Will universal health care motivate the 'job-locked' to start businesses?(post-gazette.com)
post-gazette.com
Will universal health care motivate the 'job-locked' to start businesses?
http://www.post-gazette.com/pg/09196/983864-28.stm
9 comments
I've read this comment 4 times now and I can't find anything constructive in it. People are manifestly restrained from entrepreneurship because of private health insurance in the US. You don't like the idea of the government stepping in. Fine. What's your suggestion?
The post is pretty clear to me: Healthcare in the US is in the state it is now because of the way government treated it (via regulation and taxation). The GP's link documents this very well.
>You don't like the idea of the government stepping in. Fine. What's your suggestion?
The government stepping out.
>You don't like the idea of the government stepping in. Fine. What's your suggestion?
The government stepping out.
Sincerely out of ignorance, are there (or have there ever been) any free market health care systems which have been considered widely successful (by the public, not the providing companies)?
And what happens then?
Taxes go down and the deficit decreases. Those from Texas can legally buy insurance from companies in Florida or Vermont or wherever they choose. No health care is tax advantaged or disadvantaged - it just is. People can order insurance custom to their needs; a pick and choose model that serves their situation. Healthcare lobbyists flood the street seeking alternative employment. Insurance is bought and sold like cell phone or cable service. Startups become highly tuned to the needs of the market and excel in matching people up with insurance companies and health plans in innovative ways. The market is allowed to operate like it should.
And then all is good with the world.
Edit: Fixed spelling mistake
And then all is good with the world.
Edit: Fixed spelling mistake
Or, taxes don't change enough to move the needle on health insurance affordability.
We further deregulate the insurance market, and the private insurers of last resort in several locales move to more profitable markets.
Meanwhile, the insurers in the states with the greatest consumer protections move to the venues with the least consumer protections, producing a net decline in health care quality for the entire country. With barriers to interstate insurance removed, the industry is also free to concentrate itself through M&A.
While that's happening, the adverse selection problem with health insurance continues to fester, as our "free market", in enabling "the pursuit of happiness" for everyone, especially 20-something bachelors, cons the whole consumer market into believing they can free-ride into their 40s (or their first child) and then get reasonable insurance, while draining the entire risk pool of all the low-risk patients.
Those same 20-something bachelors show up in emergency rooms, bankrupting themselves over broken bones --- but no problem, by the time they're old enough to care about their credit rating, the only people who will care about this health event are the hospitals and doctors, who will raise rates on everyone else to cover.
At the same time, nothing is done to address the fundamental problem that even in the most consumer-friendly venues, tens of thousands of totally normal families are unable to obtain private insurance coverage at any rate because of preexisting condition coverage.
I'm totally sold.
We further deregulate the insurance market, and the private insurers of last resort in several locales move to more profitable markets.
Meanwhile, the insurers in the states with the greatest consumer protections move to the venues with the least consumer protections, producing a net decline in health care quality for the entire country. With barriers to interstate insurance removed, the industry is also free to concentrate itself through M&A.
While that's happening, the adverse selection problem with health insurance continues to fester, as our "free market", in enabling "the pursuit of happiness" for everyone, especially 20-something bachelors, cons the whole consumer market into believing they can free-ride into their 40s (or their first child) and then get reasonable insurance, while draining the entire risk pool of all the low-risk patients.
Those same 20-something bachelors show up in emergency rooms, bankrupting themselves over broken bones --- but no problem, by the time they're old enough to care about their credit rating, the only people who will care about this health event are the hospitals and doctors, who will raise rates on everyone else to cover.
At the same time, nothing is done to address the fundamental problem that even in the most consumer-friendly venues, tens of thousands of totally normal families are unable to obtain private insurance coverage at any rate because of preexisting condition coverage.
I'm totally sold.
I think you'd have tons of undesirable side-effects. For instance, anyone with a prior history of an illness could never ever get affordable health care. With car insurance, I can understand the principle (bad drivers pay more), but I just don't think it's ethical to let sick people pay (significantly) more than healthy people.
I think your link between wage freezes and the rise of health insurance is tenuous at best. I was born in an Asian country that traversed a similar path from self-pay to health insurance to (now) public health care - and wage freezes were simply not an issue there.
This has nothing to do with meddling, and everything to do with the fact that self-pay health care bankrupts people, creates sick populations, and insurance is unaffordable to anyone but employers.
