AB 1400

[nimbus]

Calcare is a M4A style single payor universal healthcare. Supported by 65% of Californians. We have a large proportion of indigent and uninsured patients. Would be nice if everyone is covered. Private insurance companies will oppose it.

https://cdn.ymaws.com/www.naswca.org/resource/resmgr/files/2021lld/AB-1400-fact-sheet.pdf

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[kidthor]

I'm curious whether this would negatively or positively impact blended units and overall payment. It could eliminate "self" / no pay cohorts but at a rate in the 20s per unit. Also unclear if it would erode private insurance subscriptions via the exchange, and/or would would a corollary to medicare advantage emerge (and if it did would that improve anesthesia billing above the govt rate, probably not).

 

[coffeebythelake]

Medicaid for all?
These systems ultimately fail and at the expense of healthcare providers.

 

[deleted941485]

I'm curious whether this would negatively or positively impact blended units and overall payment. It could eliminate "self" / no pay cohorts but at a rate in the 20s per unit. Also unclear if it would erode private insurance subscriptions via the exchange, and/or would would a corollary to medicare advantage emerge (and if it did would that improve anesthesia billing above the govt rate, probably not).

Yeah just based on the handout attached it’s not clear this does anything to improve anesthesia abysmal govt reimbursement for anesthesia in general esp in Cali.

Something is better than nothing justification is hollow. It would likely bring down what’s left of the private system in CA.

 

[nimbus]

I'm curious whether this would negatively or positively impact blended units and overall payment. It could eliminate "self" / no pay cohorts but at a rate in the 20s per unit. Also unclear if it would erode private insurance subscriptions via the exchange, and/or would would a corollary to medicare advantage emerge (and if it did would that improve anesthesia billing above the govt rate, probably not).

Private insurance would not be allowed. The rate would have to be negotiated. It would be a big money grab at the beginning.

 

[nimbus]

https://a27.asmdc.org/sites/a27.asmdc.org/files/2021-10/FAQ%20-%20AB%201400_final_10-6-21.pdf

 

[deleted941485]

Private insurance would not be allowed. The rate would have to be negotiated. It would be a big money grab at the beginning.

https://a27.asmdc.org/sites/a27.asmdc.org/files/2021-10/FAQ%20-%20AB%201400_final_10-6-21.pdf

This is lame. It’s just a grab bag of goodies. (Do you cover X? Yes. Will it cost more? No because we will make it cost less. Does it address inequality? Yes. Can you leave calcare? No.) No mechanism for how it’s paid not like it would matter. Just forcing “providers” to take calcare shouldn’t be a problem…plenty of pushover docs there in Cali.

Also why isn’t this on the front page of the NYT?

 

[GassYous]

I'm curious whether this would negatively or positively impact blended units and overall payment. It could eliminate "self" / no pay cohorts but at a rate in the 20s per unit. Also unclear if it would erode private insurance subscriptions via the exchange, and/or would would a corollary to medicare advantage emerge (and if it did would that improve anesthesia billing above the govt rate, probably not).

Cue the hysterical news articles "GREEDY DOCTORS CHARGING 2000% MORE THAN CALCARE"

 

[deleted941485]

Cue the hysterical news articles "GREEDY DOCTORS CHARGING 2000% MORE THAN CALCARE"

They fail to mention they pay like 10/unit for a case if MediCal is any guide.

Voters can't do math but they do understand the word free and they like it.

The real hard hitting questions from the pamphlet

What will this cover? - Everything
How much will it cost? - It will cost less and you will pay nothing
Can I leave? - Why would you want to?

 

[kidthor]

What will this cover? - Everything
How much will it cost? - It will cost less and you will pay nothing
Can I leave? - Why would you want to?

Do I get a free phone with it? And it better be an iphone 13.

 

[deleted941485]

Do I get a free phone with it? And it better be an iphone 13.

Foolish doctor, Smart Phones are medical equipment fully reimbursable by CaliCare Fee Schedule.

