Health care reform

State-Run Single-Payer Health Care Would Be Prohibitively Expensive—and Possibly Illegal

Would the Trump administration give states permission to pursue government-run health care? That's what California and New York would need.

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Stephen Boitano/Polaris/Newscom

State lawmakers in California and New York voted this year to pass state-run single payer health care plans, despite the fact that both states would need to double their existing tax revenue to pay for the new entitlement.

Both proposals have cleared one legislative chamber—in California, the state Senate; in New York, the state Assembly—and still need further approval before they can become law.

But even if those political hurdles are overcome, and even if the two states figure out how they are going to come up with the necessary tax revenue—about $400 billion in California's case, and somewhere between $91 billion and $225 billion in New York's—to make those systems functional, both may run into another problem: The whole thing could be against the law.

"Technically, it would be illegal for a state to set-up a single-payer health care system without getting permission from the federal government," says Gail Wilensky, a health economist who worked in the George W. Bush administration and now serves as a senior fellow at Project HOPE, an international health foundation.

That permission, granted by the Department of Health and Human Services in the form of a waiver, would allow states to repurpose federal funds for Medicaid or Medicare, for example, into a newly established state-run health care system. Wilensky told Reason that there's no reason to assume the federal government would block single-payer plans, but not all waiver requests have been granted in the past and politics are sure to play a role in how the Trump administration would handle such a request.

California's single-payer proposal, which cleared the state Senate with a 23-14 vote last week, contains language instructing the state "to work to obtain waivers and other approvals" for California's medical assistance program (Medi-Cal, which is partially funded by Medicaid, the joint federal-state insurance program for the poor), the state's Children's Health Insurance Program, and the federally funded health insurance exchange program established as part of the Affordable Care Act. Getting those waivers means "any federal funds and other subsidies that would otherwise be paid to the State of California, Californians, and health care providers would be paid by the federal government to the State of California and deposited in the Healthy California Trust Fund. That trust fund would become the literal "single payer" for all Californians.

To get those waivers, California would invoke Section 1332 of the Affordable Care Act, which remains the law of the land for federal health care policy until and unless Congress repeals it. Under that provision of the ACA, states are allowed to request waivers "to pursue innovative strategies for providing their residents with access to high quality, affordable health insurance," as long as they met the basic standards outlined by other parts of the ACA. Under the terms of the federal health care law, waivers could not be granted until 2017 and are only good for five years, although they can be renewed.

Guidance documents issued by CMS regarding the Section 1332 waivers say the Department of Health and Human Services and the Department of the Treasury are "interested in working with states on Section 1332 that would lower premium for consumers, improve market stability, and increase consumer choice."

Depending on how the feds choose to look at it, a single-payer proposal might fail to satisfy those intended goals. While California's proposal would lower premiums (by abolishing them altogether), it's unclear whether destroying the state's private health insurance market would count as improving stability. Further, it is difficult to argue that a single-payer system would "increase consumer choice," since the only choices provided by the Healthy California Act would be to accept government-run health insurance or to leave the state.

Wilensky says the Trump administration could take a more expansive view of waivers to let states out from under some Obamacare regulations, but whether that permissive approach would extend to waivers for single-payer systems like those proposed in California or New York will remain unknown until a state asks.

Beyond the obvious reasons—HHS Secretary Tom Price is no fan of single-payer health care and would be able to block a waiver proposal if he wanted—there's plenty to suggest that the Trump administration would be skeptical of plan's like the one being crafted in California. For example, the fact the Healthy California Act would provide health coverage to undocumented immigrants. Writing at National Review, Austin Yack says that provision of the plan makes it "especially unlikely" federal officials will look favorably on California's waiver request. In a review of single-payer legislative efforts in several states this weekend, The New York Times similarly conceded that getting federal waivers "might be difficult with Trump appointees running the Department of Health and Human Services."

In general, the Times concluded, "state and federal single-payer proposals appear mainly to embody the sweeping ambitions of a frustrated party, rather than to map a clear way forward on policy."

The legal issues are the most important, but it's worth noting that states have little hope of being able to pay for a single-payer plan without getting a federal waiver—or, rather, they have even less hope of paying for it without them.

Again, California's proposal is instructive. A new analysis released last week by researchers at the University of Massachusetts-Amherst suggests that California's single-payer system would cost about $400 billion annually.

