Colorado Single Payer health care

[nawhite]

The search function isn't working for me so if someone knows of another thread discussing this can you point me that way?

So on the ballot this November in Colorado there is a ballot initiative for statewide single payer healthcare. They haven't defined many of the details but the broad strokes are:

6.6% income tax paid by employers
3.3% income tax paid by employees
(10% income tax paid by those self employed)

All health expenses in the state would be paid by the government.

They haven't talked about how it would work when travelling but I think the only way it works is if CO pays out of state providers for care given.

The proponents website is here: http://www.healthcareforallcolorado.org/

Personally, I know it would be awesome overall but it would be terrible for me and my family because we are young and high income. It leaves me very conflicted on how to vote. Regardless, seeing as I'm living in an RV currently (see signature) if it passed, I'd change my residence to another state because this would make health insurance and care crazy expensive compared to what I currently get.

Curious if anyone else has an opinion on it or is conflicted?

[stoaX]

I clicked on their FAQs but they haven't posted anything yet.  The question I was hoping to see is how do they prevent people with costly chronic medical issues from moving to Colorado to get better/cheaper coverage and thus bankrupting the system? 

In underwriting terms this problem is known as "selection" or "anti-selection" and underwriters agonize and negotiate over it all day long.  It is a big, difficult thing to go to another country to get on a better health care system but moving to another state isn't as hard (especially an attractive place like Colorado!).   That's why health care reform works best when happens on a national scale.

[DocMcStuffins]

As you will be leaving the state............so will many others........pretty hard to have an economy grow when self employed and employers leave or don't come to your state. 

[stoaX]

Is there any chance that it will pass?  California has had a single payor proposition on the ballot at least once in the past but it didn't come close to passing.

[woodnut]

I'm also a CO resident and am currently a high a income earner, but very close to FIRE or a significant down shift.  I am also conflicted.  I'm not thrilled with the current ACA options, Kaiser and Anthem HMO.  Anthem is dropping the PPO option next year, so that means new doctors for the whole family if I leave full time employment.  All the other providers are so expensive they aren't even worth considering.

As an employee, amendment 69 is a significant cost increase to me for my health care.  As an early retiree, I think it will be a lower cost than ACA plans.  My understanding is only W2 wages are taxed at 3.3%.  Your capital gains, dividends, etc will be taxed at 10%.  The estimated total budget for this program is as big as the rest of the entire state budget.  Like most ballot initiatives, I think it is poorly written.  For example, no mention about how out of state care is handled.

In general, I'm ready for a single payer system, but I'm probably going to vote against it, because of how poorly it is written, its total cost, and the inequity in how it is taxed.  The single payer should be done at the national level anyway, but I'll be dead before that happens.

[woodnut]

Is there any chance that it will pass?  California has had a single payor proposition on the ballot at least once in the past but it didn't come close to passing.

I remember seeing a few months ago it was polling in favor of passing.  I'm surprised we haven' t seen much propaganda out of the "NO" camp yet

[Greenroller]

How does it work for the unemployed? Because we have plenty of those here. Plenty of people have moved here for the Weed with no jobs. Homelessness is at its all time high. I don't see this helping our state, I wish CO would stop trailblazing. For those of us who grew up here, it now unrecoginizable.

[RosieTR]

How does it work for the unemployed? Because we have plenty of those here. Plenty of people have moved here for the Weed with no jobs. Homelessness is at its all time high. I don't see this helping our state, I wish CO would stop trailblazing. For those of us who grew up here, it now unrecoginizable.

Huh. I have the opposite reaction. I do think there are more homeless and they are a problem, but there are different populations of homeless and it's not all people showing up for pot. That's a different, off-topic thread though.

As for the ballot issue, I signed for it to get on the ballot but haven't done much reasearch yet. I've seen some online ads against. The group is something that sounds reasonable but I suspect is backed by health care corps. They would have a lot to lose in CO since the population is more fit than average but also more accident-prone. I would be loathe to go without insurance for fear of a bike or mountain accident.
A single-payer system might depress small business which would be a shame (all those breweries, pot shops, and gyms, oh my!). It might make the state more attractive to corps though, so I doubt the number of jobs would be as affected as one might think. A corp may no longer need such a big HR staff to negotiate contracts with health insurers, communicate the message to employees, deal with add/drops, etc. plus then the corp has known costs vs variable costs for labor.