This has nothing to do with meddling, and everything to do with the fact that self-pay health care bankrupts people, creates sick populations, and insurance is unaffordable to anyone but employers.
It appears that others find this more than tenuous:
http://www.reuters.com/article/latestCrisis/idUSN21171999 1943: The War Labor Board rules that a wage freeze designed to keep inflation in check during World War II does not apply to health insurance benefits, creating an incentive for employers to provide health insurance as a way to build worker loyalty.
http://books.google.com/books?id=UDWZpSUR1aMC&pg=PA100&#... As a result of wage freezes in the World War II period, group health insurance became an important component of collective bargaining...
Also, it's silly to say that only employers can afford health insurance. Obviously the employer considers the total cost of employing you, including salary, healthcare, FISA taxes, etc. If employers stopped providing health insurance, it's likely that wages would increase (approximately) by the cost of that insurance. Then you'd have that money available.
http://www.reuters.com/article/latestCrisis/idUSN21171999 1943: The War Labor Board rules that a wage freeze designed to keep inflation in check during World War II does not apply to health insurance benefits, creating an incentive for employers to provide health insurance as a way to build worker loyalty.
http://books.google.com/books?id=UDWZpSUR1aMC&pg=PA100&#... As a result of wage freezes in the World War II period, group health insurance became an important component of collective bargaining...
Also, it's silly to say that only employers can afford health insurance. Obviously the employer considers the total cost of employing you, including salary, healthcare, FISA taxes, etc. If employers stopped providing health insurance, it's likely that wages would increase (approximately) by the cost of that insurance. Then you'd have that money available.
I agree that this is not a tenuous connection, but you failed to mention in your first post that the wage freeze was during the Second World War. Oil was rationed. Factories converted for war production. The entire economy was mobilized behind the war effort. This is most definitely a case of unintended consequences as relating to health care, but your original post implied that the government just willy nilly intervened with health benefits, when the truth is that it was the side effect of mobilizing the economy for national survival.
What you're saying is true, although I'd also throw in that in addition to the war effort, there was also the Depression and inflation driving this bad legislation. One might draw parallels today with the recession and the likelihood of inflation following unprecedented borrowing, but that's neither here nor there.
In any case, I don't see how the specific motivation is relevant. The point is that the government is bad at anticipating the consequences of its actions. The initial motivation isn't what's important -- the end never justifies the means. The point is that pandering and public choice economics will always cause side effects.
In any case, I don't see how the specific motivation is relevant. The point is that the government is bad at anticipating the consequences of its actions. The initial motivation isn't what's important -- the end never justifies the means. The point is that pandering and public choice economics will always cause side effects.
Modern healthcare is a new innovation though, it's hard to compare it to the past. The term anti-biotic wasn't even coined until the 1940s (Penicillin was still new then). It's not big deal to pay out of pocket when there's not much to pay for.
Can you elaborate more? A (cursory) google search didn't really come up with anything about US wage freezes. there was a bit about price controls for 90 days when we came off the gold standard... that doesn't seem like the kind of problem you're describing.
fwiw, it looks like white male lifespan went up a ton in the first half of 20th century, 48 to 66, 37%! vs 66 to 74, just 12%. I'm pretty sure each 1 percent is exponentially harder than the last though.
fwiw, it looks like white male lifespan went up a ton in the first half of 20th century, 48 to 66, 37%! vs 66 to 74, just 12%. I'm pretty sure each 1 percent is exponentially harder than the last though.
The change came from wage controls during the Second World War. Ever since, employer-provided care is paid with pre-tax dollars while most private insurance outside of the workplace is paid with after-tax dollars. That's a huge penalty.
http://books.google.com/books?id=_TRBtKwBr4oC&pg=PA261&#...
It is also illegal to buy health care insurance across state lines, so it isn't a competitive national marketplace.
We need to make health care more market oriented, not less.
http://books.google.com/books?id=_TRBtKwBr4oC&pg=PA261&#...
It is also illegal to buy health care insurance across state lines, so it isn't a competitive national marketplace.
We need to make health care more market oriented, not less.
Sorry. While you were asking, I was editing my OP to include a reference.
here's a bit on FDR's wage freeze and its effect on health insurance: http://faculty.smu.edu/tmayo/health%20care%20timeline.htm
Google "roosevelt wage freeze" for more on the freeze itself.