The study's authors say that considerable cost savings would be achieved through efficiency, but there's good reason to doubt that a government-run system would be more efficient than a private one. Even if the state somehow achieves those efficiencies, however, it would need to come up with about $330 billion. The majority of that total, according to the Amherst analysts, would come from repurposing existing federal health care funds.

"Assuming the state is successful in obtained these waivers, these funds will provide $225 billion in funding for the state's single-payer program," the Amherst analysis estimates.

With the waivers granted and repurposed federal funds flowing to the Healthy California Act, the state would still be facing more than $100 billion in tax increases to pay for the rest of the single-payer plan. Without the waivers and accompanying federal cash, the plan would be even more prohibitively expensive and would never have a chance of becoming reality.

That's a lesson one state has already learned. Vermont experimented with single-payer health care, but ultimately abandoned the project in 2014 because it was too costly. The legislation passed by the Vermont legislature and signed by Gov. Peter Shumlin instructed the state to seek a Section 1332 waiver, but the state never got far enough down the road to begin that process.

California and New York are both one step away from following Vermont down that path—and both will likely discover that the costs are similarly too high. The waivers might be the ultimate stumbling block, but hardly the only one.

Wilensky says the debate over the waivers is secondary to the bigger questions about the future of health care in the United States, and how we pay for it. Will people support health care proposals that come with massive tax increases? Will they give up the right to make their own choices about their health care?

"At the end of the day," she says, "it's really a question of whether people in states will give that much power to the state government to make those decisions."

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  1. Yup. Thanks to ObamaCare and the other federal bloat programs Medicare and Medicaid, state law for medical care would be pre-empted by federal law.

    1. I’m making over $7k a month working part time. I kept hearing other people tell me how much money they can make online so I decided to look into it. Well, it was all true and has totally changed my life.

      This is what I do… http://www.webcash10.com

  2. Do it! Grant the waivers! Don’t save these states from themselves. The waiver should read explicitly that the states will not receive one dime of funding from the federal government over what they already do for health care. No bailouts, etc., when the plans fail.

    1. I’m with you. Let them be the warning to the rest of the US.

      1. Agreed; If NY and CA can’t win at socialized medicine, nobody can!

    2. Of course there will be bailouts when this clusterfuck collapses. What makes you think for one second that there won’t be bailouts. We bail out private banks for fucks sake. We are put in a position where we need to oppose California and New York’s internal legislation because everyone else in the country is going to be 1. On the hook to pay for it in the first place, and 2. bear the liability for bailing them out when it fails. If you think 45-100% increases year over year in healthcare costs was bad, just wait until these two states start bleeding us.

    3. Yes, let the states experiment with this doomed plan. Vermont was too small an example, we need a huge failure to make the point. I want to get to where I almost feel sorry for the people of those states for making such a stupid decision. Almost Venezuela sorry.

      1. You think people will actually learn something from the failure? You have a much higher opinion of my fellow idiot Californians than I do.

        When it fails, the reasons will “actually” be one of the following:
        *Because Republican obstruction. (or Drumpf/Boosh/Tea Baggers/popular SJW catchphrase of the day)
        *Because evil rich white people. (specifically, Kochtopus)
        *Because not the right top men.
        *Because it wasn’t really single payer even though we said it was before.
        *Because market failure! (see above)
        *Because they didn’t socialize hard enough.

        Therefore, we need to do it again! And harder this time!

        Like a broken fucking record.

      2. Could you please point to any existing examples of a healthcare system you might prefer? And could you state what the objectives of such a system should have? And could you please describe what should happen to people who can afford, but choose not to have health insurance under any given system?

        I can provide at least 10 that you characterize as “socialist” that do:

        Germany, Sweden, Netherlands, Belgium, Denmark, Switzerland, Austria, France, Canada, and even UK.

        Please provide comparative metrics and sources that publicly and comprehensively describe collection and analysis methodologies.

    4. Hey. CA already fucked me over by issuing driver’s licenses to anyone without proof of identity (illegal aliens to some, undocumented to others).

      I had to go renew my passport just to be able to board a continental flight. My CA DL will soon be worthless as identity, even in my own country.

      1. …just another whiner.

