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Don’t jump on the single-payer bandwagon yet – we can’t afford it!

Uploaded: Jan 26, 2022
Toss away those Medicare and MediCal cards – they will be invalid. Forget about paying your monthly health premium rates – you will no longer be charged for such insurance. Don’t worry anymore about co-pays and deductibles. They are vanishing.

Yes, welcome to Cal Care, a new single-payer health care system being debated (sort-of) by California officials that will, if adopted, completely change the health care system for all Californians in future years.

At first blush, it sounds wonderful. But beware of the nasty details. What you now may see as a happy rose-colored future, could, well, darken and end up bankrupting this state.

First the positives of the proposed single-payer health care system for Californians:

If adopted by this state, all of us, rich and poor, will get all medical services from CalCare.

All primary care, doctor’s visits, routine checks, preventive care, hospital services and stays, all prescription drugs, mental health and substance abuse treatment, lab and diagnostic work, maternity care, ambulatory services will be provided.

But wait, as they say, there’s even more. Dental, hearing and vision coverage will be provided by CalCare. We can choose our own doctors, hospitals and other providers, in any network. No premiums or co-pays. The Golden State will even cover you in your golden years.

The list, to me, seems like a whopping package of health care goodies that CalCare will provide.

And the negatives?

Well, you will no longer be covered by Medicare. Or MediCal. The state would have to convince the feds to turn over the Medicare money they are paying for us – or the state will have to bear all the cost. And it will have to coordinate all the physicians, hospitals, clinics, health facilities et al to make sure they will accept CalCare.

The biggest problem, as in really BIG, is the cost – I’ve seen estimates at first at $163 billion a year, but this week, Los Angeles columnist George Skelton said staff estimates now range between $314 billion to $391 billion a year. EVERY YEAR.

Gov. Gavin Newsom has just introduced a budget of $286 billion for the upcoming year – without any single-payer provision.

So where’s the $314 (+ / -) billion for CalCare coming from?

Think about it.

Didn’t take long, did it. Yes, YOU and ME, the taxpayers, have to cough up the dough. And how will we be asked to pay for it? Enormous state tax hikes -- the far largest in history, one legislator said.

Some health care experts suggest our yearly state taxes will have to triple or quadruple to cover the costs for single-pay. Also, payroll taxes will experience a big hike.

So we get free medical care, prescriptions, hospital stays in exchange for lots of our money to pay not only for us , but for everyone.

Some say Europe has had government pay for health care, and it works well now. True, but it took these countries 50 years or so to refine the system. In Denmark, middle-class individuals are now taxed somewhere near the 50 percent level. Also, Europe does not have the spiraling prescription drug costs that we are encountering in the U.S.

The state legislature in Sacramento reviewed the single-payer concept this month, and as Skelton reported, a rushed- through a version of this bill (AB 1400) came before the Assembly Appropriations Committee. Without any discussion (!), it was approved on party lines 11-3. No analysis of whether single payer makes financial sense.

Maybe our legislators don’t like to disturb their handsome heads over details like that. The Assembly has a Jan. 31 deadline to send the bill to the Senate. If it gets there, and it may not, we will see if the Senate is any better at examining future expenses than the Assembly is.

To me, this whole thing is scary – scary that such an omnibus bill that offers to pay for everyone’s health care costs for years on end is even being considered without a lot more study (e.g., do the poor pay anything, including higher taxes?), and scary that our legislature is so cavalier about getting such legislation passed in a hurry.

It probably won’t get voted on this year, because it’s an election year, but next year – just watch out!

As I recall, Gov. Newsom offered up this plan late last year, but now has remained silent about it. Maybe he’s realizing that he may be creating a monster.

I have several liberal friends who, upon hearing this, said, “Yes, this is great. We need single-payer in California.”

Now that you know a little more about it, do we really? In principle, yes, but it’s not financially feasible.

Do you think Sacramento is capable of enacting such a massive program affecting all of our health care costs?

I don’t.
Democracy.
What is it worth to you?

Comments

 +   9 people like this
Posted by I+miss+my+small+town+feel, a resident of another community,
on Jan 27, 2022 at 7:51 am

I+miss+my+small+town+feel is a registered user.

Soaring crime and inflation and now it seems already high taxes will have to double... why do people here keep voting for these politicians?


 +   18 people like this
Posted by Tamika Jeffries, a resident of North Whisman,
on Jan 27, 2022 at 9:56 am

Tamika Jeffries is a registered user.

[Post removed.]


 +   46 people like this
Posted by Daniel Garepis-Holland, a resident of University South,
on Jan 27, 2022 at 10:15 am

Daniel Garepis-Holland is a registered user.

You clearly have a complete misunderstanding of the issue. The US, including employers, currently spend a total of $12,500 per person on healthcare. This is more than double the worldwide average, double that of countries with extremely high quality healthcare systems like Switzerland. All when 60% of Americans cannot afford a surprise $1000 medical bill, a common occurrence even with one who has insurance. 4 in 10 Americans have unpaid debt in medical bills. People's lives are being destroyed because of illnesses they can't control, and many do not get preventative care because they are afraid of the cost, leading to medical costs for us all down the line.