Google "roosevelt wage freeze" for more on the freeze itself.
Start businesses? Probably not.
That's something a minority will ever do.
But -join- small businesses? Yes.
Labor will become far more mobile and small business will be on more-equal footing if they aren't forced to pay more for competitive benefits packages.
That's A Good Thing(tm).
But -join- small businesses? Yes.
Labor will become far more mobile and small business will be on more-equal footing if they aren't forced to pay more for competitive benefits packages.
That's A Good Thing(tm).
I think more people would start their own businesses (not many, but more than now), simply because they could continue to work part-time somewhere to bring in money while growing their business. Part-time jobs usually don't offer health care benefits, so as of now it's either: (a) stay at current job full time for health benefits, and work on the business after hours, or (b) quit, have no health benefits, and work full time on the business in order to get up and running as quickly as possible (potentially at the cost of skipping important parts of the development process, marketing, etc.)
The argument isn't that a majority of people would start small businesses with health insurance. It's simply that more people, in absolute terms, would.
Again, I don't see how this could not be the case. The same dynamic that keeps the head of a family of 4 from joining a startup keeps that same person from starting a startup. There are fewer start-ers than join-ers, but they face the same obstacle.
Again, I don't see how this could not be the case. The same dynamic that keeps the head of a family of 4 from joining a startup keeps that same person from starting a startup. There are fewer start-ers than join-ers, but they face the same obstacle.
Labor mobility is broken and it is a huge problem with American capitalism.
Working for a small business is great, I have enjoyed and learned at everyone that I have worked for.
Now that I am the small business owner, my employees are my family. If I were to behave like a corporate employer I would be a lonely man.
Working for a small business is great, I have enjoyed and learned at everyone that I have worked for.
Now that I am the small business owner, my employees are my family. If I were to behave like a corporate employer I would be a lonely man.
Until recently, Labor Mobility was helped greatly by the housing boom - anyone could sell their house with little economic impact and move to a better job in a different area.
Now we have the double-whammy of a housing bust and astronomical health care costs. Cobra helps, but it only lasts 18 months, and that's definitely not long enough to build a successful business.
Now we have the double-whammy of a housing bust and astronomical health care costs. Cobra helps, but it only lasts 18 months, and that's definitely not long enough to build a successful business.
Oh I hope so.
This is an excerpt from a blog I wrote on this exact issue. It was on Myspace which I don't expect anyone to want to log into to so I have just copied and pasted.
" As an immigrant to the US, it took me years to realize that many Americans stayed in shitty jobs because they were afraid to lose their health care.
Well, it's almost 20 years later and I have had health care for about two of them, none recently, and I still won't keep a shitty job over health care. In fact I have owned my own business for the other 18 years and … wait for it…..STILL DON'T have health care.
Why? Because it's a bad deal. A sucker deal, because it's not really health care, it's insurance and insurance companies are money grubbing, fear mongering scumbags.
I used to have affordable product liability insurance, and then they tripled the price post 9/11, because…….terrorists were gonna, what, ummm, file frivolous lawsuits? Please, that was the last straw.
Insurance sucks. It costs a fortune, health, auto, liability, property, it's all a bad deal, if you self insured on most of them or just absorbed your losses. On an actuarial basis 99 percent of people would come out ahead, vs. paying premiums their whole lives. That one percent? Well in my world, we have benefits and it seems to work out.
But, that's too scary if you grew up with "The Fear" that every American gets indoctrinated with.
I'll probably die of untreated cancer which is just a guess at this point, but the freedom I have now by not having to pay for all that insurance is worth it.
Don't misunderstand, some I legally have to have, auto, workers comp, but the rest I let lie. In exchange for taking this risk, I have been able to pursue my not so lucrative dreams.
I would love to see nationalized health care, not so much for myself, but just to see my friends be able to leave "The Fear" behind and be able to follow their dreams.
I love America. Here's to better times. Soon."
This is an excerpt from a blog I wrote on this exact issue. It was on Myspace which I don't expect anyone to want to log into to so I have just copied and pasted.
" As an immigrant to the US, it took me years to realize that many Americans stayed in shitty jobs because they were afraid to lose their health care.
Well, it's almost 20 years later and I have had health care for about two of them, none recently, and I still won't keep a shitty job over health care. In fact I have owned my own business for the other 18 years and … wait for it…..STILL DON'T have health care.