But I agree that if it's a bungled mess that might be worse than getting a good system in place. Ideally nationwide but who knows if that'll happen.

[CBnCO]

I'm a CO resident and have done some research on this proposition and have decided I'll vote against it. The bottom line is that productive and healthy people will pay for the healthcare of unhealthy and poor people. Further, it's going to be administered by a large, government-like bureaucracy that has little chance to be efficient. The top earners and those with retirement income will pay significantly higher rates than they can get on the ACA, so it will give incentive to leave the State. And, morally, any system that you cannot freely leave just doesn't seem right to me and this one, like the ACA, can only survive by forcing people to take part whether they want to or not.

Just my 2 cents..

[a plan comes together]

Further, it's going to be administered by a large, government-like bureaucracy that has little chance to be efficient.

That's misinformed right-wing garbage that has been proven wrong by anyone who has done the research.

http://time.com/198/bitter-pill-why-medical-bills-are-killing-us/
Medicare, for example, has an overall administrative and management cost of about two-thirds of 1% of the amount of the claims, or less than $3.80 per claim. According to SEC filings, Aetna, for example spends about $30 for each of its claims, or about 29% (almost 10X!).
Plus - large government insurers are able to negotiate better rates. The larger, the better - power in numbers.
AND they pay less to executives and nothing to stockholders in dividends (or have profit margins to account for).

[ender]

Further, it's going to be administered by a large, government-like bureaucracy that has little chance to be efficient.

That's misinformed right-wing garbage that has been proven wrong by anyone who has done the research.

http://time.com/198/bitter-pill-why-medical-bills-are-killing-us/
Medicare, for example, has an overall administrative and management cost of about two-thirds of 1% of the amount of the claims, or less than $3.80 per claim. According to SEC filings, Aetna, for example spends about $30 for each of its claims, or about 29% (almost 10X!).
Plus - large government insurers are able to negotiate better rates. The larger, the better - power in numbers.
AND they pay less to executives and nothing to stockholders in dividends (or have profit margins to account for).

What percentage of each claim that Aetna deals with do you think is the result of government regulations?

[Paul der Krake]

Further, it's going to be administered by a large, government-like bureaucracy that has little chance to be efficient.

That's misinformed right-wing garbage that has been proven wrong by anyone who has done the research.

http://time.com/198/bitter-pill-why-medical-bills-are-killing-us/
Medicare, for example, has an overall administrative and management cost of about two-thirds of 1% of the amount of the claims, or less than $3.80 per claim. According to SEC filings, Aetna, for example spends about $30 for each of its claims, or about 29% (almost 10X!).
Plus - large government insurers are able to negotiate better rates. The larger, the better - power in numbers.
AND they pay less to executives and nothing to stockholders in dividends (or have profit margins to account for).

What percentage of each claim that Aetna deals with do you think is the result of government regulations?

Are you saying the Medicare claims are not subject to government regulations?

[marty998]

Plus - large government insurers are able to negotiate better rates. The larger, the better - power in numbers.

I agree about shareholders, executive pay, etc., but this quoted part always seems strange to me.  I want single payer too, but I'll play devil's advocate for a minute.

Say we are in a single payer system and a company creates a new wonder pill that is far better than anything else on the market.  They pull a number out of their collective asses and decide to charge $50,000 per pill.  Now, what is their incentive to give the government a break?

If the government refuses to pay their price, then it is denying better medical care to people.  People will be up in arms because better care is being denied by the government.

If the government pays their price, then it isn't doing anything to lower the cost of care.  People will be up in arms because the government is wasting so many taxpayer dollars for each pill.

If the government steals the new formula and lets some other manufacturer into the market for competition, then investment dollars into R&D will dry up.  People will be up in arms because the US government just stole from a private corporation.

With private insurance companies (or individuals) paying the price, the company can only charge what the market can afford.  If big government is paying, they can charge whatever they want and it puts the government in a tough spot: deny better care for people, pay the ransom, or steal from the company.

Maybe it's just the cynic in me, but I can see a day where we switch to single payer and corporations decide to jack up the prices on all their patented products just because they can.  We have already seen some examples recently like the EpiPen where companies jack up their prices and there is public outcry.  What happens when the costs are paid by the government and patients don't even see the bill?