Clearly, something is wrong with our healthcare system. You cite higher taxes and ignore the fact that extremely high and wasteful healthcare costs already come out of our pockets through out-of-pocket costs and out of our salaries. And universal healthcare has worked so well in every other nation where it has been applied. Countries much poorer than us are able to provide free, quality healthcare to all of their citizens.

As usual, privileged white people [portion removed] are preventing progress in our society. Don't listen to this woman. CalCare and universal healthcare are a policy that every American should be advocating for.


 +   18 people like this
Posted by Rashaun Williams, a resident of East Palo Alto,
on Jan 27, 2022 at 11:24 am

Rashaun Williams is a registered user.

[Portion removed.]

Universal healthcare is a sign of a civilized society and America is far from achieving this lofty goal.

And why is that?

Because the wealth class perpetuates greed and does care about anybody or anything but themselves.

So what if CalCare is an expensive program as it is time for the wealthy to start paying more in support of key societal expenditures instead of always looking for ways to avoid paying taxes and shirking societal responsibility.


 +   12 people like this
Posted by Alicia Gomez, a resident of Castro City,
on Jan 27, 2022 at 11:59 am

Alicia Gomez is a registered user.

Elder home care subsidies should also be included in this package as the cost of placing someone in an assisted care facility is very expensive unless one is wealthy or can easily afford to do so.

Considering how the State of CA wastes and misappropriates taxpayer dollars (i.e. the $31B paid out to fraudulent EDD claims), developing a universal statewide healthcare system should be a fiscal breeze.

As others have mentioned, simply tax the wealthy corporations and those making more money than the average person.

Only fiscally OCD white Republicans would oppose such a measure.


 +  Like this comment
Posted by Raul Mendez, a resident of East Palo Alto,
on Jan 27, 2022 at 12:19 pm

Raul Mendez is a registered user.

[Post removed.]


 +   17 people like this
Posted by Peter Skolnick, a resident of Old Mountain View,
on Jan 27, 2022 at 1:17 pm

Peter Skolnick is a registered user.

Would CalCare coverage be accepted in other states as well?

And would those incarcerated in CA state prisons also be eligible to seek innovative & specialized medical treatment outside of county hospitals and prison sick wards?

As a progressive Democrat who supports the humanistic ideals of Bernie Sanders, Elizabeth Warren, and Alexandria Ocasio-Cortez we must move forward with this proposed concept regardless of the projected costs.

As others have suggested, the wealthy can easily cover much of these costs because the majority of them (e.g. Musk, Bezos etc.) have more money than they can ever spend in one lifetime.

Why don't these individuals put their money to good use rather than promoting sub-orbital tourism (at $250,000.00 a trip) or buying a private island in Hawaii (Ellison/Oracle)?

Excessive greed and vanity on the part of a few self-centered individuals have been the downfall of countless former countries and societies.


 +   5 people like this
Posted by Jennie Layne, a resident of Cuesta Park,
on Jan 27, 2022 at 1:48 pm

Jennie Layne is a registered user.

[Post removed.]


 +   5 people like this
Posted by Mondoman, a resident of Green Acres,
on Jan 27, 2022 at 2:08 pm

Mondoman is a registered user.

I'm really disappointed at the race-based condescension of multiple comments here. Perhaps some are just from trolls and not real Palo Altans? (one can hope)


 +   8 people like this
Posted by Benson Chang, a resident of another community,
on Jan 27, 2022 at 2:41 pm

Benson Chang is a registered user.

[Post removed.]


 +   5 people like this
Posted by Malvina Hopkins, a resident of Another Mountain View Neighborhood,
on Jan 27, 2022 at 3:22 pm

Malvina Hopkins is a registered user.

[Portion removed.]

If anything, California residents should be offered a choice between Medicare & MediCal or the CalCare program.

And whoever offers the most cost-free benefits will most likely be the program of choice.

CalCare is not a doomsday prophecy, just another costly state program of which we have many.

One more will not break the bank and I imagine that most Millennial aged citizens support the implementation of CalCare.


 +   5 people like this
Posted by Neal, a resident of Community Center,
on Jan 27, 2022 at 5:08 pm

Neal is a registered user.

We definitely need universal health care, but it must be done at the national level, not the state level. We need Medicare for all. And yes, we will have to raise taxes. In order to prevent sticker shock it should be phased in with the age of eligibility being lowered each year. For example, this year, cover people 64 years old and next year cover people 63 years old, etc., etc. At the same time, phase in higher taxes to cover the additional costs.


 +   9 people like this
Posted by Eric Filseth, a resident of Downtown North,
on Jan 27, 2022 at 7:04 pm

Eric Filseth is a registered user.

One of my old friends spent many years as an executive in the Canadian pharmaceutical industry, and I asked him once why prescription drugs were so much cheaper there. He said essentially the single point of negotiation. He told the following story, and this is pretty close to verbatim.

He said, “suppose we have a new drug. We go to market it in, for example, France, and we basically have to negotiate with the government there. We say, ‘we have this new drug, and it costs X.' And of course the French government says, ‘well, your drug sounds useful, but we only want to pay Y for it, so if you want to sell it in our country ..." And if we don't reach agreement, we can't sell it anywhere in France."