  3. To be fair California already pays like 250 billion in taxes for health care and this would replace that. And Californians buy insurance through employers and on their own for like $170 billion. So given a reduced personal expenses for just supplemental plans it could be a wash. Now realistically it’s probably closer to $800 billion as history shows these estimates are always absurdly low and it doesn’t change the ethics of government control and extra taxes.

    1. As someone who lives in a single-payer state for liquor (PA), I can tell you that a government health insurance monopoly will be spectacular! The customer service alone will be epic.

      1. I think that’s “single-seller”.

        1. Single payer liquor might be kinda awesome.

      2. Could you please point to any existing examples of a healthcare system you might prefer? And could you state what the objectives of such a system should have? And could you please describe what should happen to people who can afford, but choose not to have health insurance under any given system?

        I can provide at least 10 that you characterize as “socialist” that do:

        Germany, Sweden, Netherlands, Belgium, Denmark, Switzerland, Austria, France, Canada, and even UK.

        Please provide comparative metrics and sources that publicly and comprehensively describe collection and analysis methodologies.

      3. Hey, I’ve been to states that have state run liquor stores and had to buy a bottle of wine BEFORE going to restaurant and then pay the restaurant a corkage fee to open the now-legal bottle I brought with me.

        That kind of crap just ain’t so funny when you have to live it. It’s enough to make a drinking progressive into a die hard libertarian!

    2. “To be fair California already pays like 250 billion in taxes for health care and this would replace that”

      Cite?

      1. California’s total governmental budget isn’t even $250 billion, so it’s safe to say this guy is talking out of his ass

        1. Yeah, I found this: http://lao.ca.gov/Publications/Report/3612
          “The Governor’s budget proposes $19.1 billion General Fund for Medi?Cal.”

          And I was waiting to see if the $250Bn included, oh, the costs of running ant-smoking ads or some such.

      2. Total General Fund as of 2016 totaled $117 billion.

        http://www.sco.ca.gov/Files-ARD/CAFR/cafr16web.pdf

        Page 42

      3. Perhaps he’s referring to the total amount Californians pay for health care, health insurance, and taxes (including federal) that go to medical care.

    3. And Californians buy insurance through employers and on their own for like $170 billion.

      Protip: people don’t want to give up their employer insurance premiums and sign up for public welfare.

      1. There’s the real nut of it. Many people have the opportunity to pay for high quality heath coverage, this is a major downgrade for them. Ironically, in CA and NY most of them voted for these clowns that are trying to force them onto the public rolls.

      2. I have a couple of million dollars in retirement investment accounts. I live in CA. You’d think I could easily retire.

        But, I’m working until I’m 65 to maintain my employer paid for health care insurance premiums. My employer’s cost for my wife and I, for an HMO plan, is $2,000/mo. That is a cost I would face if I retired now, at least until Medicare age. That’s also more than any house payment I’ve had in my life! And, it’s especially expensive in this time of low yields on investments.

        I have noticed that an awful lot of young people who’ve never considered the cost of health care because they are young and relatively healthy and, because their employer pays for their healthcare and they never really see a bill, are ignorant of this reality.

        I’m literally at a point in life where I work for health care. As will be many others in my generation as this reality sinks in.

        1. Same for me dude. Same for every poor sucker ‘Murrkin.
          As will be forever in ‘Murrkah unless we ditch the nonsense about “freedom” meaning I don’t have responsibilties and “fairness” only for those pulling down $800K/year and those inheriting >$5mm being able to dodge all taxes and corporations hiding their money in tax shelters and paying congress for all kinds of goodies and privatizing everything so all the above get to enjoy their fruit of their greed.

          Or, you could move to Canada, Germany, Sweden, Denmark, Austria, Switzerland, Netherlands, Belgium or France.

  4. the Healthy California Trust Fund

    I can see where this one is going already. I’m sure there are controls in place to make sure the trust fund is in some sort of lock box to make sure the funds are only spent on healthcare. You know what would make people more healthy? If there wasn’t so much pollution, like from so many cars on the road. If California had a high-speed train system, that would mean fewer cars and less pollution, so funding a high-speed train system is really a healthcare expense, right? Unless there’s a provision that any excess funds can’t be spent or loaned out but must be invested, in which case what better investment could the fund make than buying bonds from the high-speed train project?