Again, please don't take the above comments to mean I don't want some sort of single payer system.  I'm just worried that there are going to be some pretty severe unintended consequences if a new system isn't implemented properly in the US.  Right now we are the cash cow of the world for pharmaceutical and medical device companies and I'm certain they will do everything they can to make sure that flood of money doesn't get turned off.  And if they can increase the flood in the form of taxpayer dollars, they damn sure will.

Patents expire and generics come into play. This is why the government needs to set the rules to allow a healthy period of profit to foster innovation, but then quickly move to allow competition.

Of course, finding that balance is the hard part and Big Pharma has been pretty good a lobbying to extend the life of these patents though...

Do some research on Australia's pharmaceutical benefits scheme. It's a single payer for drugs and medicines and has incredible negotiating power. If the pharmaceutical companies don't like the price the PBS is willing to pay, they lose access to a market of 24 million people who have the capacity to pay for their product.

[Metric Mouse]

10% of income is pretty steep.  Sounds like a great step in the right direction though.  How would this mesh with the ACA reqirements?

[forummm]

Plus - large government insurers are able to negotiate better rates. The larger, the better - power in numbers.

I agree about shareholders, executive pay, etc., but this quoted part always seems strange to me.  I want single payer too, but I'll play devil's advocate for a minute.

Say we are in a single payer system and a company creates a new wonder pill that is far better than anything else on the market.  They pull a number out of their collective asses and decide to charge $50,000 per pill.  Now, what is their incentive to give the government a break?

If the government refuses to pay their price, then it is denying better medical care to people.  People will be up in arms because better care is being denied by the government.

If the government pays their price, then it isn't doing anything to lower the cost of care.  People will be up in arms because the government is wasting so many taxpayer dollars for each pill.

If the government steals the new formula and lets some other manufacturer into the market for competition, then investment dollars into R&D will dry up.  People will be up in arms because the US government just stole from a private corporation.

With private insurance companies (or individuals) paying the price, the company can only charge what the market can afford.  If big government is paying, they can charge whatever they want and it puts the government in a tough spot: deny better care for people, pay the ransom, or steal from the company.

Maybe it's just the cynic in me, but I can see a day where we switch to single payer and corporations decide to jack up the prices on all their patented products just because they can.  We have already seen some examples recently like the EpiPen where companies jack up their prices and there is public outcry.  What happens when the costs are paid by the government and patients don't even see the bill?

Again, please don't take the above comments to mean I don't want some sort of single payer system.  I'm just worried that there are going to be some pretty severe unintended consequences if a new system isn't implemented properly in the US.  Right now we are the cash cow of the world for pharmaceutical and medical device companies and I'm certain they will do everything they can to make sure that flood of money doesn't get turned off.  And if they can increase the flood in the form of taxpayer dollars, they damn sure will.

Other than the US, all (or nearly all) industrialized nations negotiate their drug prices down. And it works. The rest of the rich world pays half as much for the same drugs as Americans do. We are subsidizing the rest of the world. And padding the profits of some of the most profitable firms in the world. Simply because we refuse to have a reasonable healthcare system (like the rest of the industrialized world). Even with much cheaper prices, there would still be plenty of money in the system to incentivize new drug creation. The rest of the world hasn't put a halt on drug development by paying half as much. Most drug development research in the US is already paid for by the government (mostly via NIH at universities).

[a plan comes together]

Other than the US, all (or nearly all) industrialized nations negotiate their drug prices down. And it works. The rest of the rich world pays half as much for the same drugs as Americans do. We are subsidizing the rest of the world. And padding the profits of some of the most profitable firms in the world. Simply because we refuse to have a reasonable healthcare system (like the rest of the industrialized world). Even with much cheaper prices, there would still be plenty of money in the system to incentivize new drug creation. The rest of the world hasn't put a halt on drug development by paying half as much. Most drug development research in the US is already paid for by the government (mostly via NIH at universities).

Exactly. There is a reason why the Turing AIDS drug is $350/pill here and less than $1 in Canada. And Epipen is $600 here and less than $100 in Canada.