My friend said, “here's the thing. We know we could negotiate harder with the French, and we should. But usually we don't, because we know we can just charge more in the States to make up for it."

There are a lot of different approaches to universal health care in the world, and I suspect the US will get to one or another of them. But as we sift through the options, one element we ought to have at the top of our list is figuring out how to centralize price negotiations on pharmaceuticals.


 +   19 people like this
Posted by Jennifer, a resident of another community,
on Jan 27, 2022 at 7:36 pm

Jennifer is a registered user.

Whether we need universal health care isn't the issue. It's whether we can afford it. Diana is spot on. Single-payer health care died in California in 2017, and it failed in three blue states. Colorado, Vermont and Massachusetts. And the reason it failed - it's not financially feasible.


 +   1 person likes this
Posted by Mondoman, a resident of Green Acres,
on Jan 27, 2022 at 10:16 pm

Mondoman is a registered user.

@Eric Filseth
You're right that the US is basically providing the bulk of the profits to the pharmaceutical industry. However, having the US "overpay" means that more new drugs get developed than would exist otherwise (so they can be sold here). Getting rid of US "overpayment" by whatever means would mean fewer new drugs get developed. I worry that one of those new drugs that do not get developed is one that I would have needed.

The fair thing to do is to tax all the world's developed countries to provide those drug-development-motivating "overpayments" so the US is not stuck with the burden, but I'm not sure how. Any ideas?


 +   3 people like this
Posted by Sunny Storm, a resident of Woodside: other,
on Jan 28, 2022 at 7:17 am

Sunny Storm is a registered user.

Any state-wide health-care for all would have employer contributions. They wouldn't get off scott free.

I do expect states will need to start this long before the Feds are able too.


 +   7 people like this
Posted by Sunny Storm, a resident of Woodside: other,
on Jan 28, 2022 at 7:29 am

Sunny Storm is a registered user.

Proposed Funding

2.3% tax on businesses that gross more than $2 million annually in revenues
1.25% payroll tax on businesses with more than 50 employees
1% tax on businesses where employees make more than $49,900 annually.

The above replaces what businesses currently pay for employee Healthcare.

Individuals making more than $149,509 in taxable income would see an additional 0.5% tax, with the tax rate progressively increasing to 2.5% of taxable income for those individuals making more than $2.48 million annually.

Maybe the US would like to join the Developed World, rather than continue the descent to 3rd world status we are on.


 +   26 people like this
Posted by Carrie Peterson, a resident of another community,
on Jan 28, 2022 at 8:50 am

Carrie Peterson is a registered user.

As the author stressed, the idea sounds good but is it long term fundable?

Tax increases will undoubtedly be required and this in turn will exacerbate inflation as the price of countless goods & services will rise.

And deficit spending by parlaying debt off into the future is not the practical answer either.

We simply cannot afford an expansive state health care program of such magnitude.

Providing universal healthcare falls on the shoulders of the federal government and perhaps Obamacare should be revised and expanded instead.

I am also of the firm belief that those covered by any government assisted healthcare program should pay higher premiums if their health conditions are attributable to preventable diseases such as smoking, alcoholism, drug abuse and obesity.

This approach is no different than careless drivers having to pay more for their automobile insurance.








 +   5 people like this
Posted by NeilsonBuchanan, a resident of Downtown North,
on Jan 28, 2022 at 9:37 am

NeilsonBuchanan is a registered user.

This is complicated politically and fiscally. One option could be modelled after the VA, which has remarkably improved. The average citizen is not ready for this model yet, unless quality and access were better stated. Skepticism is healthy.

Starting with Medicaid the Feds could create a national option for states to include their beneficiaries. When sufficient states expressed interest in the option, then details could be ironed out. Hopefully enough contiguous states would step up for new Medicaid healthcare delivery system to evolve. Kaiser, VA and many HMOs have sufficient experience if sufficient Medicaid scale could be offered to the marketplace. For example, a special subdivision of the VA might evolve.

Medicaid is a difficult nut to crack; Medicare is easier.

Medicare has been experimenting with greater alignment of payment schemes with dedicated, accountable healthcare systems. This needs to be accelerated to match consumer doubt and expectations. Proof of concept would be significant integration for healthcare systems (ie docs and hospitals) with insurance schemes... operating seamlessly across state boundaries. This has not played out well. Even Kaiser has not achieved interstate success.

The Medicare and Medicare have partially addressed their purchasing power. I agree with Eric. Proof of concept suggests that federal and state government would exercise their purchasing power to create national price lists available to any Medicaid(MediCal) or Medicare beneficiary. This is politically feasible by having pharmaceutical companies opting out and taking consumer risks.

IMO new, constructive market forces would evolve in our very inefficient markets. When Medicare was created in the mid-1960s, some hospitals expressed interest in opting out of Medicare. When push came to shove, all hospitals opted in and continue to operate within very imperfect market conditions.


 +   31 people like this
Posted by Melinda Dillon, a resident of Duveneck/St. Francis,
on Jan 28, 2022 at 10:50 am

Melinda Dillon is a registered user.