    1. so funding a high-speed train system is really a healthcare expense, right?

      I assume you’re joking here but this argument has already been made. It was made with a spectacularly failed and corrupt bike-sharing system, claiming that once everyone was riding bikes, the city and the state would save hundreds per head on healthcare costs because of all that exercise everyone would be getting.

      1. It is amusing that no one ever includes the costs of bandaging-up all those bikers knocked on their asses while running stoplights.

        1. Those injured cyclists’ BMI has never been lower, tyvm.

      2. You say spectacularly failed. That implies that what CA spends on ped-bike programs has ended.

        As a public employee involved in transportation in CA I can tell you truthfully, that isn’t so. We are still saddled with laws and regs that require an equivalency of expenditures on bike and pedestrian facilities for every dollar spent on streets and roads. To be “fair’ of course. And yet, the number of people walking or riding bicycles continues to drop! No one even lets their kid walk to school anymore! Instead, a thousand cars converge on the school at bell times to drop off or pick up little Tommy or Irene and the parents get in fights, have accidents an constantly approach municipal and school administrators about providing better auto access at the school.

        We live in completely illogical times.

    2. And all the state workers who retired at 50 will be healthier if their pensions are fully funded….

      1. Actually, I own two homes in two different cities in CA and there are lots of retirees walking around the block in both communities. And, sure enough, they are all 50 something public employees enjoying their retirements.

        I keep saying a civil war is coming when the private sector workers trapped into working until their sixtyfive are going to up and rebel against all these freeloading, retired at fifty with health care coverage for life, public employees.

        1. It’s true that many state and municipal employees (most of all police and fire) got gold-plated retirements. This is due largely to the financing of these entities’ budgets: private debt rather than local and federal taxation. And fairly distributed taxation (fair = to whom the most benefit of the system, from them is most owed). The system of public finance in ‘Murrkah is a giant Ponzi scheme whose primary and most secure beneficiaries are the large investment banks providing this “service”.

          But it seems you’re saying ‘murrkins are only capable of acting on their envy and resentment by worsening the lives of others rather than trying to improve theirs?
          Yes, I agree.

          But, we have that already. It’s called the Trump voters. Joined by and preceded by all the fools that fell for the frauds perpetrated by tea-party-tunists and libert-ideologues.

          If the way you think society should operate is as a pure zero-sum game, well, ‘murrkah will look a lot like a South American economy and society.

    1. Eric had to hide his Bernie sympathies in alt-text.

  5. It’s kinda cute that you think something being expensive and illegal would slow down a Progressive.

    Adorable, even.

    1. Those conservatives are all about legality and fiscal responsibility, too.

      1. Yeah, but… I had something for this…

      2. I like your screen name

      3. Thankfully we have niskanen to show us the one true way.

    2. Could you please point to any existing examples of a healthcare system you might prefer? And could you state what the objectives of such a system should have? And could you please describe what should happen to people who can afford, but choose not to have health insurance under any given system?

      I can provide at least 10 that you characterize as “socialist” that do:

      Germany, Sweden, Netherlands, Belgium, Denmark, Switzerland, Austria, France, Canada, and even UK.

      Please provide comparative metrics and sources that publicly and comprehensively describe collection and analysis methodologies.

      1. Who’s footing the bill?

  6. So, how do they move over the money currently being paid for insurance by employers and employees? Do they demand employers just pay the government what they were going to pay the insurance company? Or do they impose a new business health care tax instead?

    This is going to be fun to watch in a Schadenfreude way. Pretty soon living in California will mean turning over 100 percent of your paycheck to federal, state and local government. And life will be a shimmering, verdant Eden.

    1. It’s just money, don’t be so greedy.

    2. “So, how do they move over the money currently being paid for insurance by employers and employees?”

      Floated ideas:

      15% payroll tax
      2% tax on all business REVENUES
      increase taxes on all business by 2%

  7. That picture is adorable. Looks like every single old man in the universe with a hard candy. It almost makes you forget he’s Bernie 🙂

  8. It is amazing to see progies suddenly see the value in federalism. (I know that it is entirely utilitarian, but it is fun to watch)

    1. As you say, this is a clear attempt by Taxifornia to grab federal healthcare money when ObamaCare goes belly up or is finally repealed. Their hope was to incorporate Medicaid and medicare money to pay for their single-payer.