Why? Because it's a bad deal. A sucker deal, because it's not really health care, it's insurance and insurance companies are money grubbing, fear mongering scumbags.
I used to have affordable product liability insurance, and then they tripled the price post 9/11, because…….terrorists were gonna, what, ummm, file frivolous lawsuits? Please, that was the last straw.
Insurance sucks. It costs a fortune, health, auto, liability, property, it's all a bad deal, if you self insured on most of them or just absorbed your losses. On an actuarial basis 99 percent of people would come out ahead, vs. paying premiums their whole lives. That one percent? Well in my world, we have benefits and it seems to work out.
But, that's too scary if you grew up with "The Fear" that every American gets indoctrinated with.
I'll probably die of untreated cancer which is just a guess at this point, but the freedom I have now by not having to pay for all that insurance is worth it.
Don't misunderstand, some I legally have to have, auto, workers comp, but the rest I let lie. In exchange for taking this risk, I have been able to pursue my not so lucrative dreams.
I would love to see nationalized health care, not so much for myself, but just to see my friends be able to leave "The Fear" behind and be able to follow their dreams.
I love America. Here's to better times. Soon."
As much as I disagree with the unbridled spending that has been going on in Washington recently (but is just continuing a trend from the past several administrations), I just don't see any non-selfish reasons why someone would argue against having universal healthcare.
I mean, it's the 21st century! We were supposed to have flying cars and such already, but there's still tens of millions of people in our country that can't get treatment for even minor illnesses (which, untreated, can worsen and bring on deadly complications).
The only thing that I'm afraid of in this case (other than the cost) is that the system becomes too bureaucratic, where most people continue to use private doctors simply because there's too much "red tape" to get treated in a public facility.
I mean, it's the 21st century! We were supposed to have flying cars and such already, but there's still tens of millions of people in our country that can't get treatment for even minor illnesses (which, untreated, can worsen and bring on deadly complications).
The only thing that I'm afraid of in this case (other than the cost) is that the system becomes too bureaucratic, where most people continue to use private doctors simply because there's too much "red tape" to get treated in a public facility.
Nobody worth listening to is saying, "Hey, I don't want that guy to have health insurance! I want that guy to die in pain!"
It's just that when you get past the touchy-feely "Nobody should be poor! Everybody should have health care! Why can't we all just get along‽", and down into the real world of economics and finite resources, it's not so easy. It isn't all that hard to create a universal health care system that is worse than the one we have now, and there are all kinds of other issues, too.
You might get me to sign up for health-care vouchers provided from the government if you really insist, but all current proposals seem to just beg for further increasing costs as the health care industry is further isolated from pricing signals and beg even harder for regulatory capture within five years by the already-powerful health care lobby. (The idea that the medical lobby will be defanged by centralizing all the power is so absurd I can't believe anybody who can think the words "regulatory capture" can believe it for more than five seconds without bursting out in laughter.)
It's just that when you get past the touchy-feely "Nobody should be poor! Everybody should have health care! Why can't we all just get along‽", and down into the real world of economics and finite resources, it's not so easy. It isn't all that hard to create a universal health care system that is worse than the one we have now, and there are all kinds of other issues, too.
You might get me to sign up for health-care vouchers provided from the government if you really insist, but all current proposals seem to just beg for further increasing costs as the health care industry is further isolated from pricing signals and beg even harder for regulatory capture within five years by the already-powerful health care lobby. (The idea that the medical lobby will be defanged by centralizing all the power is so absurd I can't believe anybody who can think the words "regulatory capture" can believe it for more than five seconds without bursting out in laughter.)
Like I wrote in my reply to "DanielBMarkham" above, I've actually heard people say that they aren't paying for someone else's health care, and that they simply don't care what happens to people without it. That's just a personal anecdote, but I'm sure the people who said that to me aren't the only ones out there.
I understand the real-world economics of the problem, but I think the real underlying issue is that many (not all, but a significant) number of Americans have simply become too selfish over the past 100 years or so. Those people simply aren't willing to sacrifice a little bit of their time and money to build a stronger community, because they don't see that they have anything to gain.
I also think that however this thing works out, it's going to become such a bureaucratic mess that it really won't be worth anything except to the most desperate people. The worst part is that we'll still spend the money, and it'll all get funneled away into mega-corporations without any real improvement in anyone's standard of living.
