CalCare, AB-1400 Guaranteed Health Care for All.
January 27, 2022 10:21 PM   Subscribe

Will California Create Nation's First Universal Health Care System?
California Democrats on Tuesday took their first step toward abolishing the private health insurance market in the nation's most populous state and replacing it with a government-run plan that they promised would never deny anyone the care they need.

But the proposal that cleared a legislative committee in the state Assembly is still a long way from becoming law. Assembly Bill 1400, which would create a universal health care system called CalCare, faces strong opposition from powerful business interests who say it would cost too much. And even if it does become law, voters would have to approve a major income tax increase to pay for it — a vote that might not happen until 2024.

Still, Democrats hailed Tuesday's vote for jump-starting one of their long-stalled policy goals and signaling they won't back away from a fight even during an election year. In an hours-long hearing, some lawmakers and advocates assailed a health care industry they say has benefited corporate interests at the expense of consumers.
Fight for Single-Payer Healthcare Continues in Sacramento - "In the next week, legislation that would help create a single-payer health plan in California will face a key test. The bill must pass out of the Assembly by January 31 or it's dead. The effort is being led by the state's nurses union, but opposed by the largest association of doctors. Guest: Dr. Micah Johnson, co-author of the book Medicare for All: A Citizen's Guide..." (who is worth listening to! skip ahead to 2m ;)
posted by kliuless (54 comments total) 22 users marked this as a favorite
 


A friend has been trying to get me to move near him outside Reno in CA, where he has retired to. This would be a big incentive to do so if it becomes law.
posted by maxwelton at 12:09 AM on January 28, 2022 [2 favorites]


5th largest economy in the world, right? Surely we can afford it.
posted by Mister Cheese at 1:31 AM on January 28, 2022 [10 favorites]


From the banana in the photo for scale department: When discussing 'public healthcare but just for one US state'.
There are about as many Californians as Canadians. If, as it might depending on how one games things out, CalCare provokes a competing TexMed; there are about as many Texans as Australians.
So the institutions would be of comparable sizes.
posted by bartleby at 1:50 AM on January 28, 2022 [5 favorites]


5th largest economy in the world, right? Surely we can afford it.

&

There are about as many Californians as Canadians. If, as it might depending on how one games things out, CalCare provokes a competing TexMed; there are about as many Texans as Australians.
So the institutions would be of comparable sizes.


Are two sides of the same coin since centrally funded healthcare is almost completely scale invariant in terms of affordability and management complexity beyond the very small scale. In other words, being the world's fifth or fiftieth largest economy has no bearing on affordability because costs and available funding both scale with population more or less linearly. Only per-capita metrics really matter if you're providing per-capita services.

Health care system administration complexity also doesn't really scale with size because all the critical, tightly coupled interactions are patient- or case-centric. It's not like suddenly all the cardiac surgeons in the state have to jump on a group Zoom every Friday. Most single payer systems operate their hospitals either individually or as part of regional sub-systems with little day to day interaction with the wider system beyond a funding stream and a set of rules which is basically the same way they are coupled into Medicare and insurance systems in the US. A GP practice in the UK has a standard contract to provide a service with the wider system and is actually just a private business the same way a US medical practice is... except that most independent US practices are being gobbled up into MBA-run medical groups, ironically because complying with the bureaucratic para-statal nightmare of the insurance system creates way more overhead than the simple NHS GP practice contract.
posted by atrazine at 2:28 AM on January 28, 2022 [27 favorites]


"Americans already pay a massive “tax” to fund health care, they say. It just happens to go to private insurance companies, rather than the federal government."

If there were to exist a split between the fully adequate but relatively no-frills care provided by the State-run single-payer system and the luxury add-ons covered by private insurers that's similar to what we have in Australia, then it should be possible, by virtue of scale and vastly improved administrative efficiency, to fund the entirety of the State-run system by taking a mandatory slice out of what employers are currently paying the private insurers.