      1. Still probably won’t cover the tab, all the same. Especially considering that they are neck deep in unfunded mandates already.

      2. Can you please comment on the comparative employment, economics and well-being of Californians compared to other states? Please start with your preferred example of Kansas?

        1. I can. I live here. It’s not the paradise you seem to think it is.

          We ain’t in Kansas anymore Dorothy.

          1. Oh. I see. You didn’t understand that complex question.
            Let’s see if repeating it helps:

            Compared to where?

            Here’s some further help: compared to most OECD countries, yes, anywhere in the USA is going to suck.

            Some further help: for instance, that you are staring at your navel and are unhappy with it does not necessarily mean that there aren’t better or worse navels. You may look up and around and discover that you have the best navel or the worst. Or maybe just average. Your view of it as “not paradise” is the usual navelology that nearly all “libertarian”/conservatives practice. I advise reading up on empirical method and share with your like-minded friends and relatives. It will substantially raise the level of discussion and possibly, by using it, speak the same language as us democratic socialists.

          2. Oh. I see. You didn’t understand that complex question.
            Let’s see if repeating it helps:

            Compared to where?

            Here’s some further help: compared to most OECD countries, yes, anywhere in the USA is going to suck.

            Some further help: for instance, that you are staring at your navel and are unhappy with it does not necessarily mean that there aren’t better or worse navels. You may look up and around and discover that you have the best navel or the worst. Or maybe just average. Your view of it as “not paradise” is the usual navelology that nearly all “libertarian”/conservatives practice. I advise reading up on empirical method and share with your like-minded friends and relatives. It will substantially raise the level of discussion and possibly, by using it, speak the same language as us democratic socialists.

  9. I will concede the theoretical possibility of any government-run system being cheaper than the free market system it replaces, given that it exactly reproduced the existing mechanics but eliminated the markup for profit, R&D, marketing, etc.

    But that government system will fall further and further behind market based alternatives, given that same lack of profit motive, the elimination of R&D, the loss in mind share due to elimination of marketing, and the general malaise and drop in morale from working a stagnant job at a stagnant organization. It might take 5, 10, 20 years, but eventually the gap between static government system and reality will grow so big that alternatives will arise, will be funded, will be cheaper and better, and will reduce the demand for the government system so much that its original design will be shown as the moribund crap that it always was.

    1. I will concede the theoretical possibility of any government-run system being cheaper than the free market system it replaces, given that it exactly reproduced the existing mechanics but eliminated the markup for profit, R&D, marketing, etc.

      It depends how you define ‘cheaper’. If you define cheaper as: this is how much gets spent per capita on healthcare, it’s entirely possible. Probable even.

      1. Venezuela demonstrates that you can spend less if you don’t care about outcomes.

        1. Germany, Switzerland, Denmark, Sweden, Netherlands, Norway, Belgium, France, Canada, UK, Belgium… and few more.

          Unless something changed, Venezuela is not considered a developed country. However, as your remark perhaps implies and the above list suggests, the USA is something not quite a developed country as far as healthcare is concerned despite its position as an OECD member country.

      2. Pretty simple: take the existing system, even the same people and buildings and everything, reproduce it or hire them or buy them out, then eliminate all profit, all marketing, all R&D, etc.

        Cheaper. Same inputs, same outputs. But only at the instant of replacement. From there on, it’s inexorably downhill, and the government clone cannot and dare not modernize or change in any way.

        1. eliminate all profit

          But that’s the key difference that makes it impossible to “take the existing system” and just make it government-run and expect that to reduce costs.

          Once it’s government-run, the people working for the system no longer have a motivation to work efficiently or capably. There is no longer incentive to improve anything, and there isn’t really even an incentive to perform the basic function. The incentives become all about avoidance and blame-shifting.

          Therefore, any “efficiencies” associated with having the government run something evaporate immediately in losing the profit motive.

          You just can’t have the benefits of free market competition without free markets. Not even theoretically.

          1. That’s my friggin point! State stuff only “works” in static society. The slightest change and it falls apart. The corollary is that the State has to try to maintain the status quo precisely because it can’t cope with change.