I understand the real-world economics of the problem, but I think the real underlying issue is that many (not all, but a significant) number of Americans have simply become too selfish over the past 100 years or so. Those people simply aren't willing to sacrifice a little bit of their time and money to build a stronger community, because they don't see that they have anything to gain.
I also think that however this thing works out, it's going to become such a bureaucratic mess that it really won't be worth anything except to the most desperate people. The worst part is that we'll still spend the money, and it'll all get funneled away into mega-corporations without any real improvement in anyone's standard of living.
That's part of what I mean; "I don't want to pay for it" is simply one facet of the limited resource side, just phrased oddly. Moreover, you call it "selfish" but that is leaping to conclusions. Some people really can't pay for others, and the fact is that all of us have limits on how much more we can pay for. I'm not entirely averse to some contribution, but I do have my limits, both to what I'm comfortable with and what to what I can sustain even in theory, and in light of the creation of a system disconnected from price signals and with no particular incentive to stop consuming it's not "selfish" to become concerned; it's just rational.
I think a lot of these people, though by no means all, have far more complicated motivations and opinions than you think, and only a handful are really, truly saying "screw you all". (I think it's nonzero, but that gets into the "not worth listening to" class of people. These marginal people exist for all topics, though it's important to not classify large numbers of people that way.) Most people are not going to eloquently describe their full belief system, anymore than I have my own here, and even if they did, you probably wouldn't listen. (Any more than I would; this is not a criticism.)
I think a lot of these people, though by no means all, have far more complicated motivations and opinions than you think, and only a handful are really, truly saying "screw you all". (I think it's nonzero, but that gets into the "not worth listening to" class of people. These marginal people exist for all topics, though it's important to not classify large numbers of people that way.) Most people are not going to eloquently describe their full belief system, anymore than I have my own here, and even if they did, you probably wouldn't listen. (Any more than I would; this is not a criticism.)
Unfortunately, there just isn't anything you or anyone else is going to be able to do to combat people's "selfishness".
It may not be the way we want things to happen, but nobody is going to be able to convince every facet of the population to give up portions (however small) of their livelihoods to "build a stronger community" for exactly the reason you mentioned: nobody can see that they have anything to gain.
It may not be the way we want things to happen, but nobody is going to be able to convince every facet of the population to give up portions (however small) of their livelihoods to "build a stronger community" for exactly the reason you mentioned: nobody can see that they have anything to gain.
But because insurance works best when the risk pools are largest, and irrational behavior among consumers (ie, spending zero in your 20s and free-riding in your 50s) will prevent those pools from being built organically, this seems like a perfectly sensible place for the government to apply regulation.
Oh, I completely agree on the regulation front - health care in this country is broken right now. I'm not in agreement with the current Administration's plans to fix it, but something needs to be done.
I just think that when people start claiming that "selfishness" is the underlying problem with our broken health care system, they're ignoring the pressures that brought on this "moral decline".
It's really no different than the far-right nutjobs who blame the state of our inner cities on the "laziness" of the people living there.
I just think that when people start claiming that "selfishness" is the underlying problem with our broken health care system, they're ignoring the pressures that brought on this "moral decline".
It's really no different than the far-right nutjobs who blame the state of our inner cities on the "laziness" of the people living there.
I'd like to address the finite resources thing.
The American government has completely failed it's citizens. There should be plenty of money for us to have a vibrant all encompassing economy.
We are the most productive nation on earth per capita. We should be rolling in it.
But it's all gone. To the Caymen Islands, Austria, Switzerland and China. In private bank accounts and foreign government coffers.
That does not even include all them good old American Dollars held by all the drug traffickers or used by all those poor people in countries whose national currency is a joke where the defacto currency is the greenback.
The American government has completely failed it's citizens. There should be plenty of money for us to have a vibrant all encompassing economy.
We are the most productive nation on earth per capita. We should be rolling in it.
But it's all gone. To the Caymen Islands, Austria, Switzerland and China. In private bank accounts and foreign government coffers.
That does not even include all them good old American Dollars held by all the drug traffickers or used by all those poor people in countries whose national currency is a joke where the defacto currency is the greenback.
You're afraid health care will become too bureaucratic? Are you familiar with health insurance companies? There's already a bureaucrat between you and your doctor - the fact that he's from the private sector doesn't change that fact.