So if you don't support AB1400, you are a greedy POS white privilege supremacist antivaxxer greedy doctor who needs to be burned at the stake while your family and patients are forced to watch and applaud your demise!

 

[nimbus]

Cue the hysterical news articles "GREEDY DOCTORS CHARGING 2000% MORE THAN CALCARE"

You couldn’t charge 2000% of Calcare. The way it’s written now, if you participate in Calcare, you don’t take anything else. There would be no private insurance in CA. Only a tiny fraction of doctors who don’t participate in Calcare at all would be able to participate in other plans.

 

[Status Sciaticus]

LOL can you just not participate in it? Similarly, can you jut not accept poor paying medicaid patients?

 

[deleted941485]

LOL can you just not participate in it? Similarly, can you jut not accept poor paying medicaid patients?

No and if your a hospital based specialty you sure as **** will be in this. Also if your banning all other payors in the state and requiring all medically nessesary procedures to be covered by it…it’s pretty much implied.

 

[chessknt]

They are just accelerating the inevitable and at least this way they knock out the health insurance company executives making millions just leaving the hospital executives. They should have gone for public seizure of all healthcare facilities too. Burn it all down our system sucks.

 

[Status Sciaticus]

No and if your a hospital based specialty you sure as **** will be in this. Also if your banning all other payors in the state and requiring all medically nessesary procedures to be covered by it…it’s pretty much implied.

One more reason to stop living in that S***hole state

 

[narcotics999]

What about Kaiser? How can it survive in this CA version of Medicare/MediCal for all?

 

[deleted941485]

What about Kaiser? How can it survive in this CA version of Medicare/MediCal for all?

HAHA - knowing them KHN probably supports it. Probably worked out some backdoor deal that screws the MDs or something.

 

[HemeOncHopeful19]

What would happen if someone was on vacation out of state and got sick? They’re just self pay?

 

[chessknt]

What would happen if someone was on vacation out of state and got sick? They’re just self pay?

They pay the median network rate remember? Coming soon to a single digit conversion factor near you.

Meanwhile a single ineffective drug for people with a terminal disease singlehanded gets reimbursed at asking price at the expense of everyone. Gotta love it.

HHS secretary orders Medicare to ‘reassess’ premium increase driven by Alzheimer’s drug

Secretary of Health and Human Services (HHS) Xavier Becerra on Monday ordered Medicare to “reassess” a proposed premium increase after an expensive new Alzheimer’s drug fell in price.“Today I’m ins…

thehill.com

 

[deleted941485]

They pay the median network rate remember? Coming soon to a single digit conversion factor near you.

Meanwhile a single ineffective drug for people with a terminal disease singlehanded gets reimbursed at asking price at the expense of everyone. Gotta love it.

HHS secretary orders Medicare to ‘reassess’ premium increase driven by Alzheimer’s drug

Secretary of Health and Human Services (HHS) Xavier Becerra on Monday ordered Medicare to “reassess” a proposed premium increase after an expensive new Alzheimer’s drug fell in price.“Today I’m ins…

thehill.com

And when your the only payor…there won’t be a median…just a rate.

 

[chessknt]

And when your the only payor…there won’t be a median…just a rate.

Isn’t that what the no surprises billing law is going to be in a few years once they effectively collide? Except with that there are a bunch of executives congratulating themselves on profiting off of the lower median rates while doing blow off a hooker. At least in this scenario it will be an overpaid office drone sitting through a sexual harassment annual training video. Everyone suffers!

 

[deleted941485]

Isn’t that what the no surprises billing law is going to be in a few years once they effectively collide? Except with that there are a bunch of executives congratulating themselves on profiting off of the lower median rates while doing blow off a hooker. At least in this scenario it will be an overpaid office drone sitting through a sexual harassment annual training video. Everyone suffers!

No surprises becomes redundant when AB passes.

 

[nimbus]

No surprises becomes redundant when AB passes.

Yep. There will be no deductibles, out of pocket costs, or billing at all if it comes to fruition as described.