This would, of course, totally fuck over the private insurers. Which, yes, I'm saying that like I think it's a good thing. Pack of fucking parasites the lot of them. And as the worst of them dry up and drop off the body politic, over time the amounts the employers pay them would decline, making business cheaper for everybody else while simultaneously improving both healthcare quality and equity across the board and making it so that nobody needs to hang onto an otherwise shitty job for no better reason than to retain access to adequate healthcare for themselves and their families.
posted by flabdablet at 2:33 AM on January 28, 2022 [28 favorites]


This would, of course, totally fuck over the private insurers. Which, yes, I'm saying that like I think it's a good thing.

I think one of the things that shocks non-Americans is the cost of prescriptions. Where I am, in the UK, the NHS is able to negotiate very low prices for pharmaceuticals as a results of being virtually the only buyer and by the buying in bulk that this implies. So having something similar would fuck the private providers but really, haven't they been fucking all the customers over for as much as they could get? They're owed fuck all as far as I can see.
posted by biffa at 3:47 AM on January 28, 2022 [13 favorites]


Funny how 90% of the quotes in the article are from people who oppose it or who have "concerns".
posted by clawsoon at 4:19 AM on January 28, 2022 [8 favorites]


I really think it makes a lot of sense to fund health care publicly, and that it benefits everyone to keep everyone healthy. I want all of my neighbors to see a doctor, or treat their conditions, as early as possible, and I don't think access should be partitioned.

Hmmm... how are people thinking about the possibility that lots of people will be motivated to move to any place with a policy like this? Is there some kind of provision to keep the system from being overwhelmed?

I've heard this point raised, and I'm pretty sure I've heard a reasonable response to it, I just can't remember what that was.
posted by amtho at 4:40 AM on January 28, 2022


Sounds like a good thing.

I don't think the size of CA is an issue, the real issue to me would be about how taxes are collected and split between CA & the US federal government and how much of that money can be directed toward financing this system.

Here's an example of the complexities that can arise. In Canada, all provinces administrate their own independent health care system which has to respect some parameters set by a federal law. So they're responsible for funding those systems usually through income/sales taxes and also significant federal transfers. This has created a weird situation where money to administrate the system is not fully levied by the provinces, and the total share of the cost of the system paid by the federal government keeps getting lower. And even if a province would like to change that share, its a federal decision and it's hard to move the needle on this even with all provinces unified in their demands.

No, due to the current political climate in the US, I'm guessing CA will not be expecting much federal assistance beyond what's already there, and will set this up to be independently financed.

Hopefully it'll happen, be a success, and make other states follow.
posted by WaterAndPixels at 4:49 AM on January 28, 2022


I'm pretty sure I've heard a reasonable response to it, I just can't remember what that was.

The reasonable response is that it's far less difficult for a government department to keep an eye on immigration numbers and plan and fund public health care infrastructure expansion accordingly than for a private sector motivated solely by profit to do so.

Once a State is as big as California, changes in population size have almost no effect on per capita health care spending, nor on per capita health care funding availability.
posted by flabdablet at 4:51 AM on January 28, 2022 [2 favorites]


Hopefully it'll happen, be a success, and make other states follow.

What we clearly need is a lot of mainstream media articles headlined "Is California's single-payer health policy proposal doomed by Betteridge's Law?"
posted by flabdablet at 4:55 AM on January 28, 2022 [6 favorites]


"If government-run health care becomes law, millions of Californians will flee the state — either to avoid the $163 billion per year in new taxes or to escape the lengthy waits for care that will become the norm," Assembly Republican Leader Marie Waldron said.
Maybe they'll flee to Australia, where we pay less tax overall than Californians and have free-at-point-of-use universal health care and don't experience lengthy waits for care unless there happens to be a raging pandemic in progress as a result of total ballsups on quarantine and vaccination availability and test kit availability on the part of our local Shit Party federal government.
posted by flabdablet at 5:01 AM on January 28, 2022 [7 favorites]


