With Obamacare in jeopardy, California considers going it alone with 'single-payer' system

[Jimbo101]

Political Wire

LA Times

With President Trump now vowing to put forward a replacement for the Affordable Care Act in March, some California politicians and healthcare advocates are once again promoting the idea of a state-run “single-payer” system that operates like Medicare.

Backers say the uncertainty surrounding Trump’s promise to repeal Obamacare presents California with a chance to rethink how healthcare is delivered to its 39 million residents.

“In a single-payer system, residents would pay into a state agency that essentially functions as an insurance company. The agency would pay doctors and hospitals when people sought treatment.”

[taught_me_patience]

1. No thanks

California already has horrible doctor reimbursements because it allows Blue Cross/Blue Shield to have a near monopoly on the market. I hate to imagine how a state run agency would pay.

[unitedwethrive]

2. Agreed, if the reimbursements get any worse, there will be an exodus of providers.

I was just having this discussion with colleagues a few weeks ago, and many of us have had very tempting offers from other states. Something like this could really push people over the edge.

[pnwmom]

4. Speaking of reimbursements, one of Seattle's top hospitals (a "non-profit")

has been caught up in what appears to be a patient "churning" scandal. After the Seattle Times investigation, the hospital CEO resigned.

From the patient perspective, it appears that patient quality of care is being affected by a system that reimburses surgeons on a piecework basis -- so there is a built in incentive to perform more procedures and more expensive procedures.

It must be frustrating as a doctor to know you could make a lot more money in another state (maybe Washington), but as a patient, it is frustrating to know we can't count on our course of treatment not being influenced by how much our doctors might hope to personally profit from it.

When doctors' earnings come from salaries, patients don't have to worry about that.

https://projects.seattletimes.com/2017/quantity-of-care/hospital/

Just a few years later, Providence and Swedish had overhauled the way Cherry Hill’s neuroscience program approaches the business of medicine, enriching the nonprofit institution and its star surgeons.

A steady churn of high-risk patients undergoing invasive brain and spine procedures allowed Cherry Hill to generate half a billion dollars in net operating revenue in 2015 — a 39 percent increase from just three years prior. It also had the highest Medicare reimbursements per inpatient visit of any U.S. hospital with at least 150 beds.

By those metrics, Providence’s acquisition of Cherry Hill has been a rousing success story.

But the aggressive pursuit of more patients, more surgeries and more dollars has undermined Providence’s values — rooted in the nonprofit’s founding as a humble home where nuns served the poor — and placed patient care in jeopardy, a Seattle Times investigation has found.

SNIP

Surgeons with production-based contracts can increase their revenue by adding more stages to a surgery. That’s particularly true when it comes to spine cases.

SNIP

http://www.seattletimes.com/seattle-news/times-watchdog/swedish-ceo-resigns-in-wake-of-seattle-times-investigation/

Swedish Health Services CEO Tony Armada has resigned from his position, hospital officials said Tuesday, less than two weeks after a Seattle Times investigation exposed the turmoil and troubles inside Swedish’s acclaimed neurosurgery institute.

[andym]

10. What do you think of Medicare payments? nt.

[taught_me_patience]

14. Medicare (+supplimental) pays better than BC/BS in Cali for General Practitioners

depending on the contract, so my wife is happy to take Medicare patients. The BC/BS ACA plans are the worst. Those typically pay 20% less than typical BC/BS plans. My wife is slowly starting to push those patients to the back of the line because 20% less reimbursement=40-50% less net pay for her and NOBODY wants to do the same amount of work for 50% less pay. Lowering reimbursements any more will cause shortages of doctors in California. We could make 3x the amount of money working in Houston instead of Los Angeles and it's starting to get tempting.

[andym]

3. If California goes ahead with this, they should look to kaiser permanente

for guidance on how to run it, since they appear to be the most functional provider/insurer in the state.

[still_one]

6. Kaiser is a great model. It is similar to the Mayo Clinic model

[taught_me_patience]

8. Why would Kaiser give guidance on how to run

something designed to completely put them out of business?

[andym]

9. Because they could be made the administrator of the state run health care

which I think would be a winning model. The new law could require an outside administrator(s)-- which would probably be a good idea. Moreover, their medical practices would likely remain in business as a separate division-- only their insurance component would be eliminated.

[still_one]

5. I will be more than happy to pay higher taxes for this. If the republicans really wanted to

do something for people they would replace the ACA with Medicare for all, but that isn't going to happen.

Good for my state, I hope they do it

Since the implementation of the ACA, the uninsured rate in California dropped by over 50%. That along with expanded Medicaid as part of the ACA has helped Californians immensely.

At least California is trying for a backup plan if these assholes destroy the ACA without the same or better replacement

[Wounded Bear]

7. They're big enough to pull it off...

assuming, of course, they did it right.

(See complaints above. )

[brooklynite]

11. Vermont couldn't do it; Colorado couldn't do it...

I'm not convinced this is practical at a State level.

[andym]

12. Couldn't do it or wouldn't do it? It's the proposed huge payroll tax that has stopped single payer

The proposed payroll tax of 11.5% in Vermont wouldn't fly. Colorado's plan was not adequately funded by a payroll tax-- an 8 billion dollar deficit was projected.

California may face the same problem-- as would a national plan. Since Reagan, no party/key elected official dares to propose such a large tax.

[brooklynite]

15. IOW, they couldn't...

No State has found a financial solutions that's politically acceptable.

[Ezior]

16. Why would it be cheaper at the federal level?

I'm not sure how "increasing the size of the population" helps with making things cheaper. Sure, there will be more tax payers to fund the system, but at the same time there are more patients so you need more doctors, equipment and hospitals.

If California can't pull it off, then nobody can. The only issue might be that old, poor, sick people would move from all over the US to California to save their lifes and get treatment. It's a horrible thought, but you might need laws against that?

11% tax increase sounds nice. It's almost 15% for the universal health care system in Germany. It's cheaper than normal insurance for low-income families, but obviously more expensive for high-income families. That's just the way it is. The monthly rate is capped somewhere around 600€ or 700€ though, IIRC.

[Xolodno]

13. If any state can pull it off....it's California.

And if they manage to pull it off right, more employers will flock to the state.

Repubs talk about being pro business, but, many companies that provide health care insurance want a single payer system.