[forummm]

Other than the US, all (or nearly all) industrialized nations negotiate their drug prices down. And it works. The rest of the rich world pays half as much for the same drugs as Americans do. We are subsidizing the rest of the world. And padding the profits of some of the most profitable firms in the world. Simply because we refuse to have a reasonable healthcare system (like the rest of the industrialized world). Even with much cheaper prices, there would still be plenty of money in the system to incentivize new drug creation. The rest of the world hasn't put a halt on drug development by paying half as much. Most drug development research in the US is already paid for by the government (mostly via NIH at universities).

Exactly. There is a reason why the Turing AIDS drug is $350/pill here and less than $1 in Canada. And Epipen is $600 here and less than $100 in Canada.

I see no reason for the US to be subsidizing Japan and Germany in this way. They have plenty of money too. I also don't think we should be subsidizing their security with our military, but that's another issue.

[marty998]

Do you know off-hand if there has ever been a case where the PBS refused to buy at a pharmaceutical company's price, so the product never hit the Australian market?  Or if the PBS caved and paid a much higher rate than they originally offered?  I'll look into it as well.

The product still hits the market. If the PBS doesn't cover it then it may be covered by Private Health Insurance (rarely), otherwise the consumer has to pay the exorbitant price for it out of their own pocket.

Business does not like it when lobbyists and media turn up on their doorstep asking why they are charging families hundreds of thousands for drugs that will potentially save cute little babies lives.

Corporates have much thicker skins in America to be able to do it. Over here they cave in pretty quickly and lower the price of the drugs to the point where it makes it cheap/acceptable enough for the government to pay.

I will point out though that every time US/Australia Free Trade negotiations come up (most recently with the TPP) you guys attempt to fuck us by trying to dismantle the PBS. We have held out on this till now, but I'm not sure how much longer the government will be able to hold back the tsunami that is Big Pharma.

[marty998]

http://www.pbs.gov.au/pbs/home

Link to the website. Quite a bit of useful reading/info on there.

[Bucksandreds]

I hope it passes.  We really need a laboratory to test single payer in the US

[Clever Name]

One thing I don't see mentioned here is that if it passes, there will no longer be any coverage for abortions in the state of Colorado. A 1984 ballot initiative prohibits any state funds from being spent on abortion and the language of the single-payer initiative does not repeal or amend the abortion funding ban, meaning it would still apply to the single-payer system.

[Mississippi Mudstache]

10% of income is pretty steep.  Sounds like a great step in the right direction though.  How would this mesh with the ACA reqirements?

Really? Average U.S. household income is ~$53,000, and the average annual cost of healthcare to a family of four on an employer-sponsored plan is $22,000, of which $9000 comes directly out of the family's pocket. If Colorado could actually get this plan up and running for 10% of income, that would be a gigantic cost savings.

[fa]

10% of income is pretty steep.  Sounds like a great step in the right direction though.  How would this mesh with the ACA reqirements?

Really? Average U.S. household income is ~$53,000, and the average annual cost of healthcare to a family of four on an employer-sponsored plan is $22,000, of which $9000 comes directly out of the family's pocket. If Colorado could actually get this plan up and running for 10% of income, that would be a gigantic cost savings.

The proposal states that the 10% can be raised if there is a shortfall, or benefits could be cut.  If the numbers you posted are correct, it is hard to see how a state of 5.4 million people is going to negotiate such enormous cost savings with drug companies etc.  Where are these savings going to come from?  I suspect that, if accepted, the wheels would come off pretty quickly.  Especially when if would be easy to imagine that poor and sick people would move to the state in a hurry to take advantage of the benefits, thereby increasing the health care expenditures.

[Bucksandreds]

10% of income is pretty steep.  Sounds like a great step in the right direction though.  How would this mesh with the ACA reqirements?

Really? Average U.S. household income is ~$53,000, and the average annual cost of healthcare to a family of four on an employer-sponsored plan is $22,000, of which $9000 comes directly out of the family's pocket. If Colorado could actually get this plan up and running for 10% of income, that would be a gigantic cost savings.

The proposal states that the 10% can be raised if there is a shortfall, or benefits could be cut.  If the numbers you posted are correct, it is hard to see how a state of 5.4 million people is going to negotiate such enormous cost savings with drug companies etc.  Where are these savings going to come from?  I suspect that, if accepted, the wheels would come off pretty quickly.  Especially when if would be easy to imagine that poor and sick people would move to the state in a hurry to take advantage of the benefits, thereby increasing the health care expenditures.