A single-payer system has been a staple of California progressive political rhetoric for decades. But it's not been easy to accomplish in a state where most people pay for private health insurance through their jobs. In 1994, voters overwhelmingly rejected a ballot initiative that would have created a universal health care system.
Interesting to think about what would happen if the policy proposals included specific language about businesses being required to pay the difference between the new healthcare business taxes and the old per-employee healthcare premiums directly to those employees as a mandatory wage increase. Net increase to cost of business: zero. Less than zero, in fact, because businesses are already required to prepare tax paperwork and would be saving admin costs on no longer needing to deal with insurers on top of that.
posted by flabdablet at 5:07 AM on January 28, 2022 [9 favorites]


I love this and I hope it works. In the same way that people should be focused on local elections rather than just national ones, it seems like the most effective way forward right now is to focus on state-level legislation. Marijuana legalization, gay marriage, and other recent successes have all started at the state level.

Not having insurance companies siphoning off a huge share of medical costs should save a lot of money. Providing care to everyone should save a lot of money and improve health. When the benefits are apparent, a lot of states are going to go in this direction.

Progressive policies are overwhelmingly beneficial to the 99%. When described neutrally, they are supported by a majority of the population. Between the Senate and the Supreme Court, the federal government is pretty hopeless right now. Let's get the change we want at whatever level we can get it (city, state, etc). Let it prove itself and roll it out from there.
posted by snofoam at 5:13 AM on January 28, 2022 [2 favorites]


A GP practice in the UK has a standard contract to provide a service with the wider system and is actually just a private business the same way a US medical practice is...

While I agree with the overall accuracy of atrazine's comment, GP structure is a little more complex than 'a private business' for a different (and saner, but not sane) series of reasons than the american clusterfuck.
posted by lalochezia at 5:14 AM on January 28, 2022 [1 favorite]


Having lived in California and in NZ (where I pay a ~10% lower marginal rate than I did in CA) the main difference I see in the way that doctor's offices work is that my current Dr's practice (6 Drs and a couple of practice nurses I think) has 1 person working behind the desk while in California a similarly sized practice would likely have 5 ish people there - why? because they spent all day hassling insurance companies to pay up - the overhead that private insurance brings is enormous (let's not forget that it's for-profit too).

The bug issue in the US of course is how to you manage the switch over from employer pays for some to taxes pay for everyone - ideally those who currently get insurance through their insurer should be given what their employer currently pays as increased income so they can pay the higher state taxes but we all know that wont really happen (and, thanks to Trump and the GOP, the feds will tax that money before you see it - employer medical is currently a tax-free benefit)
posted by mbo at 5:51 AM on January 28, 2022 [1 favorite]


I hope this can end up happening in a well-thought out way, and doesn't get so watered down during the legislative process. For us personally, not being tied to employer health care would be such an enormous thing. If California were able to show that this can work in an American context, then there would be hope for other states adopting it, whether or not it ever genuinely happened at the national level.
posted by Dip Flash at 6:41 AM on January 28, 2022 [1 favorite]


Vermont explored this, and it didn't go well. The governor leading the project kept delaying its findings, which were that it was too expensive. Reasons for that: a much older population (statistically, the older we get the more health care we consumer) and a smaller one.
posted by doctornemo at 7:50 AM on January 28, 2022 [1 favorite]


Do you think maybe, and I'm just throwing this out there, that we could tax the corporations that have offices in California as part of this to take some pressure off the middle class voters pocketbooks? Like, idk, Salesforce and Airbnb and Apple and Microsoft and Twitter and, and, and...
posted by ananci at 7:50 AM on January 28, 2022 [2 favorites]


The payroll tax increases were also too high for MA's taste.
posted by Selena777 at 8:04 AM on January 28, 2022


