[df3]

A well-executed single-payer system would make California even more attractive for entrepreneurship and increase labor mobility for everyone. Life would be much easier if we could start companies or switch jobs without worrying about healthcare.

[neltnerb]

Completely agree. The trick is making sure it's well-executed so that other states can use it as a template. Once one state proves that single-payer can be done well, I suspect it will cascade inevitably.

With 100% seriousness, if the ACA is repealed I will likely be choosing between Massachusetts (where Romneycare would hopefully take priority again) or another country. It's too risky to do otherwise.

My extended and immediate family members have too many horror stories about being denied coverage or it being prohibitively expensive. Like a cousin who had to choose working over being a stay-at-home mom to take care of her kids, since her husband's policy as an entrepreneur wouldn't cover her. She didn't even have any ongoing health problems, just a technical pre-existing condition.

I am unwilling to be stuck in a job or forced to accept unreasonable compensation or a nasty work environment because I have to have health coverage. Which is a decision too many in my family have been forced to make. Many family members (including myself) have far worse chronic illnesses, so it's utterly involuntary -- work or die. And thankfully I have a choice in where to live by virtue of my education and credentials.

I have been blessed so far to not have to deal with it because I've only lived in MA as an adult prior to Obamacare -- where Romneycare was in place by the time I finished undergrad. But I've heard enough first hand accounts and seen the suffering that kind of horrible choice creates. And the absolutely perverse incentives it puts onto the job market, and onto individuals. Health care is not a voluntary market, and treating it like one is bonkers.

Now I'm in California. I seriously doubt I will be able to stay without a guarantee that I can manage medical expenses, and I'm definitively privileged economically compared to the majority of the US population.

[zaroth]

California had guaranteed issue before the ACA. Any small business with at least 2 employees could get it. Premiums were reasonable as the "rating adjustment factor" was capped on these plans. A one time 6 month waiting period on pre-existing conditions is waived if you have prior credible coverage without more than a 62 day gap in coverage.

For example, a husband and wife working together in a sole proprietorship, would qualify.

I'm not sure the current state since ACA passed, but I depended on CA guaranteed issue myself for several years before ACA and it provided access to high quality expensive insurance (~$500 / person / month) with unlimited annual benefits, as well as somewhat cheaper HMO plans (~$350-400 / person / month).

Google 'AB 1672'.

[andrei_says_]

> ... stuck in a job or forced to accept unreasonable compensation or a nasty work environment because I have to have health coverage.

Which is what makes this a huge political issue and an incredible leverage point.

I wish we could unite and end the use of healthcare coverage / availability to enslave workers ("enslave" being used loosely for the ones Who are as pedantic as I sometimes am).

[erichocean]

> It's too risky to do otherwise.

Uh, you could just buy insurance yourself. It's not like no-ones covered unless the State writes the check. smh

[genericpseudo]

This is the point where America discovers European liberal political theory and praxis! This is one of their key points; universal healthcare is a hard-L liberal position because only the state can insure certain classes of catastrophic risk, and by doing so you increase individual freedom of action.

(European liberalism is clearly culturally distinct from social democratic thought; where it comes to the same positions it's typically by other means – not that there's anything wrong with social democracy or democratic Socialism, for that matter.)

A good starting point would be, at pan-Europe level, the ALDE; https://en.wikipedia.org/wiki/Alliance_of_Liberals_and_Democ.... National-level parties you might have heard of are the Liberal Democrats (UK) and Democraten 66 (Netherlands).

[davidw]

Very much agree. I wrote this about single payer, entrepreneurship and my time in Italy:

https://journal.dedasys.com/2017/02/22/entrepreneurship-and-...

[mmanfrin]

I managed to crash my bike in to a car in Italy; I remember the process of going to a doctor (which happened to be the closest door on the sidewalk where I hobbled over to) and having them send me to a hospital. I got looked at, xrayed, and given a diagnosis without having to even talk about money or anything beyond a 4-line form for my information.

Single-payer is wonderful, and I believe an absolute necessity as we march towards a future of automation and enormous economic inequality.

[df3]

Thanks for sharing! I also lived in Berlin for four years and was impressed with how easy healthcare was.

[TheOsiris]

I don't think anyone disagrees that single payer requires higher taxes than we currently pay. so given that, you're trying to tell me that a state with the highest taxes (much much higher than #2) in the nation, with the lowest housing affordability will attract more entrepreneurs than before?

why? because the young and invincible will be choose cheaper healthcare over being able to live comfortably? I highly doubt it. this has nothing to do with whether or not single payer is a good idea. I just did the idea that people will choose CA over cheaper states just for that reason

[ihaveajob]

I can't speak for everyone else, but the two reasons that were holding me back as an employee of a large corporation instead of starting my own company were employer-provided healthcare and visa restrictions at the moment. This measure would have eliminated one of those major constraints.

[dariopy]

CA #1? What are you talking about? The state with the highest tax burden is NY. CA doesn't even make it to the top 10.

https://wallethub.com/edu/states-with-highest-lowest-tax-bur...

