
What Startups Need To Know About Health Insurance in 2013 - g_h
http://blog.simplyinsured.com/what-startups-need-to-know-about-health-insurance-in-2013/
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kzahel
Everything I read about healthcare recently just reinforces the notion that we
need public health care. Let's just model our system after say, Canada's, and
call it done.

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paulhauggis
Issues I have with public health care:

1) The government hasn't been able to run anything efficiently as long as I've
been alive. It's not like we can just go back if UHC doesn't work out.

2) The more the government runs our lives (especially something like health
care), the more they will be able to dictate our choices (what we eat, risky
behavior, etc).

3) I haven't seen one person that supports public health care tell me the
downsides. I know they exist and we need to know the risks (and talk about
them openly) before making such a huge change to our current system.

~~~
rprasad
Issues with private health care:

1) Private health insurers haven't been able to run anything efficiently as
long as I've been alive. My premiums go up by double digit percentages every
year because "costs" keep increasing, but at the same time, insurers' profits
go up by double digit percentages every year. It seems like this is simply a
money transfer to health care executives.

2) The more private companies run our lives (especially something like
healthcare), the more they will be able to dictate our choices (what we eat,
risky behavior etc). Oh wait... corporations already do dictate what we eat,
what sort of medicine we use, where we work, how we communicate, how we move
around, what we wear...The only difference between corporate control and
government control is that we actually have some say in how the government
controls us _because at the end of the day we control the government._

3) I haven't seen on person that supports privated health care tell me the
downside. I know they exist and we need to know the risks and talk about them
openly before we stick with such a horrible system.

But anyways, the downsides to public health care: cafeteria health care (i.e.,
standardized treatments) which is good for most patients but not for the few
who have nonstandard variations of ailments; higher taxes; less personalized
care as a consequence of standardized treatments; potentially reduced choice
of health care provider(s) (but if the entire system is UHC this may not be
the case); potentially longer waits for medical treatment that cannot be
handled in a day (i.e., anything that cannot be handled outpatient or by
nurses or nurse practitioners).

And the downsides to private health care: _all of the above, plus:_ risk of
claim denial for valid claims (though admittedly less of a risk now as a
consequence of numerous state and federal laws cracking down on claim
denials); double-digit increases in premiums every year despite no
corresponding increase in costs ( _this is actually happening, and has been
happening, every year for the past decade_ ); reduced choice of health care
providers (which is actually the case now, i.e., in-network vs. out-of-
network); ruinous medical bills; unnecessary tests and treatments; private
health information being shared with "business partners"; inadequate medical
facilities as a result of lack of capital investment due to premiums being
redirected to marketing or executive retention.

It turns out the downsides of a private health care system outweigh the
downsides of a public health care system, since you have all of the same
downsides but the additional downsides that come with a profit-seeking
business. And as history has amptly demonstrated, cost-cutting is not one of
the benefits of a private health care system (costs are cut in a way that
benefits the insurer's profits, but in ways which are detrimental to the
insured).

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IanDrake
Total BS.

Have any figures to support your first point? Here's CIGNA:
<http://yhoo.it/TLkvyd> increase in Net Income: 2010 - 3.3%, 2011 - (1.3%)

>the more they will be able to dictate our choices

Private companies can't force you do to anything, only government can do that.
<http://bit.ly/Q4lj1s> <http://nbcnews.to/rK90ox>

>government control is that we actually have some say in how the government
controls us because at the end of the day we control the government.

That was a joke right?

As it is there is a shortage of nurses and doctors. Partly because it costs a
lot of money and effort to enter that profession. How many people will be
motivated to go that direction if they'll be slaves to government decree? It
will take some time, but the effect of government controlled healthcare will
be a race to the bottom.

Also, the profit motive is what keeps costs down and service levels high. The
less regulated an industry is, the better the service and products are
available to consumers who now have choice.

~~~
beagle3
> As it is there is a shortage of nurses and doctors. Partly because it costs
> a lot of money and effort to enter that profession.