Something that will arise in the debate is the fact that someone can simply move to California to get healthcare. Las Vegas once gave bus tickets to their homeless to out-of-state cities that had homeless shelters, for example. Imagine a company that opens an office in California only to relocate their sickest employees, as a sound business decision. Universal healthcare relies on a universal aspect more than is realized, in order to distribute the risk. However, I would consider their plan brilliant if they had a remote option and allowed any doctor worldwide to serve a patient and order tests and medications, and refer them to the specialist.
posted by Brian B. at 8:32 AM on January 28, 2022 [3 favorites]


What would be even better is if you allowed out of state residents to buy into the California system. Premiums would still be cheaper than most private insurers, and California could likely bargain down drug prices in the way that Medicare currently can’t (by law).
posted by leotrotsky at 8:39 AM on January 28, 2022 [7 favorites]


My wife is a nurse and I’m curious why the nurses support this but the doctors oppose it.
posted by freecellwizard at 9:00 AM on January 28, 2022


Cynically, doctors likely get more kickbacks in the current system...
posted by kaibutsu at 9:02 AM on January 28, 2022 [1 favorite]


"Doctors" don't necessarily oppose it, an association of doctors does (I didn't see where the association was named anywhere, but if it's the AMA, the doctors I work for by and large consider them useless and too conservative).
posted by joannemerriam at 9:32 AM on January 28, 2022 [2 favorites]


I feel like the idea that people would migrate en masse to another state solely for free healthcare is... not super grounded in the reality of how people live and make decisions? Yes, it would be a major selling point among other factors for individuals who are geographically un-rooted or broadly seeking to relocate. But the majority of people simply aren't looking (or able) to uproot themselves around the country every time the material conditions suddenly improve elsewhere. Besides, in most contexts states are chomping at the bit to attract new blood-- some of them budgeting millions of dollars in pursuit!
posted by dusty potato at 10:27 AM on January 28, 2022 [2 favorites]


One concern I have and am curious how they will be addressing is people moving for a temporary period of time. So: you’re a Californian, but you go to school in New York (or vice versa). Do you only get the healthcare while you reside in CA, or will this provide insurance you can take to other states?
posted by corb at 10:46 AM on January 28, 2022


I feel like the idea that people would migrate en masse to another state solely for free healthcare is... not super grounded in the reality of how people live and make decisions?

We're only talking about people in dire need* and the individual decision would be made before the law even passed. Someone in their church or family would gift them the moving expenses, for example. It is the reason most developed countries aggressively restrict travel and immigration. California would be dangling a healthcare solution to millions in the US with chronic disease and who are under-insured. The question is how fast most of them would jump at the chance, knowing that the race is on to get in line before they shut the door.

*The top 1 percent of health-care spenders use more resources, collectively, than the bottom 75 percent, according to a new study based on national surveys. Slice the data a different way, and the bottom half of spenders all together rack up only about 3 percent of overall health care spending — a pattern that hasn’t budged for decades.
posted by Brian B. at 11:10 AM on January 28, 2022


One concern I have and am curious how they will be addressing is people moving for a temporary period of time. So: you’re a Californian, but you go to school in New York (or vice versa). Do you only get the healthcare while you reside in CA, or will this provide insurance you can take to other states?

Presumably you pick up a different plan when you go to another state, or if you are young maybe there is a period where you can stay on your parents’ plan. But if you plan to come back, at least you don’t have to worry about whether you can get back on because it is universal. Also, if other states start doing it they could make it easy to transfer or have reciprocity.
posted by snofoam at 11:38 AM on January 28, 2022 [1 favorite]


Once a State is as big as California, changes in population size have almost no effect on per capita health care spending

Normal changes in population size, yes. Even maybe double. But just a casual scan of this thread shows someone considering moving there. I'd be tempted. We're talking about people who don't already have the kinds of jobs that provide health coverage, so the jobs aren't hard to leave. Lots of people aren't super tethered to their local communities. And sickness? Pain? Fear of death? Inability to live life fully? Those are incredibly strong motivators -- the strongest.