          2. What we need from our health care system is high quality, low cost, widely available medical care. None of these characteristics were provided by the pre-ObamaCare for profit system. The system that TrumpCare wants to return to. The system that is the cornerstone of the free market fantasy.

            High quality medical care is provided by a system run by doctors making medical decisions, not accountants in insurance companies trying to make profits. Doctors are professionals who provide medical care both capably and efficiently in medical terms rather than in terms of profitability for an insurance company.

            For profit health care insurance companies in the US provide the most expensive model for pre-planned medical care in the world. One dollar of for profit insurance premiums provide only 80 cents of medical care. One dollar of payroll taxes for Medicare provides 97 cents of medical care.

            That the pre-ObamaCare model of for profit health insurance companies were not able to provide widely available health care is so obvious that it shouldn’t have to be mentioned. The costs of for profit individual insurance coverage was so high that the majority of Americans couldn’t afford it and progressively fewer companies couldn’t afford to provide it to their employees.

      3. There is nothing theoretical about Germany, Switzerland, Denmark, Sweden, Netherlands, Norway, Belgium, France, Canada, UK, Belgium… and few more.

        Although, not all of these are single-payer “government run” systems. Some are public/private hybrids, most notably Germany.

        All these systems are by all or a majority of healthcare and health outcome metrics superior even to the substantially improved version of ‘murrkin healthcare of ACA.

        Please provide corresponding real-world examples of systems (ideally more than one tiny one) that demonstrate any advantage or superiority over the above-listed.

    2. Profits, R&D & marketing costs will be replaced and then some by government agency skimming and overhead as funding passes from federal to state to local and then finally to the service provider.

      You think I’m kidding? Just look closely at the schemes used to fund transportation costs these days. It is exactly as I described. Everybody gets a cut along the way.

  10. Again, California’s proposal is instructive. A new analysis released last week by researchers at the University of Massachusetts-Amherst suggests that California’s single-payer system would cost about $400 billion annually.

    I still say that cost estimate is light. Very light.

    1. Yeah, but they can cover those costs with savings from the bullet train build-out being under budget, and excess earnings from the state pension plan investments.

  11. A state-run single-payer health care plan is a terrible idea, but there’s no way it’s against the law. Check the Constitution. Powers not granted to the federal government (and socializing the health care industry was not) are reserved to the states.

    1. I don’t think Chief Justice Roberts as already spoken on this.

    2. That’s not the point he was making- the subtitle is not very good. The point is that CA needs federal money to do it. It can’t raise the money itself. So it needs to go ask the federal government to give it the money via Medicare and Medicaid waivers.

    3. The “cascade” effect of a SCOTUS ruling in that direction – making all the shit the federal government does, that isn’t in Article 1, section 8, illegal – would cause chaos throughout the nation.

  12. If a waiver is approved, it should stipulate that the federal funds that are provided must first be used to pay for anyone wanting to move out of state to get real healthcare.

    1. How about anyone paying for their own health care, whether by insurance or out of pocket, doesn’t have to pay any taxes to support any government system?

      I’d be real happy with that as a general principle. No government program can be a monopoly, and anyone paying for a private alternative does not have to pay to support the government version.

      I’d also be real happy if I could shit gold turds for resale.

  13. As long as the state is going to pay for it and don’t get any additional federal funds I say let them go for it, their citizens will just love the doubling of their taxes.

  14. This analysis is seriously flawed. We have examples in the US of single payer health care delivery systems that are much more efficient at providing health care than the private, for profit insurance company model that ObamaCare and TrumpCare rely on for expanding health care coverage in the US. The US government, between Medicare, Medicaid, the Federal government employee health care benefits and the military’s and VA’s TriCare pays for more than 50% of the medical care in the US. Medicare and the VA’s medical care is much more efficient than the for profit model in ObamaCare and in the free market fantasy.

    One dollar of money spent on for profit insurance premiums buys just 80 cents of medical care in ObamaCare. This is the main reason that under ObamaCare the government has to heavily subsidize these premiums. One dollar in payroll taxes for
    regular Medicare buys 97 cents of medical care.

    This analysis doesn’t take these savings into account. Even if we have to pay more in taxes to support single payer our overall expenditures for health care would be less. The overall costs of medical care in the US is twice the average cost for medical care in the other developed countries. This hurts our competitiveness in international trade much more than all other negative factors combined.