Having paid for memory care for the past 2 years for an elderly family member who passed away last November, I do like some parts of the plan.


If it passes, it will be an interesting experiment to say the least. It’ll be a test to see if single payor universal healthcare can work in the USA.

 

[GassYous]

Yep. There will be no deductibles, out of pocket costs, or billing at all if it comes to fruition as described.


Having paid for memory care for the past 2 years for an elderly family member who passed away last November, I do like some parts of the plan.


If it passes, it will be an interesting experiment to say the least. It’ll be a test to see if single payor universal healthcare can work in the USA.

Pay less and get better quality from reducing waste and improving efficiencies! It's so crazy it might work!

What are the chances that they have zero clue about how the system works and not only will costs go up but physician pay will go down

Too many ignorant do gooders in that godforsaken state

 

[coffeebythelake]

If it passes, it will be an interesting experiment to say the least. It’ll be a test to see if single payor universal healthcare can work in the USA.

single payor universal healthcare only works when everyone is faithful and fair in negotiations for price.
right now, the government wants to set a pathetically low price and force it down your throats

 

[deleted941485]

single payor universal healthcare only works when everyone is faithful and fair in negotiations for price.
right now, the government wants to set a pathetically low price and force it down your throats

This is what it essentially boils down to…I do not trust them treat physicians fairly. If current govt health programs are any guide, you are in for a terrible future. And if you complain, you’ll be silenced.

 

[chessknt]

single payor universal healthcare only works when everyone is faithful and fair in negotiations for price.
right now, the government wants to set a pathetically low price and force it down your throats

Private insurers are going to do this too plus they get to keep the profit to buy corporate jets.

 

[coffeebythelake]

This is what it essentially boils down to…I do not trust them treat physicians fairly. If current govt health programs are any guide, you are in for a terrible future. And if you complain, you’ll be silenced.

When I drove down orange county and saw rows of million dollar houses, average house price 700k, and that 80% of the population was on California medicaid, I knew this state was ****ed beyond redemption. Now thry want to add onto this dumpster fire. I guess they don't want medical providers in the state. Not even midlevels would want to work in places like this, except doing cash sales cosmetic BS

 

[anbuitachi]

is it even legal to ban private insurance? this sounds like a monopoly!

 

[deleted941485]

They’re really banking the good weather and local amenities for you to put up with their bull**** is what this is about. It’s not because they’re enlightened.

Placed was ****ed well before ab1400 showed up.

When I drove down orange county and saw rows of million dollar houses, average house price 700k, and that 80% of the population was on California medicaid, I knew this state was ****ed beyond redemption. Now thry want to add onto this dumpster fire. I guess they don't want medical providers in the state. Not even midlevels would want to work in places like this, except doing cash sales cosmetic BS

 

[deleted941485]

is it even legal to ban private insurance? this sounds like a monopoly!

It’s just a starting point. I could see them roping in insurance companies by allowing them to administer the public health program lol. CalCare advantage! Lol

 

[GassYous]

They’re really banking the good weather and local amenities for you to put up with their bull**** is what this is about. It’s not because they’re enlightened.

Placed was ****ed well before ab1400 showed up.

I mean it is pretty nice to have 60s when the midwest and the east coast are in the 20s

 

[Status Sciaticus]

is it even legal to ban private insurance? this sounds like a monopoly!

the ACGME would like to have a word
The Joint Commission would also like to have a word

 

[nimbus]

Universal healthcare is a very popular idea. Medicare is very popular among seniors and considered untouchable. People will not move out of the state in droves because of AB1400.


The vast majority of Americans support UHC and the proportion of people who support universal single payor healthcare are even higher in countries that already have it. The majority of first world countries already have it. In this regard, the US is again in the third world tier.