I feel like the idea that people would migrate en masse to another state solely for free healthcare is... not super grounded in the reality of how people live and make decisions?

I disagree. Strongly.

I'm not saying this policy is not a great idea. I just think that the potential influx of desperate people is such an obvious probability that there _must_ be some plan somewhere for it, and I'm curious about that plan, because it seems like a super hard problem, and I want to know what top policy thinkers have to say about it. Because I'm interested in solving these kinds of problems myself.
posted by amtho at 12:21 PM on January 28, 2022 [3 favorites]


One concern I have and am curious how they will be addressing is people moving for a temporary period of time. So: you’re a Californian, but you go to school in New York (or vice versa). Do you only get the healthcare while you reside in CA, or will this provide insurance you can take to other states?

In Canada (heh, sorry about bringing that up again) most provinces have reciprocity agreements to make your coverage available everywhere in the country (limited to the care they usually cover in-province since that can vary), or will cover up to the fee they usually do if they don't have an agreement. Most provinces require a fixed amount of days or residency to consider you a resident and cover you, this explains why snowbirds will usually limit their days in the states to not lose their Canadian coverage.

So while in NY a CA resident would probably be covered for the negotiated fee in CA, which could be very different from what you'd pay in NY, so you'd need private insurance.

Although there are usually special rules for international or out of province students in Canada, so it's hard to have a good idea of how that would work.
posted by WaterAndPixels at 12:30 PM on January 28, 2022 [1 favorite]


I'm not sure there's much of a basis on which to concretely argue for or against the mass migration hypothesis without very specific expertise or some fairly sophisticated research. So I guess I'll move onward to the "and then what"... I agree that in a void, it's an interesting policy question, but in reality, it's a line of thinking that's highly vulnerable to being subverted as a cudgel against basically any regional or local idea for progress that doesn't occur on a nationwide basis at the federal level. The fact is, any universal health system presumably ought to have plans for a sudden influx of people with elevated medical needs, regardless of why-- what if there's a mass disabling event (other than the one we're all currently living through)?
posted by dusty potato at 12:46 PM on January 28, 2022


I'm mean, you just need a residency requirement to stave off basically all of that, right? That already exists for admission to state funded schools. You have to be a resident for a year to qualify. If you spend a year living and working in the state, then you should be eligible for the benefit.
posted by team lowkey at 1:08 PM on January 28, 2022 [5 favorites]


I agree that in a void, it's an interesting policy question, but in reality, it's a line of thinking that's highly vulnerable to being subverted as a cudgel against basically any regional or local idea for progress that doesn't occur on a nationwide basis at the federal level.

The danger is not by theory, but by practice. When it stumbles and is associated with companies leaving, the idea of universal healthcare is ruined nationally, and California turns rightward as a reactionary result. There are many conservative policies that race to the bottom from deregulation, now this looks like a way for some states to say to their voters, "If you want public healthcare, move to California." Regardless, it will be owned by California and conservative states will never copy it just because, dooming it nationally on that level too. I would encourage California to experiment with things that lead the way, such as less doctor gate-keeping (giving nurses, pharmacists, foreign doctors more access to patients) and finding major savings using home-based chronic case management.
posted by Brian B. at 2:31 PM on January 28, 2022 [1 favorite]


My wife is a nurse and I’m curious why the nurses support this but the doctors oppose it.

When the UK switched to its current system of low or zero cost at point of use, the responsible minister suggested he had got the doctors on board by "stuffing their mouths with gold". Essentially allowing them to continue to see some patients privately while meeting obligations to the NHS. The deal the doctors might get in any US state seems likely to have huge potential points of variation and having a better idea of what is on offer (or not accepting the first offer) is perhaps not totally unreasonable.
posted by biffa at 3:59 PM on January 28, 2022


CalCare provokes a competing TexMed; there are about as many Texans as Australians.
All right, I've waited this remark out long enough, and nobody has pointed out that a move by California towards universal care (which as a socialist I support 100%, because if states are gonna do something other than prop up the ruling class, the least they can do is look after the people whose labor makes everything possible) would almost undoubtedly result in Texas doubling down on its currently awful system of insurance, if you want to even call it that.