Couldn't Colorado just legally import all meds from Canada if drug companies won't play ball?  I always here that same moving to and from argument about a wide variety of things, especially taxes, yet California (Very high tax state) continues to grow rapidly.  New Hampshire has no income tax and Massachussetts is high tax yet Massachussetts adds more to there population yearly than New Hampshire.  Libertarian ideals are built around logical arguments which often times don't have any real evidence to back them.  I used to fall into the logic trap myself but now I look for real world evidence.

[NatureKnight]

I think I'll be voting against it. If we do this, I think it needs to be the whole country. I wouldn't feel comfortable being a part of the experiment state.

We are young and healthy for now. I know that could change at any moment, but for now this would increase our healthcare costs.

Any money I do get from working counts as self-employment. We are renting now. If it passes I think I'd strongly consider moving. Housing is already expensive now, and the extra 10% of any money I manage to make would probably push me over the edge to favor moving elsewhere.

I'm definitely not against changing our healthcare system, but I'd rather it be for the whole country ... or another state I don't live in, ha.

[Goldielocks]

How does it work for the unemployed? Because we have plenty of those here. Plenty of people have moved here for the Weed with no jobs. Homelessness is at its all time high. I don't see this helping our state, I wish CO would stop trailblazing. For those of us who grew up here, it now unrecoginizable.

Ok, in reality, your unemployed are getting free emergency care anyway, and studies have shown that in these cases, free preventative care can often reduce the total costs of emergency visits for critical issues.

Also,  parents of 20 somethings would not have to keep paying for their kids coverage, so that is a win for higher income earners, too.

[nedwin]

I am voting against this.  A similar proposal was considered in Vermont and rejected:  http://www.politico.com/story/2014/12/single-payer-vermont-113711

If they couldn't figure it out with 11.5% payroll taxes and up to 9.5% of income in premiums, I don't see any way Colorado could pay for it with only a 10% payroll tax.

[singh02]

Vermont couldn't figure it out because they wanted to offer a platinum level plan for everyone.  That is not possible.  Most countries ( I should say every first world country) have government coverage that provides basic preventive and emergency care.  Usually there is a form of private insurance  that provides for more elective (and speedier) coverage.

As much I favor some form of government health care, I agree having one only one state having it can be hard to implement and dilutes negotiation power.  Howver, if california had this proposal, after more in depth reading I would support it.

[packlawyer04]

Further, it's going to be administered by a large, government-like bureaucracy that has little chance to be efficient.

That's misinformed right-wing garbage that has been proven wrong by anyone who has done the research.

http://time.com/198/bitter-pill-why-medical-bills-are-killing-us/
Medicare, for example, has an overall administrative and management cost of about two-thirds of 1% of the amount of the claims, or less than $3.80 per claim. According to SEC filings, Aetna, for example spends about $30 for each of its claims, or about 29% (almost 10X!).
Plus - large government insurers are able to negotiate better rates. The larger, the better - power in numbers.
AND they pay less to executives and nothing to stockholders in dividends (or have profit margins to account for).

Do you know who actually operates Medicare? I'll give you a hint, they have executives and shareholders.

[Metric Mouse]

10% of income is pretty steep.  Sounds like a great step in the right direction though.  How would this mesh with the ACA reqirements?

Really? Average U.S. household income is ~$53,000, and the average annual cost of healthcare to a family of four on an employer-sponsored plan is $22,000, of which $9000 comes directly out of the family's pocket. If Colorado could actually get this plan up and running for 10% of income, that would be a gigantic cost savings.

Any data for this in Colorado specifically? Seems like you're comparing apples and the rear-wheel horsepower of 60's American muscle cars?

Did the research myself - Avg. Colorado employee makes 47K. ACA Bronze plans for Denver area run about $350 a month. So, in this scenario, a healthy person would be at a net loss at a 10% income tax. SO it could be described generously as a break even proposition, if the ACA law would allow such a subversion of its wording and not penalize people covered by their state.

[fa]

10% of income is pretty steep.  Sounds like a great step in the right direction though.  How would this mesh with the ACA reqirements?

Really? Average U.S. household income is ~$53,000, and the average annual cost of healthcare to a family of four on an employer-sponsored plan is $22,000, of which $9000 comes directly out of the family's pocket. If Colorado could actually get this plan up and running for 10% of income, that would be a gigantic cost savings.