Increasing share of Americans favor a single government program to provide health care coverage

63% of U.S. adults say the government has the responsibility to provide health care coverage for all, up slightly from 59% last year.

www.pewresearch.org

70 percent of Americans support ‘Medicare for all’ proposal

Seventy percent said they supported providing “Medicare for all,” also known as single-payer health care, for Americans, according to a new American Barometer survey. The poll, con…

thehill.com

http://irpp.org/wp-content/uploads/assets/po/health-care/nanos.pdf

 

[anbuitachi]

UK is vastly different than US. US is way more diverse and way more expensive than UK. UK is 87% white...

I hear from my colleagues that medicare with their parts abcd or whatever is very expensive? like 10k+ per person per year. cheaper than private but still super expensive? Not sure how it works exactly since i havent qualified yet

 

[anbuitachi]

Actually i looked it up cause i was curious
for 2022
Maximum cost for premium only not including deductible
Medicare part a 499/month
part b 578/month
part c depends on plan
part d is 78$ plus premium

thats 13860 per year per person on medicare A B D (not including premium price for part D which is likely another 1k+ per year)!!

i find it crazy that medicare cost varies so much by income since the higher income people paid more to medicare tax previously... but it is what it is

i guess it also helps explain why poor people of the world immigrate to USA

 

[deleted941485]

Universal healthcare is a very popular idea. Medicare is very popular among seniors and considered untouchable. People will not move out of the state in droves because of AB1400.


The vast majority of Americans support UHC and the proportion of people who support universal single payor healthcare are even higher in countries that already have it. The majority of first world countries already have it. In this regard, the US is again in the third world tier.

Increasing share of Americans favor a single government program to provide health care coverage

63% of U.S. adults say the government has the responsibility to provide health care coverage for all, up slightly from 59% last year.

www.pewresearch.org

70 percent of Americans support ‘Medicare for all’ proposal

Seventy percent said they supported providing “Medicare for all,” also known as single-payer health care, for Americans, according to a new American Barometer survey. The poll, con…

thehill.com

http://irpp.org/wp-content/uploads/assets/po/health-care/nanos.pdf

Turning anything that’s costly into a free public good will always be popular. It’s a facile argument. “Everyone else is doing it” is also not an argument.

 

[Twiggidy]

Universal healthcare is a very popular idea. Medicare is very popular among seniors and considered untouchable. People will not move out of the state in droves because of AB1400.


The vast majority of Americans support UHC and the proportion of people who support universal single payor healthcare are even higher in countries that already have it. The majority of first world countries already have it. In this regard, the US is again in the third world tier.

Increasing share of Americans favor a single government program to provide health care coverage

63% of U.S. adults say the government has the responsibility to provide health care coverage for all, up slightly from 59% last year.

www.pewresearch.org

70 percent of Americans support ‘Medicare for all’ proposal

Seventy percent said they supported providing “Medicare for all,” also known as single-payer health care, for Americans, according to a new American Barometer survey. The poll, con…

thehill.com

http://irpp.org/wp-content/uploads/assets/po/health-care/nanos.pdf

Many Americans support universal healthcare but I don't think there is the same amount of support among physicians. I could be wrong. Brits love their healthcare but it's not breaking news that the NHS has staff shortages and is overwhelmed even when it was a "non-Covid" world. As per usual, this will hurt specialist more than it hurts primary care. I suspect many older docs will lean toward retirement, some mid career docs may actually consider a move, younger doc will have to alter their lifestyle if they want to be a California doctor. Homes wont get cheaper because physicians are getting paid less. Just theories.....

 

[nimbus]

Turning anything that’s costly into a free public good will always be popular. It’s a facile argument. “Everyone else is doing it” is also not an argument.

Sure it is. Not speaking as a doctor but as a citizen. Why shouldn’t we offer what our peer nations offer?

 

[nimbus]

Many Americans support universal healthcare but I don't think there is the same amount of support among physicians. I could be wrong. Brits love their healthcare but it's not breaking news that the NHS has staff shortages and is overwhelmed even when it was a "non-Covid" world. As per usual, this will hurt specialist more than it hurts primary care. I suspect many older docs will lean toward retirement, some mid career docs may actually consider a move, younger doc will have to alter their lifestyle if they want to be a California doctor. Homes wont get cheaper because physicians are getting paid less. Just theories.....