• "I am also of the firm belief that those covered by any government assisted healthcare program should pay higher premiums if their health conditions are attributable to preventable diseases such as smoking, alcoholism, drug abuse and obesity."

Should Covid vaccination also be a part of this determination process?

The unvaxed who contract COVID are overwhelming the healthcare system and preventing other patients from receiving elective surgeries, many of which are critical to their survival.


 +   8 people like this
Posted by Online Name, a resident of Embarcadero Oaks/Leland,
on Jan 28, 2022 at 11:32 am

Online Name is a registered user.

A quick Google search shows that the US is STILL not allowed to negotiate drug prices for Medicare and other plans -- one obvious reason our drug and health costs are so much higher than elsewhere.

We've all read about the outrageous prices for EpiPens, the price gouging of "PharmaBoy" and the high prices of diabetes and cancer drugs that aren't experimental but necessary. We've all seen the price comparisons for drugs sold in the US and abroad where the US prices are many times higher.

Why not fix this obvious problem by mandating price negotiations and tell the lobbyists enough already before doing anything else?


 +   19 people like this
Posted by Ronen, a resident of Menlo Park: Suburban Park/Lorelei Manor/Flood Park Triangle,
on Jan 28, 2022 at 8:06 pm

Ronen is a registered user.

I would feel much more confident about possible a single payer if the state could figure out how to offer reasonable service at the DMV.

So long as they can't even get that right, there's no way I'm trusting them with medical care for my family. No thanks.


 +   16 people like this
Posted by Myron Stein, a resident of Old Palo Alto,
on Jan 29, 2022 at 12:12 pm

Myron Stein is a registered user.

"those covered by any government assisted healthcare program should pay higher premiums if their health conditions are attributable to preventable diseases such as smoking, alcoholism, drug abuse and obesity."

"The unvaxed who contract COVID are overwhelming the healthcare system and preventing other patients from receiving elective surgeries, many of which are critical to their survival."

"I would feel much more confident about possible a single payer if the state could figure out how to offer reasonable service at the DMV."

"Considering how the State of CA wastes and misappropriates taxpayer dollars (i.e. the $31B paid out to fraudulent EDD claims),"

In addition to the projected costs, the State of California & their duly appointed civil servant & bureaucrats are incapable of administering a proposed program as broad & potentially complicated as CalCare.





 +  Like this comment
Posted by Jim Lancaster, a resident of another community,
on Jan 29, 2022 at 1:20 pm

Jim Lancaster is a registered user.

As a CA expatriate currently residing in Henderson NV and a long-term recipient of SNAP (food stamps), MediCal, SSD, Medicare, Social Security, an Obama phone, & VA benefits, I would not want to file all of the new paperwork most likely required of CalCare applicants.

If the system works, why complicate matters?


 +  Like this comment
Posted by Edel Hererra, a resident of Castro City,
on Jan 29, 2022 at 4:45 pm

Edel Hererra is a registered user.

Would CalCare also cover individuals who reside in Mexico (Tijuana, Ensenada and Baja California) but commute daily to the southern San Diego area for work?

Many were born in the United States and
both them and their families have dual citizenship.


 +   2 people like this
Posted by Bill Bucy, a resident of Barron Park,
on Jan 30, 2022 at 10:49 am

Bill Bucy is a registered user.

This idea, if not the current legislation, will be thrashed out over some time. However, a few things to consider when thinking of how it will be financed:

The federal government is barred by law from negotiating drug prices with big pharma. Nothing would prevent California with a patient base of 35 million people from doing so.

The current 1.45 percent Medicare payroll tax could go to the state. Perhaps.

Medicare premiums of $145 a month could be redirected. Perhaps.

Medicare recipients who pay for supplemental insurance would be relieved of their premium burden.

Deductibles and co-pays would disappear.

There is no prohibition on the purchase of supplemental or private insurance.

As for costs...

Private insurers spend 12 to 18 percent on administration. Medicare spends about 2 percent. Under the current proposal Cal Care would be administered by state agencies already in existence so it's reasonable to assume California's bureaucratic costs would be similar.

Unlike private insurers, Cal Care wouldn't need to generate profits.

Even if Cal Care doesn't fly it will be worthwhile to study and learn because proposals for public insurance for all are going to be with us for a long time.



 +   2 people like this
Posted by Online Name, a resident of Embarcadero Oaks/Leland,
on Jan 30, 2022 at 10:58 am

Online Name is a registered user.

This week tech billionaire Mark Cuban announced an online drug company that will drastically cut the price of many common drugs.
Web Link

It would be nice if California watched this endeavor and maybe participated before charging into this new program when it has such problems managing programs, tracking expenditures etc.

Given the problems, lawsuits, cutbacks etc at CA's huge existing healthcare providers like Sutter/PAMF. Stanford and Kaiser, just maybe it could focus on improving them since they cross county lines and hence are outside individual counties' jurisdiction?? Why we're getting our vaccinations and booster at Safeway, drugstores and CostCo while PAMF/Sutter doesn't provide them and STILL allows unvaccinated / non-boosted staff boggles the mind.

Our taxes are already SO high and CA is taking on so many big problems/ challenges at once that it would be nice if they focuses more.


