{"id":5156,"date":"2017-06-08T14:50:35","date_gmt":"2017-06-08T21:50:35","guid":{"rendered":"http:\/\/occupysf.net\/?p=5156"},"modified":"2017-06-08T14:52:10","modified_gmt":"2017-06-08T21:52:10","slug":"5156","status":"publish","type":"post","link":"http:\/\/occupysf.net\/index.php\/2017\/06\/08\/5156\/","title":{"rendered":"“A FAQ About California’s Single Payer Health Care Legislation, SB 562” by JP Massar"},"content":{"rendered":"
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Enthusiastic California nurses leading a rally at the State Capitol for SB 562<\/figcaption><\/figure>\n<\/div>\n<\/div>\n<\/div>\n
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June 7, 2017 (dailykos.com)<\/p>\n

I\u2019ve gathered together many of the questions people ask, and objections they raise, when single payer health care is discussed. Accompanying the questions are my answers: some definitive, some an admission of doubt and uncertainty. \u00a0With a few jabs and a bit of snark thrown in.<\/p>\n

So enjoy! And point your dubious friends here when they ask you any of these 50+ questions…<\/p>\n

THE BASICS<\/strong><\/p>\n

Q.<\/strong>\u00a0What is SB 562?<\/em>
\nA.<\/strong>\u00a0It’s\u00a0legislation introduced by Senator Richard Lara<\/a>\u00a0into the California legislature in 2017, designed to create a single-payer, universal health care system in the state. It would set up an organization called Healthy California to administer the program.<\/p>\n

Q.<\/strong>\u00a0Who would it cover?<\/em>
\nA.<\/strong>\u00a0Everyone who is a resident of California, using a residency requirement very similar to that of California’s current Medicaid program (MediCal).<\/p>\n

Q.<\/strong>\u00a0Including undocumented individuals?<\/em>
\nA.<\/strong>\u00a0Yes. Everyone.<\/p>\n

Q.<\/strong>\u00a0Homeless people?<\/em>
\nA.<\/strong>\u00a0Yes. Everyone.<\/p>\n

Q.<\/strong>\u00a0Health insurance company CEO’s?<\/em>
\nA.<\/strong>\u00a0Hmmm. Maybe there’ll be an exception…<\/p>\n

Q.<\/strong>\u00a0What would it cover?<\/em>
\nA.<\/strong>\u00a0Pretty much everything. Anything you’d normally think of as associated with doctors and hospitals as well as mental health services, dental services, vision, medical equipment purchases, nursing home and long-term care, and on. You can find a non-limiting list\u00a0in the legislation (Chapter 4, 100630)<\/a>.<\/p>\n

Q.<\/strong>\u00a0What would people have to pay to get services?<\/em>
\nA.<\/strong>\u00a0Zero. Zip. Nada. $0.00. \u00a0No copays, no fees, no deductibles, no premiums.<\/p>\n

Q.<\/strong>\u00a0How would it work from an individual’s perspective?\u00a0<\/em>
\nA.<\/strong>\u00a0You’d get a Healthy California membership card. You make an appointment. You present your card. You get treated. You go to a pharmacy. You get your medicine. You never pay anything.<\/p>\n

Q.<\/strong>\u00a0How would it work from a company’s perspective?<\/em>
\nA.<\/strong>\u00a0Companies would no longer have to deal in any way with health insurance, health insurance companies, self-insurance, or health benefits. It would all just go away.<\/p>\n

Q.<\/strong>\u00a0How would it work from a medical services provider’s perspective?<\/em>
\nA.<\/strong>\u00a0Logically, a service would scan your card, provide services to you, and then bill the Healthy California Trust Fund, which would process the request and send the service provider a check. \u00a0Of course the details may be different (e.g., reimbursements may be aggregated and sent in one weekly check, covering everyone treated, or sent via an electronic transfer). Most importantly health service providers would not be dealing with twenty different insurance companies’ rules and regulations, questions of coverage or denial of claims issues.<\/p>\n

There’s another way – the Kaiser way (integrated care). The legislation allows Healthy California to pay an organization like Kaiser a fixed fee per person per year (perhaps adjusted by age). It would be Kaiser’s responsibility to make ends meet from that revenue stream. In such a case there wouldn’t even be a need for billing or reimbursement.<\/p>\n

COSTS<\/strong><\/p>\n

Q.<\/strong>\u00a0What will it cost?<\/em>
\nA.<\/strong>\u00a0A guesstimate by the staff of the California Senate Appropriations Committee put the cost at $400 billion annually.\u00a0A detailed analysis<\/a>\u00a0by economists using hard data and modelling arrived at a figure of $330 billion annually.<\/p>\n

