
SMBC on Healthcare for Small Business Owners - saalweachter
http://www.smbc-comics.com/comic/healthcare
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DoodleBuggy
The state of US health insurance and care has become a competitive
disadvantage that discourages innovation and entrepreneurship. That's very bad
policy for any country, but particularly for one that prides itself on The
American Dream, innovation, and being your own boss. Every entrepreneur,
freelancer, and small business owner I know has a ridiculous story of costs,
insurance debacles, and often care too. You'll also now hear absurd stories
from people with group employer provided plans. That should be a national
embarrassment.

Every other developed country in the world has figured this out, and at much
lower cost.

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ljoshua
Insurance premium increases this year have seriously made me consider whether
it's worth it to continue running co-founder with my startup, or whether I
should just jump back into "normal" employment. I'd love to continue growing
my company to the point where we're hiring enough people to qualify for group
insurance or where a PEO makes sense, but we're just not there yet and we want
to continue to bootstrap it.

I am probably more familiar with insurance than most, having done detailed
research in the arena and knowing pros in the industry. My premiums this year
increased by _only_ 40%, on top of the 65% from last year's increase; a
pleasant surprise. I have a 25 sheet Excel doc that models out my family's
expected healthcare costs for the year to compare individual plans. If I were
to stay with my current plan (which I won't) it would cost me well over
$32,000 in total next year. I've spent many hours trying to figure out what
the best financial path forward is, and I still have some huge question marks.
(Ever tried to get coverage information for particular CPT codes from an
insurer? Ha, good luck!)

Unfortunately, a lot of the cost comes down to the demographics of the
individual market, and I don't know much of what can be done about that. I
don't fault the actuaries at the insurance cos for doing their job, and it's
true that despite the crazy premiums and poor coverage the insurance cos are
still bleeding money in the individual markets. Having also lived in countries
with single-payer systems I don't believe that is the solution either. But
something's got to give or entrepreneurs just won't be able to afford being
entrepreneurs anymore. (And the situation will just get worse for non-
entrepreneurs who don't have access to group coverage).

~~~
tomjen3
How is the demographics so bad for self-employed people? I would assume the
group is roughly the same as those who work for other business, with some bias
towards being more practical.

Anyway the solution is the same reason my grandmother (a retired teacher) has
very cheap home insurance: her union had their own and they were not allowed
to make a profit.

What the US need is an association of small independent business owners, who
can do the same.

~~~
ljoshua
Self-employed people are in the same demographic as other individuals without
any access to group insurance, such as those working lower-end, lower-paying
jobs. As a matter of sheer statistics, a larger proportion of this population
ends up sicker and incurs greater medical expenses.

Something similar to what your grandmother had or other unions is a PEO, or
professional employer organization. It's a collection of small businesses
(usually) that band together to get access to services otherwise only
available to larger groups. It's a little interesting because technically you
become an employee of the PEO as well as your own company, and there are
certainly costs associated with it, but it's in the same vein as union dues,
for example. Just not as clear cut and not required.

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3riverdev
One suggestion: there are several fantastic medical cost sharing plans that
end up being exponentially cheaper than traditional insurance. We use
Samaritan Ministries and have had nothing but great experiences. Full coverage
for most needs, no network restrictions, etc, all for $500/month for our
family of four. Samaritan is a religious org, but there are others that are
not, [https://www.libertyhealthshare.org](https://www.libertyhealthshare.org)
being the most notable.

~~~
maxerickson
Your link is at least quasi-religious.

[https://www.libertyhealthshare.org/do-i-
qualify](https://www.libertyhealthshare.org/do-i-qualify)

 _Our members:...Worship regularly with others_

~~~
3riverdev
Great catch! It looks like Liberty has been taken over by a different
organization. It used to be a simple "respect everyone, regardless of
backgrounds" group...

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goalieca
What good is all the capital in the world for investing in businesses when
people have to play it safe because there’s no social safety net.

~~~
RightMillennial
I partially agree, but I think is has less to do with social safety nets and
more to do with our atrocious healthcare regulations. I can go to my dentist
or a car mechanic and know how much something is going to cost me. Good luck
getting a quote from a doctor's office or medical insurance provider. And
don't mind that auxiliary bill that arrives 6 months later. Wait, what
appointment was that?

The fact is heathcare costs are outrageous, medical insurance rates are just
as bad, and our current regulations are clearly not making it better. I don't
know whether the ACA has slowed the progression or made it worse (everyone
seems to disagree). But it needs to be fixed. That could include heavy price
controls, "free-market" insurance, "single-payer" insurance, or whatever else.
That would require both parties in Congress to work together, though, and not
on pet projects.

~~~
bobdole1234
I think it's funny how you say "both parties" like there isn't exactly one
side that is completely and utterly responsible for the lack of motion on that
front.

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stmfreak
Insurance is a red herring. The true problem are the runaway costs. Costs
which are protected by government regulations. So we do need a government
intervention of sorts, but the correct answer is to reduce regulations and
cost protections--not just make taxpayers fund the entire mess.