The proposal states that the 10% can be raised if there is a shortfall, or benefits could be cut.  If the numbers you posted are correct, it is hard to see how a state of 5.4 million people is going to negotiate such enormous cost savings with drug companies etc.  Where are these savings going to come from?  I suspect that, if accepted, the wheels would come off pretty quickly.  Especially when if would be easy to imagine that poor and sick people would move to the state in a hurry to take advantage of the benefits, thereby increasing the health care expenditures.

Couldn't Colorado just legally import all meds from Canada if drug companies won't play ball?  I always here that same moving to and from argument about a wide variety of things, especially taxes, yet California (Very high tax state) continues to grow rapidly.  New Hampshire has no income tax and Massachussetts is high tax yet Massachussetts adds more to there population yearly than New Hampshire.  Libertarian ideals are built around logical arguments which often times don't have any real evidence to back them.  I used to fall into the logic trap myself but now I look for real world evidence.

Colorado couldn't do that because importing medications from other countries is prohibited.

The annual growth in GDP of California from 1963 until 2014 has been on par with Tennessee, and far below Texas and Colorado:  http://angrybearblog.com/wp-content/uploads/2013/10/growth1.jpg

Apparently CO and TX have been able to handle their economies much better than CA.  The large net migration of population from CA to CO speaks to that.  That has been happening for years.  In other words, people are voting with their feet.  That, to me, is real world evidence.

[stoaX]

10% of income is pretty steep.  Sounds like a great step in the right direction though.  How would this mesh with the ACA reqirements?

Really? Average U.S. household income is ~$53,000, and the average annual cost of healthcare to a family of four on an employer-sponsored plan is $22,000, of which $9000 comes directly out of the family's pocket. If Colorado could actually get this plan up and running for 10% of income, that would be a gigantic cost savings.

The proposal states that the 10% can be raised if there is a shortfall, or benefits could be cut.  If the numbers you posted are correct, it is hard to see how a state of 5.4 million people is going to negotiate such enormous cost savings with drug companies etc.  Where are these savings going to come from?  I suspect that, if accepted, the wheels would come off pretty quickly.  Especially when if would be easy to imagine that poor and sick people would move to the state in a hurry to take advantage of the benefits, thereby increasing the health care expenditures.

Couldn't Colorado just legally import all meds from Canada if drug companies won't play ball?  I always here that same moving to and from argument about a wide variety of things, especially taxes, yet California (Very high tax state) continues to grow rapidly.  New Hampshire has no income tax and Massachussetts is high tax yet Massachussetts adds more to there population yearly than New Hampshire.  Libertarian ideals are built around logical arguments which often times don't have any real evidence to back them.  I used to fall into the logic trap myself but now I look for real world evidence.

Colorado couldn't do that because importing medications from other countries is prohibited.

The annual growth in GDP of California from 1963 until 2014 has been on par with Tennessee, and far below Texas and Colorado:  http://angrybearblog.com/wp-content/uploads/2013/10/growth1.jpg

Apparently CO and TX have been able to handle their economies much better than CA.  The large net migration of population from CA to CO speaks to that.  That has been happening for years.  In other words, people are voting with their feet.  That, to me, is real world evidence.

Many of those migrating out of CA are doing so because their employers are leaving the state or expanding operations elsewhere leaving a smaller number of jobs in CA.  An informal list of companies in this situation include Nestle, AAA of California (ironical, ain't it!), Sprint, Chevron, Toyota and Jacobs Engineering.  Other reasons people leave California is to retire a place with a lower cost of living.

[Mississippi Mudstache]

10% of income is pretty steep.  Sounds like a great step in the right direction though.  How would this mesh with the ACA reqirements?

Really? Average U.S. household income is ~$53,000, and the average annual cost of healthcare to a family of four on an employer-sponsored plan is $22,000, of which $9000 comes directly out of the family's pocket. If Colorado could actually get this plan up and running for 10% of income, that would be a gigantic cost savings.

Any data for this in Colorado specifically? Seems like you're comparing apples and the rear-wheel horsepower of 60's American muscle cars?

Did the research myself - Avg. Colorado employee makes 47K. ACA Bronze plans for Denver area run about $350 a month. So, in this scenario, a healthy person would be at a net loss at a 10% income tax. SO it could be described generously as a break even proposition, if the ACA law would allow such a subversion of its wording and not penalize people covered by their state.