Q.<\/strong>\u00a0That’s a lot of money, even by Carl Sagan standards. How could we possibly come up with a sum like that?<\/em>
\nA.<\/strong>\u00a0In order for these numbers to have any meaning, they must be compared to what California spends now on health care per year. That’s close to $370 billion! \u00a0So the money already exists and is being used for the same purposes. No one has to “come up with it.”<\/p>\n

That $370B figure includes all money spend by the federal government in California (e.g., Medicare, Medicaid, CHIP, ACA subsidies, emergency room subsidies, etc), all money spent by the state and local governments (insurance premiums for employees, costs to keep County hospitals open, mental health services spending, etc), all money spent by employers on health insurance premiums and other health benefits, and all money spent by individuals on premiums, co-pays, deductibles, fees, medical equipment, etc.<\/p>\n

For more perspective, the GDP of California is $2.6 Trillion.<\/p>\n

\"Polin-describing-analysis.jpg\"
Robert Pollin, study author, presenting its findings at a May 31st press conference in Sacramento with California Nurses looking on.<\/figcaption><\/figure>\n

Q.<\/strong>\u00a0So depending on who you believe, it will either cost California $30B more per year or $40B less per year?<\/em>
\nA.<\/strong>\u00a0Yes. Keep in mind the smaller figure is based on a rigorous analysis by a team of academics \u2014 led by Robert Pollin. Governor Brown\u2019s former economic advisor – with extensive experience in these matters. The larger figure was a fairly quick guesstimate by competent legislative staff but was by no means a rigorous analysis.<\/p>\n

Q.<\/strong>\u00a0Why might it cost less?<\/em>
\nA.\u00a0<\/strong>Insurance companies would go away. So no more insurance company profits and far less paperwork and red tape. Fewer emergency room visits. Healthier individuals overall whose conditions are treated before they become million-dollar problems. The ability (and mandate) to negotiate drug prices with pharmaceutical companies. The mandate to negotiate fair and reasonable prices for medical services based on Medicare reimbursement rates, which are less than current private-market prices. Along with other efficiencies that can be realized once you have a non-profit, single-payer entity managing the system.<\/p>\n

Q.<\/strong>\u00a0Why might it cost more?<\/em>
\nA.\u00a0<\/strong>Higher utilization and frivolous use. \u00a0More people (everyone) covered. Possible increased fraud.<\/p>\n

Q.<\/strong>\u00a0Is there any evidence one way or another?<\/em>
\nA.<\/strong>\u00a0We know that other countries, most notably Canada and Taiwan, have single-payer systems and costs a) are much less than they are in the United States per capita, and b) they don’t have unacceptable problems with too much utilization, frivolous use or fraud.<\/p>\n

We know that Canada negotiates drug prices and gets around a 30% reduction vis a vis the prices we pay in America.<\/p>\n

We know that our existing single-payer system in the United States – Medicare – has far lower administrative overhead than private insurance companies.<\/p>\n

We know, from our own personal experience and studies, that insurance companies impose huge bureaucratic burdens both on doctors and patients.<\/p>\n

Of course we don’t know for sure what will happen until we try.<\/p>\n

Q.<\/strong>\u00a0What if the analysis is wrong and it does cost more?<\/em>
\nA.<\/strong>\u00a0We still get universal coverage, dental and vision for everyone, the elimination of medical debt, peace of mind, no more bake sales and GOFUNDme’s when someone gets sick, and more. We retain the ability to look at what’s going wrong and make the appropriate corrections, unlike the situation now, where the ACA, even if it survives, can’t be tweeked or repaired because of Republican intransigence.<\/p>\n

FINANCING<\/strong><\/p>\n

Q.<\/strong>\u00a0Where will the money to pay service providers come from? How does it get into the Healthy California Trust Fund?<\/em>
\nA.<\/strong>\u00a0California would take all the money it’s getting now from the Federal government, and all other state and local allocations for health care, and direct it into the Trust Fund. New sources of revenue (aka new taxes) will be created to fund the difference, which is approximately $100B using the study’s numbers.<\/p>\n

\"california-revenue-sources.jpg\"<\/figure>\n

Q.<\/strong>\u00a0Did you say ‘new taxes’ ?<\/em>
\nA.<\/strong>\u00a0Yes. Taxes. The same sort of mechanism that now pays for schools and roads would also be used henceforth to pay for health care. It’s radical, but the alternative is continuing to pay health insurance company CEO’s millions to pay people low wages to stamp DENIED on claims.<\/p>\n

Q.<\/strong>\u00a0What taxes?<\/em>
\nA.<\/strong>\u00a0There is no specific additional tax written into the legislation at the moment. However, the financial analysis study proposed two revenue sources:<\/p>\n