In the not-so-distant-past (less than 10 years ago!) mostly because the AMA
tightly controls the influx of new people to the field, in an attempt to make
sure that the salaries remain high:
[http://skeptics.stackexchange.com/questions/4561/does-the-
am...](http://skeptics.stackexchange.com/questions/4561/does-the-ama-limit-
the-number-of-doctors-to-increase-current-doctors-salaries)

(Although now they are trying, so far unsuccessfully, to reverse it)

> How many people will be motivated to go that direction if they'll be slaves
> to government decree?

Instead of philosophizing in the void, why don't you look at other countries
where, gasp, that is the case? Look at Canada, France, the UK, Israel,
Hungary, and any other single payer country. Medical schools still have a 1:10
acceptance ratio, and are usually the hardest or 2nd hardest to get into.
There is no "race to the bottom" in countries that had this system for over 50
years.

> Also, the profit motive is what keeps costs down and service levels high.

And yet, the US system is the most expensive system for what it gives
(compared to single payer), and what it gives isn't better when you measure
e.g. life expectancy. I would say you never actually looked at data if you can
say that with a straight face.

> The less regulated an industry is, the better the service and products are
> available to consumers who now have choice.

I agree about that, but the US healthcare industry is extremely regulated in
all the wrong ways. For example, they are exempt from any claim of
anticompetitive or antitrust. How do you think that affects choice?

~~~
IanDrake
>And yet, the US system is the most expensive system for what it gives...

I was making a generalized comment. As you said, the US healthcare industry is
extremely regulated, which is what I believe is the root of the problem we
face.

People who want a the government to control health care are pointing at a
system with a ton of government interference and saying "Look that isn't
working well, we must need more government."

>How do you think that affects choice? Poorly. But they're exempt because
they're also force to take all comers. It's a water fall of faulty logic and
regulation.

I'm not defending the current system. I'm advocating a free market system,
which isn't anything like what we have right now.

~~~
beagle3
> People who want a the government to control health care

No one wants the government to _control_ healthcare. Many people want the
government to _run_ healthcare, and accept that as a result it will be
government _controlled_ . You might consider this a distinction without
difference, but it paints supporters of public health care in a light they do
not deserve. An analogy:

You seem to want _my_ health care to be controlled by people whose _own_
profit is their motive -- in fact, by corporations who are required by law to
_maximize_ shareholder profit at the expense of _my_ health.

> "Look that isn't working well, we must need more government."

Most are saying "look, that isn't working well. But e.g. NHS in England is
working extremely well. Let's copy that". And after looking at the NHS, it
turns out that you need more (and especially, a very different kind) of
government involvement.

Can you point to a working example of a system that you believe in? Because if
you can't, I think the NHS and government involvement carry a LOT more weight
as arguments.

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ultraswank
I've been hearing a lot of anecdotal evidence lately that the costs of private
health insurance are stopping people, especially those with kids, from making
the leap into their own start ups. Is anyone else getting that same
impression? In my own experience on the topic I've become increasingly
frustrated with the U.S. system of employer provided health care. Either give
us a public option with universal coverage, or a true private system with the
benefits of market efficiencies and a standard tax policy. This muddled middle
ground seems to give us the worst of both, and the only people who benefit are
large employers who have one more thing to prevent employees from jumping
ship.

~~~
mniejiki
You can get COBRA so it's not that you won't have insurance but rather that
you will pay for it yourself. And have 18 months to find a longer term option
if you can. It's what I did although I am single without kids so my rate was
significantly lower.

Of course that is exactly what your employer paid on your behalf before. So
you're basically complaining that other people will now no longer be
subsidizing your medical costs. A private system won't help you much. A public
one will but merely because people who pay taxes will now be subsidizing you.

~~~
jgon
This is exactly why a public system would help. Because the amount you pay for
healthcare is scaled to your ability (via progressive taxes). Buying a private
plan is not.

To see why this matters, imagine embarking on your "conquer the world"
startup. You've saved up enough money for 12 months of runway. In a public
system you are making 0 dollars and thus won't be taxed. However you will
still have full health care. In a private system you will need to pair a
fairly substantial amount (but probably not too much more than the amount of
taxes that would go to healthcare in a public system) to receive coverage. You
now have the following consquences: a) less runway or, b) more time saving up
to get an equivalent amount of runway or, c) not having coverage and praying
nothing goes wrong d) you just don't pursue your idea because it would be too
hard.