What you say is probably true. There may be a few true believers who stay regardless of pay. But all in all, Calcare will have to offer competitive pay to all HCWs in order to recruit enough workers. CA already has the best paid nurses, prison guards, and sheriffs deputies in the entire nation because it’s expensive to live here. Many of the doctors who work in the UC system and county health systems also make more than their private practice counterparts and get stepwise annual raises while the rest of the doctors don’t. Somehow state employment has not hurt those people. Insurance companies probably don’t like the idea either.

 

[deleted941485]

Sure it is. Not speaking as a doctor but as a citizen. Why shouldn’t we offer what our peer nations offer?

No it isn’t. This is just another variation on the same non argument only this time instead of everyone it’s just “peers”

 

[DoctwoB]

Hard to see this passing for a lot of reasons. Universal health care as an idea is quite popular. Implementing it would be a nightmare because even if money is saved for the system as a whole where and to whom the money flows from and to becomes drastically different. Kaiser and Sutter are 2 of the biggest employers in the state. Both collapse without either high premiums (kaiser) or high private insurance payment (Sutter).

Many employers will be against it and the fact that they can no longer use insurance as a competetive advantage in employee recruitment/retention meaning the will *gasp* have to pay people more money to retain them. Many people with good insurance (e.g. the tech industry, unions) will balk at losing it. Add to that that passage would require supermajorities in both houses (which D's have, but can't afford defections), multiple propositions to pass, and federal medicare/medicaid waivers, possible authorized by congress) and it seems like a longshot.

 

[nimbus]

Notice which countries are red.

 

[nimbus]

Hard to see this passing for a lot of reasons. Universal health care as an idea is quite popular. Implementing it would be a nightmare because even if money is saved for the system as a whole where and to whom the money flows from and to becomes drastically different. Kaiser and Sutter are 2 of the biggest employers in the state. Both collapse without either high premiums (kaiser) or high private insurance payment (Sutter).

Many employers will be against it and the fact that they can no longer use insurance as a competetive advantage in employee recruitment/retention meaning the will *gasp* have to pay people more money to retain them. Many people with good insurance (e.g. the tech industry, unions) will balk at losing it. Add to that that passage would require supermajorities in both houses (which D's have, but can't afford defections), multiple propositions to pass, and federal medicare/medicaid waivers, possible authorized by congress) and it seems like a longshot.

Agree it’s a long shot.

 

[GassYous]

They are projecting it will cost like 130 billion more than what they already spend. That's just insanity. Doctors will basically be paying themselves out of their taxes to treat patients. Reimbursement from medi-cal is already super low as it is.

 

[nimbus]

No it isn’t. This is just another variation on the same non argument only this time instead of everyone it’s just “peers”

How about this argument. The government spends a lot of money on the military. We have a universal single payor military for our safety, protection, and to advance our geopolitical agenda. Why is healthcare less important?

 

[Twiggidy]

How about this argument. The government spends a lot of money on the military. We have a universal single payor military for our safety, protection, and to advance our geopolitical agenda. Why is healthcare less important?

Because I can't fill my gas tank with healthcare *tongue in cheek*

 

[anbuitachi]

every country has its differences, i thin we need to do whats best for our country. US is a very different country from our peers despite what many of us think and that includes all the countries in Europe.

 

[DoctwoB]

There are a lot of reasonable arguments for single payer (and reasonable arguments against). But these arguments for don't take into account that we're not designing a system from the ground up. We're dealing with uprooting the largest industry in America. There would be the biggest recession in recent memory. An estimate of 2 million jobs would disappear with M4A. This isn't inherently a bad thing, as by definition many of the jobs eliminated are due to increased efficiency, but it would be absolutely catastrophic, especially in regions (many) where healthcare and insurance are the dominant employers.

Medicare for All’s jobs problem

The big Democratic talking point has a big political weakness: It could wipe out thousands of jobs in places like Pittsburgh that have built their new economies on health care.

www.politico.com