I had a whole grotesque train of imagery waiting on the tracks, but fuck it, what else do you really need to know? Texas will never, ever, do the right thing. It will not try to equitably compete with California; it will double down on its "business-friendly" policies that fuck workers at every turn, and if there is some pissant analogue to Californian healthcare, it will try to pay for itself by fucking the poor, not the rich.

California does this because it's good for California, and maybe it'll serve as a model for some other states- both of which I applaud. Texas, despite its size, oil money, etc., will not take its lead from California. Fuck, if anything, its reactionary response will serve as a model to similarly willfully backward states.

I hope I'm wrong about the place I've lived for so long, but goddamn, the idea of universal healthcare here makes me laugh like, I don't know, some dude in a horror movie who's seen everyone else die and knows he's next. But you know what? I'm going out tomorrow to knock doors for Molly fucking Cook, an ER nurse who represents hope in ways I thought were more or less dead here.

In conclusion, Texas is bullshit, and it will try its best to be bullshit, but it can't be bullshit forever.

Viva socialized medicine for everyone, everywhere, forever!
posted by heteronym at 6:42 PM on January 28, 2022 [2 favorites]


So while in NY a CA resident would probably be covered for the negotiated fee in CA, which could be very different from what you'd pay in NY, so you'd need private insurance.


But...this policy would also outlaw private insurance, so where would you get it? And even if you could, what is the point of requiring every Californian to get a policy that then requires them to buy a second policy if they ever want to temporarily leave the state for more than a couple of days or risk having no coverage at all? You're just setting up Californians to end up in situations where they're uninsured or under-insured where they would have been insured under the previous regime.

I think the authors of this policy mean well, but given California's implementation of... basically everything? I have extreme difficulty believing in the state's ability to create a state-run healthcare policy and system that would actually benefit most Californians.
posted by phoenixy at 6:55 PM on January 28, 2022


Wait, what? Why would Californians be uncovered just because they were out of state? The Kaiser Permanente system still pays in Alaska or Nebraska where there are no Kaiser hospitals or doctors if I need some kind of emergency or temporary treatment in those places. Why would CalCare need to be different?
posted by flamk at 7:13 PM on January 28, 2022


the potential influx of desperate people is such an obvious probability that there _must_ be some plan somewhere for it, and I'm curious about that plan, because it seems like a super hard problem

See, what you do there is you just pay for them. This is what budget deficits are for.

To the extent that any government program actually does need to be self-funding - a notion that the example of the military strongly suggests has never actually been the case - such funding needs to be measured on a time scale of at least decades. An initial influx of desperate and expensive medical need on establishment of universal health care can just be paid for with deficit funding until such time as the immigration rate stabilizes, which it will, and health care spending vs funding returns to a sustainable rough per-capita equilibrium. The thing about funding desperately needed health care for people in dire need of it is that doing so helps most of those people get better, at which point they become economically far more productive.

The only interesting economic question is whether the overall cost of health care seen by citizens and businesses under that publicly funded rough equilibrium is going to be significantly and consistently lower than it would be under a patchwork of for-profit private insurers, to which the answer from every comparable health care model worldwide is a thunderous YES.
posted by flabdablet at 7:35 PM on January 28, 2022 [6 favorites]


Also, the thing about universal healthcare is that once you've lived in a State that provides it, the idea of choosing to go back to living somewhere that doesn't becomes almost laughable. So pretty much all of your initial desperate influx is going to stick around and contribute over the long term. Immigration almost always confers a net economic benefit.
posted by flabdablet at 7:42 PM on January 28, 2022 [2 favorites]


In a hundred years, we'll pinpoint CalCare as the start of a series of unintended consequences that lead directly to CalExit.
posted by kaibutsu at 9:53 PM on January 28, 2022 [1 favorite]


All the more reason for everyone to move there immediately :)

most of those people get better, at which point they become economically far more productive

I actually worry about the environmental impact of more human "productivity" -- not that people can't work in environmentally sustainable ways, just that most people's idea of a job, and almost all good-paying jobs, are ultimately deleterious to the natural world.