And private sector bureaucrats have an incentive to deny coverage, purge rolls, etc. - it means greater profits. In the last twenty years, health insurance companies have gone from spending 95 cents of every premium dollar on health care to roughly 80 cents today. Where did that extra money go? Greater overhead and profits. Under a universal system, public bureaucrats wouldn't have the same incentives to deny care.
Just a friendly reminder that before you start spouting cliches about "bureaucrats ruining things" you should ask whether they already have - just not from the government.
And private sector bureaucrats have an incentive to deny coverage, purge rolls, etc. - it means greater profits. In the last twenty years, health insurance companies have gone from spending 95 cents of every premium dollar on health care to roughly 80 cents today. Where did that extra money go? Greater overhead and profits. Under a universal system, public bureaucrats wouldn't have the same incentives to deny care.
Just a friendly reminder that before you start spouting cliches about "bureaucrats ruining things" you should ask whether they already have - just not from the government.
Yes, surely the incentives are different. I don't at all believe that the public-bureaucrat incentives are better.
My wife is manager of budget & reimbursement at a hospital, which means that her primary task is working with Medicare and Medicaid officials. I don't think that a day goes by that she's not telling me about some inefficiency in the process. It might be the (literally) reams of paperwork they're required to produce, or unnecessary tests that are necessitated by Medicare rules, or the attitude she gets from the public employees she must talk to. But any time you hear that Medicare is more efficient, remember that because Medicare/Medicaid nearly comprise a monopsony, it's able to push many of its administrative chores onto the healthcare providers.
My wife is manager of budget & reimbursement at a hospital, which means that her primary task is working with Medicare and Medicaid officials. I don't think that a day goes by that she's not telling me about some inefficiency in the process. It might be the (literally) reams of paperwork they're required to produce, or unnecessary tests that are necessitated by Medicare rules, or the attitude she gets from the public employees she must talk to. But any time you hear that Medicare is more efficient, remember that because Medicare/Medicaid nearly comprise a monopsony, it's able to push many of its administrative chores onto the healthcare providers.
Damn right, where is my flying car!
Seriously though, we are getting to a breaking point on several issues of which health care is just one.
Vested interests have legislative lock ins that create huge barriers to entry for new players.
The avenues for entrepreneurial success get narrower every year.
That's not the American Dream, that is a nightmare.
Creative destruction is desperately needed.
Seriously though, we are getting to a breaking point on several issues of which health care is just one.
Vested interests have legislative lock ins that create huge barriers to entry for new players.
The avenues for entrepreneurial success get narrower every year.
That's not the American Dream, that is a nightmare.
Creative destruction is desperately needed.
I just don't see any non-selfish reasons why someone would argue against having universal healthcare.
How about "my kids can't afford it"
Or "increasing demand while keeping supply constant will NOT lower costs"
Or "I should have the freedom to come up with a million-dollar-per-ill cure for cancer and not have the government take it"
None of these are selfish.
I've got others, if you'd like to hear them.
How about "my kids can't afford it"
Or "increasing demand while keeping supply constant will NOT lower costs"
Or "I should have the freedom to come up with a million-dollar-per-ill cure for cancer and not have the government take it"
None of these are selfish.
I've got others, if you'd like to hear them.
I never said the costs would be lower. In fact, the cost issue is the only real argument I see against it.
Why not offer incentives (tax breaks, for example) to coerce the system into the right state? For example, if you go to medical school or nursing school and graduate in the top 50% of your class (from any accredited school), you would be automatically reimbursed for the entirety of your tuition by the government. This would create an incentive for more students to become doctors and nurses, which is sorely needed today; at the same time, it reduces the barrier to entry (the cost), creates motivation to do well, and also keeps the price of service (what the doctor charges you) down as well (since they're not having to pay back $200k in student loans).
At the same time, the system should require everyone to get certain tests on a regular basis (e.g. a yearly physical). If you don't take care of yourself at some kind of baseline level (the doctor should be able to tell from your charts), then you will be charged a "surplus" fee since you will be requiring more medical care down the road (e.g. heart disease due to lack of exercise). This would motivate people to get in shape, or at least they'd be paying for the extra costs of their own care. So, essentially, it's free as long as you play your own little part in the system.