    1. I’m in the industry. none of those systems could work efficiently as they do now if it weren’t for private pay. many providers would consolidate and many would go out of business. the big old infra systems in inner cities and rural communities take losses on tricare and medicaid and maybe just break even on medicare, if they are lucky. of course they have low admin. they don’t negotiate, they create the process by law, they mandate everything. whemn I’m god, shit yeah things are a little easier. the amazing thing is that their admin costs are as high as they are and that the fraud is so god damn high. it’s incredible. they just caught one single attorney last week that had stolen $300 million from medicaid.

      and you are wrong, caid, care, tricare don’t provide one iota of care, they pay for it. the VA does but it is truly dogshit. terribly inefficient, and the worst outcomes in the nation. I know the man that was asked by obama to go and fix it and wouldn’t get near that mess because of incredible progressive love for that one nationalized endeavor that is a true diaper fire and of course that makes it also utterly irredeemable.

      I’m for a single payer (+ private supplemental), but you sound like a utopian or someone confused or in this buisness of dissembling. single payer will suck in many ways but it has a good chance to arrest medical inflation which is the real killer.

    2. the VA’s medical care is much more efficient than the for profit model in ObamaCare and in the free market fantasy.

      As long as you ignore the hundreds who died while waiting in line at the Phoenix VA

      1. And, in the case of your comment, ignore the fact that if you do not anticipate and then plan, hire and fund an expected quintupling the community you have to care for, you’ll have such problems. Please refer to the administration of GWBush for responsibility for any shortcomings or failure.

    3. ” our overall expenditures for health care would be less”

      I’ll take some of what you’re smoking.

      Your speaking to the cost of insurance applied to a static cost of actual care. Without a free market choice, the producers of health care have no incentive to control actual costs or come up with more efficient delivery of products and services. Consumers of health care will have no incentive to conserve their use of the products and services offered or of shopping around for the best deals.

      The prices of the products and services will soon rise, as they have since health care insurance came into the picture as the predominant way to pay for health care fifty or sixty years ago.

      Soon you have a worker’s paradise a la Cuba or Venezuela.

  15. As a retired CA state employee in human resources for 40 years the last thing I want is my health care insured and managed by any governmental employee. I want choice in who administers my health care coverage (UnitedHealthCare, Kaiser, Blue Shield Etc. ) i want the State employyee doing so anymore than i want a State emplyee to me my treating physician. Civil cervice employees have far too much job protection that enable mediocre performance. Much less unnsatisfactory or neglct of duties. Supervision in CA state government has always been a joke. Its even more so these days. So while letting State employees handle your car registration and drivers licence may be okay letting them put their hands on your health care is plain stupid. Unless you are in a CA prison.

  16. *Under that provision of the ACA, states are allowed to request waivers “to pursue innovative strategies for providing their residents with access to high quality, affordable health insurance,” as long as they met the basic standards outlined by other parts of the ACA.*

    Unfortunately for California Undocumented Aliens are not eligible to be covered under the ACA, that is a basic standard of the ACA. And a basic standard of California Care is the coverage of undocumented aliens. I’m not even sure California attempts to distinguish lawfully present from illegal at this anymore. It will be hard to even make the bullshit planned parenthood ‘we aren’t really spending it on abortions, just all the shit that makes abortions possible’ argument.

  17. Nope. Welcome to California. Pograms to the left. Welfare to the right. No questions asked. That just wouldn’t be fair.

  18. the Healthy California Trust Fund

    I can see where this one is going already. I’m sure there are controls in place to make sure the trust fund is in some sort of lock box to make sure the funds are only spent on healthcare. You know what would make people more healthy? If there wasn’t so much pollution, like from so many cars on the road. If California had a high-speed train system, that would mean fewer cars and less pollution, so funding a high-speed train system is really a healthcare expense, right? Unless there’s a provision that any excess funds can’t be spent or loaned out but must be invested, in which case what better investment could the fund make than buying bonds from the high-speed train project?

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  19. My reading of the situation is that Obamacare is clearly unconstitutional (when did the government get the right to force people to buy from a private entity?) but a state run, or single payer, would be allowed as the government already does similar things in defence, policing, social security etc.

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