I find it pretty humorous that you made fun of me for an inapt comparison, then follow through with a doozy yourself. So you looked up the premiums for the bronze plan. Good for you. That's only relevant if you don't actually, you know, use health care. You're still on the hook for up to $6600 as an individual or $13200 as a family if you actually partake of anything more than preventative care.

There would be no deductibles or co-pays in the Colorado system as the amendment is worded:

The system would replace the medical care portion of workers' compensation insurance, there would be no deductibles, and designated preventive and primary care services would have no co-payments. Beneficiaries would be permitted to choose their primary care professionals and still be covered if they are temporarily living, or traveling, in another state

FWIW, I found relevant income data for Colorado, but I could only find average healthcare spending for the nation as a whole, which is why I provided those two numbers. I'm aware that Colorado's specifics would be slightly different, but I bet they're in the ballpark.

Now, whether or not any given individual would benefit from the system is a different story, but frankly that wasn't the point of my comment. We would benefit tremendously under that system (I spend ~26% of my annual income on healthcare). Other people would lose. That's how it works.

[fa]

10% of income is pretty steep.  Sounds like a great step in the right direction though.  How would this mesh with the ACA reqirements?

Really? Average U.S. household income is ~$53,000, and the average annual cost of healthcare to a family of four on an employer-sponsored plan is $22,000, of which $9000 comes directly out of the family's pocket. If Colorado could actually get this plan up and running for 10% of income, that would be a gigantic cost savings.

The proposal states that the 10% can be raised if there is a shortfall, or benefits could be cut.  If the numbers you posted are correct, it is hard to see how a state of 5.4 million people is going to negotiate such enormous cost savings with drug companies etc.  Where are these savings going to come from?  I suspect that, if accepted, the wheels would come off pretty quickly.  Especially when if would be easy to imagine that poor and sick people would move to the state in a hurry to take advantage of the benefits, thereby increasing the health care expenditures.

Couldn't Colorado just legally import all meds from Canada if drug companies won't play ball?  I always here that same moving to and from argument about a wide variety of things, especially taxes, yet California (Very high tax state) continues to grow rapidly.  New Hampshire has no income tax and Massachussetts is high tax yet Massachussetts adds more to there population yearly than New Hampshire.  Libertarian ideals are built around logical arguments which often times don't have any real evidence to back them.  I used to fall into the logic trap myself but now I look for real world evidence.

Colorado couldn't do that because importing medications from other countries is prohibited.

The annual growth in GDP of California from 1963 until 2014 has been on par with Tennessee, and far below Texas and Colorado:  http://angrybearblog.com/wp-content/uploads/2013/10/growth1.jpg

Apparently CO and TX have been able to handle their economies much better than CA.  The large net migration of population from CA to CO speaks to that.  That has been happening for years.  In other words, people are voting with their feet.  That, to me, is real world evidence.

Many of those migrating out of CA are doing so because their employers are leaving the state or expanding operations elsewhere leaving a smaller number of jobs in CA.  An informal list of companies in this situation include Nestle, AAA of California (ironical, ain't it!), Sprint, Chevron, Toyota and Jacobs Engineering.  Other reasons people leave California is to retire a place with a lower cost of living.

Agreed.  As far as lower cost of living....there are far better choices than Colorado.

[Scandium]

Other than the US, all (or nearly all) industrialized nations negotiate their drug prices down. And it works. The rest of the rich world pays half as much for the same drugs as Americans do. We are subsidizing the rest of the world. And padding the profits of some of the most profitable firms in the world. Simply because we refuse to have a reasonable healthcare system (like the rest of the industrialized world). Even with much cheaper prices, there would still be plenty of money in the system to incentivize new drug creation. The rest of the world hasn't put a halt on drug development by paying half as much. Most drug development research in the US is already paid for by the government (mostly via NIH at universities).

Exactly. There is a reason why the Turing AIDS drug is $350/pill here and less than $1 in Canada. And Epipen is $600 here and less than $100 in Canada.

I see no reason for the US to be subsidizing Japan and Germany in this way. They have plenty of money too. I also don't think we should be subsidizing their security with our military, but that's another issue.

