deficits and “the wealthy”; no other country has that because it’s insane.

    6. Even if you were right our DoD spending would still get in the way of single payer without a lot more theft, I mean taxation.

    7. Read the Ross Report on the British system and then tell it works. It mentions ER patients dying because of the lack of doctors.

  30. and illegals will be covered… ROFLMAO!!!!

    yea they think they got a lot of illegals now? Christ in 2 years the state will default with the flood of illegals.

    1. If they are going to cover illegals then who would pay for insurance in any surrounding state? Hop into cali, it’s free!

      1. That’s why California Democrats want single payer at the federal level.

  31. Missing from the article;
    If you like your doctor, you can keep him. Period.
    If you like your insurance, though, you get what I say. Period.
    There will be an amendment prohibiting health care workers from moving out of state, and wage and price controls will be implemented.
    The people who model global warming will be hired to determine future prices.

  32. but unlike state governments that are required to balance their budgets annually, a nationally single-payer system would just be added to the federal government’s ever-growing tab. That’s not necessarily better, but it would offer something of a solution to the problem of how to pay for a hugely expensive new entitlement

    I don’t see mushrooming federal debt as a “solution” to anything.

  33. Consider, too, that the cost projections are only for the immediate future. Anyone with low income and high healthcare costs will move to California and anyone who thinks they are overtaxed for what they get in healthcare will leave. Individuals generally make economically rational decisions in their own personal best interests. This is a recipe for a death spiral.

  34. Yeah, would that be enough to inject a dose of reality (however small) once in a while and keep the waste down to a dull roar?

  35. My take-away is that looter parties sold Vermonters a communist governor, his socialized plan went bust, so 52% of those same idiot voters pulled the single lever back to “the” other choice: a nationalsocialist prohibitionist. The cylindrical walls on their Venn diagrams are evidently higher than the average Vermonter’s IQ can scale. Hope lies in the knowledge that if a fifth of the non-brainwashable 25% (identified by the Solomon Asch experiment) can be induced to vote libertarian for their own freedom, the looter parties will–because they always have–trample each other to repeal coercive legislation and the economy will blossom.

  36. Brown’s freeloaders are lining up at the border now, awaiting passage of a free health care for all system.

  37. The trick is to cap the plan and let competing insurance companies work on keeping costs down.

  38. ‘A single-payer system at the federal level would have the same fiscal problems, of course, but unlike state governments that are required to balance their budgets annually, a nationally single-payer system would just be added to the federal government’s ever-growing tab.’

    1, WRONG. Unlike state and local governments, which do use “other folk’s money” (i.e. taxes), the federal government creates dollars, out of thin air, every time it pays a bill. It does not use tax dollars and cannot run short of dollars. Period. It can pay ANY debt denominated in dollars w/o taxes & w/o borrowing. (Federal govt has a set network of banks/dealers that will ALWAYS buy US federal debt-basically a “fixed” market…oh, the horror!)

    2. ‘…federal government’s ever-growing tab.’ EB, you mean GROWING bank savings deposit balances at the Fed. Growing bank account balances at any bank BURDEN ABSOLUTELY NO ONE. Especially those growing savings account balances @ the world’s largest, most powerful & safest bank -the Federal Reserve Bank of the United States. Why no burden? Refer to point 1.

    3. INFLATION…if real resources are available from sufficient (public/private) investment, then inflation will never be problematic-plus the federal govt has a 100% ability to set inflation at any level it desires.

  39. Uh gee, if employers are not paying for employee’s health care, then maybe that money, along with a similar amount for folks not covered by an employer, could be used to pay for this?

    I relish the day when the Republican Party – and folks politically aligned with Reason – throw in the towel and support Medicare-For-All/

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