 +   14 people like this
Posted by Butch Logan, a resident of Barron Park,
on Jan 30, 2022 at 12:18 pm

Butch Logan is a registered user.

An all-inclusive California healthcare system would also encourage more transients to resituate in California and we cannot have that given the problems they will incure upon California taxpayers and residents who do want California to become a sanctuary state


 +   8 people like this
Posted by Bette Harper, a resident of Crescent Park,
on Jan 30, 2022 at 1:01 pm

Bette Harper is a registered user.

• I am also of the firm belief that those covered by any government assisted healthcare program should pay higher premiums if their health conditions are attributable to preventable diseases such as smoking, alcoholism, drug abuse and obesity.

•• An all-inclusive California healthcare system would also encourage more transients to resituate in California.

I agree. California taxpayers cannot afford to subsidize those who are intentionally negligent about their personal health concerns or are simply moving to the state for a free ride.


 +   9 people like this
Posted by Ryan Hill, a resident of Los Altos Hills,
on Jan 31, 2022 at 11:30 am

Ryan Hill is a registered user.

?"California taxpayers cannot afford to subsidize those who are intentionally negligent about their personal health concerns or are simply moving to the state for a free ride."

? Dr. Rochelle Walensky of the CDC has gone on record as saying that it was "really encouraging news" that three-quarters of vaccinated people who died of Covid had multiple underlying conditions such as obesity or diabetes.

The "intentionally negligent" of their personal health appear to be the leading cause of breakthrough Covid deaths according to Dr. Walensky.

That said, CA taxpayers should not be on the hook to provide healthcare benefits for those who are abusing their health by unhealthy lifestyles or the homeless who venture into CA from out of state.


 +   12 people like this
Posted by Kevin Wu, a resident of another community,
on Feb 1, 2022 at 11:47 am

Kevin Wu is a registered user.

Done deal as the CA legislature shot down this measure.

There is no such thing as a free lunch.


 +   4 people like this
Posted by Ismael Mahoud, a resident of Old Mountain View,
on Feb 1, 2022 at 1:59 pm

Ismael Mahoud is a registered user.

There was absolutely no way this foolhardy measure would have passed.

America becomes more socialistic when the progressive Democrats are successful in promoting their liberal agenda.

And we cannot have that if we are to survive as a truly capitalistic society where social and economic Darwinism reign supreme.

It is simple Reaganomics.


 +   5 people like this
Posted by Lourdes Gonsalves, a resident of Los Altos,
on Feb 1, 2022 at 2:49 pm

Lourdes Gonsalves is a registered user.

With Medicare, Medi-Cal, Obamacare, and free county medical services to the economically depressed, how many more entitlement programs do we need to initiate?

In America there is more access to highly-skilled health professionals than in any other country in the world.


 +   1 person likes this
Posted by Resident 1-Adobe Meadows, a resident of Adobe-Meadow,
on Feb 2, 2022 at 9:21 am

Resident 1-Adobe Meadows is a registered user.

The person pushing this bill is Ash Kalra. Wikipedia - born in Canada, went to school in the UC system, and has worked for the County of Santa Clara as his major employer. He is an employee of a state agency and is getting his health care provided by a state agency sponsored plan. The majority of employed people in this state work for commercial entities who have employees spread across the country and in order to function have to provide a health insurance plan for all of their employees. That plan has to be universally consistent for all of the employees of that company. The taxes that any company have to pay includes all of the expenses for one plan for all of the employees -and that is not a state-by-state issue.
State employed employees are oblivious to the requirements that the IRS implodes on commercial entities in the state - a lot of which show their corporate address in Delaware.
As to the Nurses union - the nurses belong to a union but are employed by a health care organization that is usually a large organization that operates in more than one state. They get their insurance plan for the organization they work for - not the union.
Nothing like a relatively new US citizen who gets into politics and wants to make a name for themselves but have no background in how the country works and what the IRS rules are for companies across the board that work in many states. He does not understand corporate accounting, IRS rules of required and acceptable expenses that they get audited on, and the general make-up of the commercial basis of this state's economy. The Bay Area News group needs to stop pushing schemes that are outside of the IRS requirements of doing business in this state. This state works within the bigger picture of the US in general and the business operations have to be consistent with the IRS regulations of how to do business in the US total.


 +  Like this comment
Posted by Preston Davidson, a resident of Los Altos Hills,
on Feb 2, 2022 at 9:58 am

Preston Davidson is a registered user.

[Post removed.]


 +  Like this comment
Posted by Leslie Bain, a resident of Cuesta Park,
on Feb 2, 2022 at 11:06 am

Leslie Bain is a registered user.

I am a fan of Ms. Diamond's, essays, but on this one she failed to do enough research. Reality: America's healthcare system is very, very broken, we are being price-GOUGED and 68 thousand of us die EVERY YEAR because they cannot afford to pay the INFLATED charges.

In 2009, Obama told us the cure: a "public option". He said we cannot trust private insurers, he proposed a public option as an alternative to help keep them honest. We did not get it, instead we got the ACA which did some good things but essentially nothing to actually make health CARE affordable. Now many have health INSURANCE, but they avoid getting CARE because they STILL cannot afford it. INSURANCE is not the same as CARE.