Then, in a public system, when your startup succeeds and you make 10 million,
you are taxed progressively on that money so as to fund the next hungry young
graduate with a dream and a compiler.

I think it is pretty clear that the public system allows for more risk-taking.
It is also important to note from your own example that private insurance is
pretty expensive unless you are young, single, and without kids. This
eliminates a huge swath of the population, all of whom might have different
and awesome ideas. We bemoan the lack of gender and racial diversity in the
computer field, but I think that the lack of age, lifestyle diversity in
start-ups is just as important an issue.

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jtchang
God damn health care is like a boondoggle of epic proportions. Finding
healthcare should be as easy as looking up a favorite restaurant and reading
the reviews.

Is there anyway to FIX this?

~~~
jacoblyles
>Is there anyway to FIX this?

No. It's a highly regulated industry with limited room for innovation. You
basically have to wait for congress to fix it.

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amit_m
What startups outside the US need to know about health insurance in 2013:
nothing.

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koops
I would recommend Kaiser coverage to anyone thinking about switching from one
of those plans with big increases. Their doctors don't get extra money for
performing extra procedures as is the case in a lot of plans, so there is more
incentive to just do what's necessary.

~~~
alok-g
Would that mean that they would send the patients back home unless they can
provably identify some issue? (This has happened to me a few times (with the
issue re-discovered at a later point), though I have never been with Kaiser.)

~~~
koops
Some of the Kaiser doctors are more evidence-based than others. But none of
them take home more money if, for example, they operate on your rather than
not. That is still true in many plans, even high-end ones, though they're not
going to tell you about it.

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mikejharrison
I'd like a single insurance policy to cover me for everything, driving my car,
riding my motorbike, health care, critical illness, theft/damage of my
possessions or property etc. I'd be happy for lots of data to be collected to
refine the policy and tailor the price specifically. Put a black box in my
vehicles, collect data about my activity / exercise with a fitbit type device,
access my medical record. If it means I have the convenience of just one
policy to renew, and I'm paying an insurance premium based on me, my
lifestyle, and my driving style - not the average Joe's, I'd be more than
happy.

~~~
sjg007
It is not clear if the aggregate pool in general results in cheaper prices vs
the complete customized personal option.

In fact, if the former is cheaper, then just paying taxes is the best option.

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tricky
I got the green light to work on my startup full time. BUT, i have to figure
out health care for my wife and infant before I can quit my job.

We've been spoiled with a tremendous insurance for so long. Can anyone offer
any advice or give helpful anecdotes about their experiences (good or bad)
going solo with a family?

~~~
cdmoyer
This is going to really depend on your state and your needs.

Many states add some rules to the providers, often to your benefit.

If you have any pre-existing conditions, having continuos coverage is really
important in many states, as it prevents companies from denying coverage for
those conditions... in many states even if you change providers, as long as
you have some coverage.

In New York, where I am, after a lot of research, I ended up joining a chamber
of commerce with my company and enrolling my company (me) in a group HMO plan.

This cost me 1535 a month last year, and will cost 1680 a month this year.
This covers basically everything, most prescriptions, numerous tests and
treatments my family has needed because of pre-existing conditions. (I pay
$300 a year to be in the chamber, as well.)

Note: If my company had an employee and I wasn't a sole proprietor, these
rates would be 10-15% less.

If I didn't know we would hit the deductible, I would have been on a high
deductible plan. If you hit the 10k deductible on the plans I looked at, it
costs the same as the plan we are on, you just may end up paying the whole
thing up-front.

So, in short, New York, family comprehensive co-pay plan, 20k a year.

(Do COBRA as long as you can, first, if you can. COBRA will almost always be
cheaper because your former employer will be a group and have better rates.)

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akurilin
What's the best place to start if you have a startup and don't know what you
should pick? Should you just get in touch with an accountant who knows about
this area and get their advice, or?

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Aardwolf
The link is down for me, does it work for you?

~~~
jaz
Cached copy here:
[http://webcache.googleusercontent.com/search?q=cache:http://...](http://webcache.googleusercontent.com/search?q=cache:http://blog.simplyinsured.com/what-
startups-need-to-know-about-health-insurance-in-2013/&hl=en&tbo=d&strip=1)

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vivekajayshah
Thank you jaz!