Especially in a place where there's already not enough water.
posted by amtho at 6:22 AM on January 29, 2022


But...this policy would also outlaw private insurance, so where would you get it? Travel insurance, just like those of us with private insurance that only covers emergency visits out of state and want more coverage if we are going to be away from our state of residence for a while.

Also I think fears of a mass migration to California are overlooking the massive housing shortage and punitively high rent and home prices. It's going to outstrip most people's ability to afford the high cost of living.

Also, when people do move here, their taxes will go to this program too. And if they are homeless... SF already has free health care for unhoused and low income folks, and has done for decades. People *already* move here for this if they are able.
posted by ananci at 6:49 AM on January 29, 2022 [1 favorite]


In a hundred years, we'll pinpoint CalCare as the start of a series of unintended consequences that lead directly to CalExit.

It already started. The point is not about depopulation (which is good, if ethical, and the only non-hypocritical anti-capitalism, imo). Rather, the point is believing that California will profit from workers paying some late-comers tax that magically exceeds the urgent healthcare reason they moved there for. Someone is dead wrong, either the sick one who sees a golden ticket, or the pols who do local election math only. Regardless, calling something with non-fixed parameters "universal" (when sick people can freely move in at the end of their productive career, and corporations and the wealthy can freely opt out to Texas to save money) will politically backfire against the concept in ways we haven't thought of yet.

First do no harm (to one's cause) applies here. California should try something bold but less predictable to failure or political damage, such as paying half of everyone's healthcare, using it to contractually enforce price controls for everything (ie, the real problem). This productively ties care to a payment that a provider can't afford to turn down, while still allowing for some creative accounting for private insurance sources, as the system "works" now (by overcharging the privately insured to pay for the non-insured, but absurdly charging cash customers the most, and avoiding medicaid because it is a less, but final, payment). The other half of the state's payment is either insurance, federal, union, or personal. If it attracts business, and is widely adopted in other states, then the state's share can be increased down the road.
posted by Brian B. at 11:30 AM on January 29, 2022


I always find it fascinating to see the knots US Americans will tie themselves into, to explain that the US can't have the universal healthcare that literally every developed country and some developing countries already have.

Yes, I pay taxes, and in return, I get healthcare for my children and myself, my children get educations through to PhD, if they want, and stipends all the way. And the great thing is that my taxes also goes to pay for my students' healthcare and education, even though many of their parents are refugees who can't work because of PhD, or have to take low-wage jobs because of language issues. My tax money also goes into infrastructure like bridges and public transportation and sustainable energy, and into research that can improve our nation and even in some cases the world. Ooh, and I forgot sick leave and a whole year of parental leave for everyone.

And weirdly, the local billionaires still live here, and still invest in new R&D and new jobs. There must be something they like about the system...

Our corner of the world is not at all perfect, and there are many people who fear that immigrants will overburden our welfare system. But their fear is not grounded in facts. Contrariwise, we need to invite more immigrants to come and stay to keep that system going.
posted by mumimor at 12:39 PM on January 29, 2022 [3 favorites]


their parents are refugees who can't work because of PhD
Was supposed to be: their parents are refugees who can't work because of PTSD
Damn autocorrect
posted by mumimor at 1:30 PM on January 29, 2022


I always find it fascinating to see the knots US Americans will tie themselves into, to explain that the US can't have the universal healthcare that literally every developed country and some developing countries already have.