The ACA was passed in great part due to the testimony on Capital Hill by my hero Wendell Potter, a former insurance executive who resigned after he saw Americans getting care in animal stalls at a county fairgrounds in Tennessee.

"Looking back over his long career, Potter sees an industry corrupted by Wall Street expectations and greed. According to Potter, insurers have every incentive to deny coverage " every dollar they don't pay out to a claim is a dollar they can add to their profits, and Wall Street investors demand they pay out less every year." Web Link

Wendell wrote extensively for The Center for Public Integrity, a nonpartisan, nonprofit organization that produces original investigative journalism. Today he is the president of Business for Medicare for All and Medicare for All NOW!- Web Link

In 2017, CA SB 562 was passed by the Dem State Senate and would have been signed into law by Dem Jerry Brown. But instead of allowing the Dem state Assembly to vote, Anthony Rendon shelved it. Why? Web Link

Ms. Diamond, I beg you to investigate this issue MUCH MUCH more thoroughly. Please. CA's economy is the fifth largest in world.


 +  Like this comment
Posted by MyFeelz, a resident of Fairmeadow,
on Feb 2, 2022 at 1:03 pm

MyFeelz is a registered user.

In regards to NeilsonBuchanan, the VA Healthcare model is by far one of the most expensive health care I've ever had. It's probably great for Vets who are by and large healthy and don't need continuous care all year long every year, and don't need meds.

The VA primary care office only wants to see me once a year. They don't want to dispense 90 day supplies of medications. During the height of COVID before there was a vaccine, the CDC recommended patients with chronic illness requiring meds to stock up, and get 90 day supplies due to the probable onset of shortages of meds. That in fact, did happen. Even blood medication was hard to get in 2020. I couldn't get my VA to provide me a 90 day supply. I have an outside pharmacy with a huge discount, where I can get 90 day supplies for $1.30. The same supply, with the VA, costs $33. It's a huge difference if you are already paying (like I am) for a medi-cal policy. That medi-cal policy is the only thing standing between me and huge co-pays for VA doctor visits, lab work, and specialty care.

The VA allows me to have no co-pay due to my medi-cal eligibility. If that goes away, so does the low cost VA healthcare. Nothing, but nothing, can change the tier structure of the pharmaceutical cost at the VA. What it does is raises an annual medi-cal payment of $250, and adds over $750 per year of VA pharmacy charges. I can't afford that, let alone the co-pays and other associated costs that are currently waived due to my medi-cal eligibility.

I know nothing about constructive markets, etc. I'm just a simpleton trying to stay alive and year after year, the playing field changes and I can afford it less and less every time it does. As for this article itself, it doesn't cover what we will all be facing if CA takes charge of our medical care: Mandatory Managed Care. They are already doing it in Medi-cal, at the expense of patients who have complex medical situations going on.


 +  Like this comment
Posted by Joanna Simpson, a resident of Another Palo Alto neighborhood,
on Feb 2, 2022 at 1:15 pm

Joanna Simpson is a registered user.

I would also like to see some progressive reform in the area of veterinary fees and cost-effective pet healthcare.

I've spent more on vet services for my two Chow Chows than I have on my three kids.


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Posted by Janice Campbell, a resident of Cuesta Park,
on Feb 2, 2022 at 2:12 pm

Janice Campbell is a registered user.

Whatever happened to the days when large companies provided their full-time employees with comprehensive health care coverage?

It is an obligation of the employers to make such provisions as part of their employee benefits package even if the premium costs are co-shared.

The unemployed can simply go to the county hospital if they are uninsured or take out healthcare insurance on their own if they prefer more customized medical care. This will serve as an impetus to get a job with benefits.

CA is not a welfare or sanctuary state despite earnest efforts by the Democrats to make it one.


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Posted by Resident 1-Adobe Meadows, a resident of Adobe-Meadow,
on Feb 2, 2022 at 3:57 pm

Resident 1-Adobe Meadows is a registered user.

One of the unique features of the companies that work in Silicon Valley is that they have a large number of H1B subcontract employees. Those people work for a company that brings people in and then subcontracts them to the companies. They are not "employees" of the companies. The employees of the company that are US citizens do have health coverage. The payroll taxes for those employees have multiple transactions which contribute to the federal FICA taxes - which is social security, as well as state taxes. The FICA tax is what feeds SSN and eventually Medicare.
The company negotiates with a health plan to get better rates. The Human Resources Department is part of the whole package. Government employees also have this feature.
Kaiser, AARP, Aetna are national companies. Whatever they are providing has to be consistent across the board.
No - we are not the 5 or 6 biggest economy in the world. Newsome like to say that to inflate his ego. If he would spend the money we have on the infrastructure then there would not be a big pot of unallocated money sitting there.
Back to the story line - Mr. Kalra has no idea what he is talking about. He is a government employee. The state cannot be the 5 or 6 biggest if it is dependent on government employees - they produce no tangible products.


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Posted by DianaDiamond, a resident of Midtown,
on Feb 2, 2022 at 4:58 pm

DianaDiamond is a registered user.