In absolute terms Americans pay more for drugs, but accounting for purchasing power-parity it's about average. Of course this include developing nations where the income is low. And countries that are better at negotiating prices do better. So the argument still stands whether the US (and India and China turns out) are subsidizing the drug R&D for the UK, Australia etc.
 

[bacchi]

In absolute terms Americans pay more for drugs, but accounting for purchasing power-parity it's about average. Of course this include developing nations where the income is low. And countries that are better at negotiating prices do better. So the argument still stands whether the US (and India and China turns out) are subsidizing the drug R&D for the UK, Australia etc.

What does that question even mean? Given Pfizer's ~40% profit margin, when does "subsidized" become "ka-ching"? In other words, if the US stopped being suckas, and Pfizer's profit margin dropped to ~30%, would Pfizer stop researching drugs? "Profits are being squeezed. We're going to start selling hand lotion instead."

[Bucksandreds]

10% of income is pretty steep.  Sounds like a great step in the right direction though.  How would this mesh with the ACA reqirements?

Really? Average U.S. household income is ~$53,000, and the average annual cost of healthcare to a family of four on an employer-sponsored plan is $22,000, of which $9000 comes directly out of the family's pocket. If Colorado could actually get this plan up and running for 10% of income, that would be a gigantic cost savings.

The proposal states that the 10% can be raised if there is a shortfall, or benefits could be cut.  If the numbers you posted are correct, it is hard to see how a state of 5.4 million people is going to negotiate such enormous cost savings with drug companies etc.  Where are these savings going to come from?  I suspect that, if accepted, the wheels would come off pretty quickly.  Especially when if would be easy to imagine that poor and sick people would move to the state in a hurry to take advantage of the benefits, thereby increasing the health care expenditures.

Couldn't Colorado just legally import all meds from Canada if drug companies won't play ball?  I always here that same moving to and from argument about a wide variety of things, especially taxes, yet California (Very high tax state) continues to grow rapidly.  New Hampshire has no income tax and Massachussetts is high tax yet Massachussetts adds more to there population yearly than New Hampshire.  Libertarian ideals are built around logical arguments which often times don't have any real evidence to back them.  I used to fall into the logic trap myself but now I look for real world evidence.

Colorado couldn't do that because importing medications from other countries is prohibited.

The annual growth in GDP of California from 1963 until 2014 has been on par with Tennessee, and far below Texas and Colorado:  http://angrybearblog.com/wp-content/uploads/2013/10/growth1.jpg

Apparently CO and TX have been able to handle their economies much better than CA.  The large net migration of population from CA to CO speaks to that.  That has been happening for years.  In other words, people are voting with their feet.  That, to me, is real world evidence.

Only data I found was that California grew .98% faster than the national average since 2010 and that is at a state with maybe the highest tax burden. Funny you didnt say anything about Massachusetts and New Hampshire.  Guess that Massachusetts growing 3.5 times faster than New Hampshire plays a part in that.  The data does not match your hypotheses. Try again.

https://en.wikipedia.org/wiki/List_of_U.S._states_by_population_growth_rate

[MayDay]

Interesting.  This is the first I've heard of it.

10% seems reasonable to me, depending on what it covers and what the OOP Max is.  We have an income of around 100K and use about 10K of OOP healthcare most years.  So it doesn't seems crazy to me as a highish income person.  I see huge value in a single system and eliminating a lot of the bureaucracy surrounding billing and paying claims. But obviously the devil is in the details. 

[AlanStache]

Did not read the link but would the CO govt become the only insurer in the state or would it 'nationalize' the states healthcare infrastructure?  I think most other single payer systems the State owns the hospitals to some extent - does anyone have data on this?

[BuildingFrugalHabits]

As another data point. The High Deductible plan at my work costs me $54 per pay period for individual coverage or $1,404 yearly ($800 of which goes to the HSA).  The employer pays $162 ($4,212 yearly).  I can currently pay my premiums and max out my HSA account every year for about what the proposed plan would cost.  I like the idea of no deductibles though but I think mine is around $1,500.  I like the fact that it would help a lot of people who are as fortunate and I think this is the direction we need to go as a nation. 

However, the biggest problem I see though is that as others have said, it needs to be done on the federal level to avoid people moving here for free healthcare and overloading the system.  We already have too many folks that moved here for the legal pot which is straining our resources and infrastructure.  If it has to start with a state, maybe California can lead the way on this one. 

[Threshkin]

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