[nickv]

I remember these arguments made when Jerry Brown first proposed the newer upper income tax bands in 2009.

Considering, for a very long time, California's taxes have been the highest in the country (to be fair, definitely not "much much higher" than NYC,) last I checked it was adding jobs at a higher percentage rate than any other state.

Do you really think there's been an entrepreneur exodus from the Bay Area and LA since 2009?

[DrScump]

  I don't think anyone disagrees that single payer requires higher taxes than we currently pay

I disagree, in the sense that I don't take that as a given. Remember, all of the current inefficiencies in and profits for the carriers go away and are instead fed directly into the system of care.

The first problem is, how could the government simply take over? Eminent Domain? Constitutional amendment?

[sjg007]

Would be great. Also would be great if two states could join up and offer single payer together.

[foota]

West coast single payer?

[rch]

There are people working on that for the interior mountain states.

[erichocean]

I'd be okay with single-payer in CA if we implemented the system in Denmark. Great mix of "everyone is covered" with choice/doctor control. I wish more people wanted it. :(

If we're just going to keep doing the ACA, no thanks. What a piece of shit that legislation turned out to be.

[toodlebunions]

Great point.

It would be good as a baseline, then companies can offer supplement plans for additional coverage or a wider network, similar to Medicare.

[jbhatab]

Here's the only thing I'm confused about. Do we have examples of the government running a service better than the private sector?

I'm not 100% on this, but it seems all of the best aspects of American services come from competition and letting capitalism thrive.

Would love a counter opinion.

[enraged_camel]

You would do well to start questioning the idea that the private sector does anything "better". After all, it was them that gave us Enron, Deepwater Horizon, and most recently, the subprime mortgage crisis, which brought the entire world economy to its knees. Those are only a few examples that spring to mind.

In addition, comparing the government with the private sector is pretty silly. They have different goals. Private companies try to maximize profit, even if it comes with massive externalities (which, barring regulations, they happily pass on to others). Governments aim to serve their citizens, even if it comes at the expense of efficiency. This means that any given problem will be handled very differently by the private sector compared to the government. The route we pick really depends on our priorities as a society.

[neltnerb]

Off the top of my head, and certainly some are up for debate. But consider how well these systems worked prior to government intervention.

You may think medicare, for instance, is run horribly -- but I'm pretty confident that seniors are far happier with it than they were pawning off their possessions to get medical treatment prior to it being created.

- Medicaid

- Medicare

- The USPS (which, let's be honest, is freaking amazing for the price)

- Social security

- Basic research

- The military (remember our private security contractors and how much more horrible they were?)

- The fire department

- The police (can you imagine how horrible a private police force would be?)

And on the flip side, consider how atrocious private prisons are compared to federally operated ones.

I'm sure there are many, many others...

[toomuchtodo]

> Would love a counter opinion.

Every other first world country?

https://en.wikipedia.org/wiki/List_of_countries_with_univers...

[FullMtlAlcoholc]

Prisons for one.

You seem to misunderstand the role of governments though. Citizens and taxpayers are not shareholders seeking to maximize return on investment. The government exists to provide for national defense, rule of law, postal service, and domestic security. Private industry would have an incentive to not provide these services for free riders (the poor, those who dodge payment, etc.)

Private industry also ignores externalities in their pricing, which is why we have regulation. I quite like not having to pay for relatively clean air.

[alexqgb]

Many. Start with highways, aviation safety, and prisons. Oh, and the history of private fire departments is a carnival of horrors. I mean, the list goes on (and on, and on).

[chimeracoder]

> Here's the only thing I'm confused about. Do we have examples of the government running a service better than the private sector?

Medicare is a good case study, because Medicare has both publicly managed plans and privately managed plans.

As it turns out Medicare Advantage (the privately managed plans) consistently beat Original Medicare on the three primary metrics: cost, medical outcomes, and patient satisfaction scores.

(In fact, Original Medicare has the lowest satisfaction rates of all major Medicare plans).

[tylersmith]

Even easier if people could just let others take care of _every_ whim. If there was a guaranteed income there wouldn't even be a need for entrepreneurship!

[thescriptkiddie]

If anything, people would be more likely to start their own businesses if they had a guaranteed income, because it would mitigate the opportunity cost of quitting their day job.

[FullMtlAlcoholc]

If you'd like to see what people actually would do with money provided by a basic income program, here are the results of a survery conducted by GiveDirectly, a company piloting the idea in Kenya.

It seems that despite your conjecture, there are a number of people investing the income into education, fishing nets, seeds for crops/livestock, fishing nets, beauty salon's, etc.

In my experience, poor people are the world's greatest entrepreneurs. Every day, they must innovate in order to survive. They remain poor because they do not have the opportunities to turn their creativity into sustainable income.

[__realtime]

the interesting thing to me is why didn't CA make these moves under Obama if they thought they had such a better plan for healthcare... either way it's a win for DT