LESLIE --
I was writing about a proposal for a California-controlled single-payer health care plan IN THIS STATE. I was not commenting on health care in the U.S. -- and in that area you make some good points.

But I do believe the single-payer health care plan, as proposed, was financially unstable. It did not provide enough funding to cover the billions of dollars needed for this program, in this state, to even start. The bill called for suddenly turning the entire health expenses of all Californians to the state, a state not equipped yet with personnel to handle such a program. After my column/blog ran, the Mercury editorialized last Sunday on the financial problems involved in such a plan. The bill failed to get Assembly approval to forward it to the house.

I agree we have a lot of health care issues today, including long waits and patient demands that cannot be handled. But one poorly-crafted bill is not the way to go. I am sure there will be others.
Diana


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Posted by Leslie Bain, a resident of Cuesta Park,
on Feb 2, 2022 at 6:01 pm

Leslie Bain is a registered user.

Diana, you wrote: "I was writing about a proposal for a California-controlled single-payer health care plan IN THIS STATE." I understood this, yes. Are you familiar with SB 562, which was ALSO a CA single payer bill?

"SB 562, the Healthy California Act, would establish an improved Medicare for all type system in California - Web Link

SB 562 was very popular, in fact, it PASSED the CA state Senate. The next step was to put the bill before the state Assembly. If it had passed there too, it could have been signed into law by Gov. Jerry Brown. That's how our democracy is supposed to work, right? Bills are voted upon in the Senate and in the Assembly, and if passed in both houses they are submitted to the Governor for final approval.

But Assembly Speaker Anthony Rendon did a VERY UNUSUAL THING. Instead of allowing the Assembly to vote upon the bill, he SIMPLY SHELVED IT. His action was the equivalent of a NAY vote from the entire assembly, it stopped the bill dead in it's tracks. Is that the way that our democracy works, a Speaker can veto a bill? No. Why would he do such a thing?

"Since 2012, Rendon and top California Democrats have received over $2.2 million in campaign donations from the pharmaceutical and health care industries. Democratic Gov. Jerry Brown would face national embarrassment if he vetoed the bill, as former Republican Gov. Arnold Schwarzenegger had done twice before."

Mark Twain told us about lies, damn lies, and statistics. Accurate numbers can be used to deceive and mislead. I'm not trying to accuse you of lying but you have talked about the costs under the new bill, which is a big number and so is scary. To be fair, you need to ALSO describe the COSTS UNDER OUR CURRENT SYSTEM, which I can assure you is also a big number, and then compare those two numbers.

If you do this, you will see that single-payer costs LESS.


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Posted by Leslie Bain, a resident of Cuesta Park,
on Feb 2, 2022 at 6:20 pm

Leslie Bain is a registered user.

I hit the comment limit, but I wanted to also share that Bernie Sanders' Medicare For All was fought by talking about how much it would cost - $32 Trillion over 10 years! Oh my goodness, how ever would we pay for it?

What was left out of the discussion was that our current "healthcare system" costs $34 Trillion over 10 years. Which means that moving to MFA at a national level would SAVE $2 TRILLION OVER 10 YEARS! That's a GOOD thing ...

Hilariously, a Koch-brothers' funded study actually provided these numbers, but of course in the conclusions they did not connect the dots to show the savings that would come from M4A. They simply scared the public with the "big numbers" - Web Link

FYI, it is illegal to price-gouge for toilet paper during a pandemic, but it is perfectly legal to increase the price of life-saving drugs by 5000% or more! Does that make any sense? Many human beings are dying because they can no longer afford these drugs. Does that matter? Should we care?

Single payer COSTS LESS because it ends the price-gouging.


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Posted by Resident 1-Adobe Meadows, a resident of Adobe-Meadow,
on Feb 3, 2022 at 10:31 am

Resident 1-Adobe Meadows is a registered user.

In the SFC 02/03/2022 - "How Progressives can save Single-payer - Joe Garofoli - It's All Political". Based on the SFC's take on this issue it revolves around the Nurses Union and Hospitals. I think the Business Section of the paper should address this issue - it is based on current tax and accounting law for corporations on the stock exchange. Companies which bring H1B people over and subcontract them to the local companies are not on the stock exchange, and they operate on their own rules.
Assemblyman Ash Kalra was born in Canada, went to UC, and is an employee of the government system. This issue is about major corporations which provide health care for the employees and pay the payroll taxes relative to health care - FICA. All of those H1B employees work for a company that farms them out and may not provide health care insurance for those workers. It is in part political - but the rules of the road are tax law at the federal level that applies to companies that do business here. The Nurses Union and Hospitals are only a part of the topic - and a small part.
The progressive brain again machinates the topic to address only the minor aspects of the topic.


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Posted by Leslie Bain, a resident of Cuesta Park,
on Feb 3, 2022 at 11:23 am

Leslie Bain is a registered user.

Essays like this one are sad because they do so much to preserve the status quo. Under our current system, healthcare is delivered in silos and the rules are different in each one: Medicare, MediCal, Big Biz policies, Small Biz policies, TriCare for the military, private insurance ... We are all intimately familiar with the problems in OUR OWN silo, and ignorant to the problems faced by those in other silos, so they never get fixed: "Divided we fall."