Yeah, that's a thing, along with the obviously untrue claims about how universal healthcare leads to death panels and other ridiculousness. But I'm not seeing any of that here in the comments. Mostly the skepticism being expressed is over the practicalities of having universal healthcare in just one part of a nation, rather than the normal situation where it is done at a national level. I would guess that smart people could solve most of the issues, but there is still going to be a limit of possibility when trying to find solutions at a local level that require higher level planning and coordination to actually solve.
posted by Dip Flash at 1:49 PM on January 29, 2022 [3 favorites]


Even worse case California ends up with universal single payer healthcare and there is a wave of healthcare immigration. So what? The US and California specifically is incredibly wealthy. California specifically could see a 20% drop in GDP and still be #1 amongst states. If people making $150K a year have to settle for a 20' boat instead of a 30' and Jo Blow from Iowa gets end of life care that seems like a pretty good trade off. If business transfer personnel every one is going to be able to regal the locals with stories of just being able to walk into any hospital anywhere and get care for no out of pocket cost.

I know the American Health Care Debate is incredibly fact resistant but it is going to be much harder for non Californian's to ignore the lived experiences of Californian's that it is for them to ignore Canadians or wherever. I'm telling you being able to just go to the ER or Urgent Care without worrying about paying for it in the short or long term will be such a culture shift.

Sure California will end up seeing some sick people moving there. But they'll also see artists and entrepreneurs moving in because they won't have to worry about becoming destitute from a broken leg while they are inventing the best thing since sliced bread.

One other thing is it might even end up directly benefiting people who don't live in California but can travel there for medical care. I have several friends who are or were in US-CANADA cross board relationships where the US half was able to access healthcare in Canada for way less than they could back home.

I do worry about the health of the Health and Fitness tag in AskMe.
posted by Mitheral at 3:01 PM on January 29, 2022 [5 favorites]


Sorry, I wasn't clear: CalExit isn't people leaving California, it's California breaking off from the US.
posted by kaibutsu at 3:33 PM on January 29, 2022


Mostly the skepticism being expressed is over the practicalities of having universal healthcare in just one part of a nation, rather than the normal situation where it is done at a national level.

Whether or not it's "normal", this is not without precedent, either. The province of Saskatchewan implemented its single-payer system several years before Canada as a whole moved in that direction. (And even then, this was not, and is not, a single national system, but thirteen provincial & territorial ones that meet certain requirements in order to obtain federal funding.)
posted by quizzical at 4:22 PM on January 29, 2022 [2 favorites]


It would work. Twenty years plus ago I was a homeless vagabond in good old California. Long story, don't get me started, I have opinions. The end strategy for that was bean counters punching shit up on their social worker / administrative screens or whatnot. Long opinionated story redacted We dump some funds into someone for a few months (like 6 maybe) to get them up to employed and paying taxes (CA high, other civilized places probably mediocre) and a year or two later that investment is already paid off. The bean counters have a black line bonus on investment instead of a red line loss. There's a little gold star next to your name. By now you've paid more taxes on your income to have made that initial investment in well being be a little blip.

I'll be watching for it on my eventual in the mailbox ballot.
posted by zengargoyle at 5:09 PM on January 29, 2022 [3 favorites]




The biggest hurdle is cost. A study of a 2017 proposal for universal health care in California estimated it would cost $331 billion, which is about $356 billion today when adjusted for inflation. Meanwhile, California is expected to account for about $517 billion in health care spending this year, with the largest chunk coming from employers and households, according to an analysis by a commission established by Gov. Gavin Newsom to study universal health care.

Seems like that isn't a hurdle at all and would rather save residents a couple hundred billion a year.

Former Republican Gov. Arnold Schwarzenegger twice vetoed similar legislation in the 2000s.

This I did not know.
posted by Mitheral at 6:07 AM on February 1, 2022


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