"“Am I a bad person?" Why one mom didn't take her kid to the ER " even after poison control said to." - Web Link

People on Medicare can complain about the high costs, but they have it lucky. Do you have any idea what private insurance costs for a healthy couple over 50? Around $20K a year, and rising. And that's JUST for the little insurance card, if you have to actually get care, it costs even more. But if you are healthy ... man that's a lot of $$$ and it's tempting to cancel the insurance when $$$ is tight.

Our system is very, very broken. They simply don't have these kinds of problems in other Western, first-world countries. Here we pay through the nose and have worse medical outcomes, what a deal. We are being PRICE GOUGED.

Here is how Bernie planned to pay for M4A: Web Link

- Creating a 4 percent income-based premium paid by employees, exempting the first $29,000 in income for a family of four.

- Imposing a 7.5 percent income-based premium paid by employers, exempting the first $1 million in payroll to protect small businesses.

- Eliminating health tax expenditures, which would no longer be needed

- Raising the top marginal income tax rate to 52% on income over $10 million.

- Replacing the cap on the state and local tax deduction with an overall dollar cap of $50,000 for a married couple on all itemized deductions.

Single-payer will save $$$ and SAVE LIVES.


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Posted by Resident 1-Adobe Meadows, a resident of Adobe-Meadow,
on Feb 3, 2022 at 12:37 pm

Resident 1-Adobe Meadows is a registered user.

Bernie is a socialist. The economic system on the stock exchange is not a socialist system. Turning ourselves into a Socialist system is not going to fly. Our current system assumes you are a working person that gets some type of insurance coverage from your employer - that is the way it always worked before. Or you are working and can pay your way.

The State of California has multiple pockets of concern - Silicon Valley, Hollywood production, in Southern California a very diverse population. Justin Phillips of the SFC would find nothing to comment on there - he would just be another want-to-be newspaper person who has other people writing his blog. What flies in SV does not apply to the rest of the state. The Sports world works in it's own area of concern. Trying to machinate state health care law does not address all of the laws and requirements associated with global companies. The SV bubble and it's set of problems is just one bubble in this state. The person pushing this was not born as an American - he was born in Canada. Just another person who comes here to the US and then tries to turn it into where they came from. He is listed as the first India legislator. Trying to get the system changed for all of his country people coming here to work.


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Posted by Joe Sessoms, a resident of Mountain View,
on Feb 3, 2022 at 1:17 pm

Joe Sessoms is a registered user.

Bernie Sanders is a Socialist and not one to be taken seriously along with the likes of AOC and Elizabeth Warren.

Establishing a cost-effective national healthcare system is a Biden administration obligation and responsibility.

And so far, he has made no mention of it nor any visible efforts because such a challenging task is beyond his capabilities and acumen.

Voters in 2020 voted for Biden with hopes that the nation could separate its scope and direction from two extremes: Trump fanaticism and the Sanders/Warren pipe dreams.

As voters we have failed once again to procure and establish a competent president in touch with reality.

On to 2024.


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Posted by Resident 1-Adobe Meadows, a resident of Adobe-Meadow,
on Feb 4, 2022 at 7:15 am

Resident 1-Adobe Meadows is a registered user.

This topic is still swirling in the papers like a soap opera. Why are you all trying to bury it? The problem at hand is the Progressive Brain which flies in people from all over to make CA an example. An example of where they originally came from and from where they fled from. In this case they are totally ignoring the accounting standards of any company on the stock exchange, as well as the federal and state tax laws regarding payroll taxes and corporate requirements to provide health care plans for the employees which must be universal across the board. They keep talking about the Nurses Union. The Nurses contribute to the union but they work for a hospital or some other medical organization which has to have a uniform set of approved accounting practices to stay in business. That includes health insurance for the employees. They all keep talking about a goal with no understanding of what they are talking about.

Here is an idea - cut CA in half - two states. The south section is highly diverse and does not seem to attract as many people trying to convert systems. The north section is less diverse and seems to attract a lot of people from out-of-state that want to convert us to something other than what is now there. You can include "The Squad" - ladies who fled horrible situations and are now trying to create those horrible situations here. Add Mr. Weiner and his housing bills - why is a person who came from another state busy creating havoc in this state.


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Posted by maguro_01, a resident of Mountain View,
on Feb 5, 2022 at 10:54 pm

maguro_01 is a registered user.

Our US, just before the Covid outbreak, was paying 18% GDP for medical care - highest in the world. For that we were number 20-something in life expectancy among developed countries. I recall someone in the news asking a drug company spokesperson why a critical drug was so expensive. The reply was "What is the value of a human life?" In other words the company had segued from a business model to more like a Godfather model - extortion. Between the medical care sector and the financial sector we must be spending 1/4 US GDP. Both are necessary, but we are being seriously taken.

What is behind it is our perpetual Pay-To-Play political system, that is, essential corruption. It has cost our country dearly over the decades, especially from the middle 1800's to 1929 and the Depression. Now, at last, it seems to be bringing us down. Most of the defects in our Constitution come from the compromises needed to accommodate the Slave South, an alien society. Those compromises are still with us and the price is too high....


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