On another note, all the people that I've heard argue against UH have all said that they don't want to pay for someone else's healthcare. While I understand where they're coming from (I hold mostly libertarian political views), you have to remember that the 'healthier' our society becomes (due to UH, or simply lifestyle changes, etc.), the "cost" per person is reduced. This is because healthier people are more able to contribute to society, rather than unhealthy people who must survive on the contributions of others.
Why not offer incentives (tax breaks, for example) to coerce the system into the right state? For example, if you go to medical school or nursing school and graduate in the top 50% of your class (from any accredited school), you would be automatically reimbursed for the entirety of your tuition by the government. This would create an incentive for more students to become doctors and nurses, which is sorely needed today; at the same time, it reduces the barrier to entry (the cost), creates motivation to do well, and also keeps the price of service (what the doctor charges you) down as well (since they're not having to pay back $200k in student loans).
At the same time, the system should require everyone to get certain tests on a regular basis (e.g. a yearly physical). If you don't take care of yourself at some kind of baseline level (the doctor should be able to tell from your charts), then you will be charged a "surplus" fee since you will be requiring more medical care down the road (e.g. heart disease due to lack of exercise). This would motivate people to get in shape, or at least they'd be paying for the extra costs of their own care. So, essentially, it's free as long as you play your own little part in the system.
On another note, all the people that I've heard argue against UH have all said that they don't want to pay for someone else's healthcare. While I understand where they're coming from (I hold mostly libertarian political views), you have to remember that the 'healthier' our society becomes (due to UH, or simply lifestyle changes, etc.), the "cost" per person is reduced. This is because healthier people are more able to contribute to society, rather than unhealthy people who must survive on the contributions of others.
Setting aside the bureaucratic monster this would necessitate, it just seems completely unAmerican.
How can you square fines for failure to exercise with "life, liberty, and the pursuit of hapiness"?
And where in the Constitution is the federal government given the power to perform these things? Even if it were a good idea, I can't see where it's legal for them to do so.
How can you square fines for failure to exercise with "life, liberty, and the pursuit of hapiness"?
And where in the Constitution is the federal government given the power to perform these things? Even if it were a good idea, I can't see where it's legal for them to do so.
You would still be welcome to "life, liberty, and the pursuit of hapiness". No one would be forcing you to use said healthcare system, but if healthcare was totally free, what's to stop people from totally trashing their bodies then asking for organ transplants on the public dime?
In such a system, checks and balances need to be in place to keep people from 'gaming the system'. IF you wanted to use the public healthcare, then you should be forced to make some compensation back to the public if you are willfully (by using your right to not exercise, or you want to be a smoker, etc.) causing harm to your body which is then causing you need to need extra medical procedures and costing everyone money!
In such a system, checks and balances need to be in place to keep people from 'gaming the system'. IF you wanted to use the public healthcare, then you should be forced to make some compensation back to the public if you are willfully (by using your right to not exercise, or you want to be a smoker, etc.) causing harm to your body which is then causing you need to need extra medical procedures and costing everyone money!
if healthcare was totally free, what's to stop people from totally trashing their bodies then asking for organ transplants on the public dime?
Hell yes, if healthcare was free, I would totally be trashing my body and getting free organ transplants - again and again - I just can't think of a better way to spend my time!
Seriously, what?
Hell yes, if healthcare was free, I would totally be trashing my body and getting free organ transplants - again and again - I just can't think of a better way to spend my time!
Seriously, what?
Some people think that way, they just don't say it like that. If you smoke two packs a day, drink until you pass out a few nights a week, and eat fried food every day, you're making conscious decisions that are affecting your overall long-term health.
My point was that if you're going to be using the public healthcare system (that everyone is paying for), then you should have to compensate that system for any damage that you purposefully cause to your own body that will drive up the costs of keeping you alive and healthy. If you live a reasonably healthy lifestyle and then get liver cancer because you're genetically predisposed to it, that's not your fault, and so you wouldn't be charged extra for it. If you got liver cancer as the result of living a hard and fast life, then yes, you should be compensating everyone else, or at least seeing a private physician instead.
My point was that if you're going to be using the public healthcare system (that everyone is paying for), then you should have to compensate that system for any damage that you purposefully cause to your own body that will drive up the costs of keeping you alive and healthy. If you live a reasonably healthy lifestyle and then get liver cancer because you're genetically predisposed to it, that's not your fault, and so you wouldn't be charged extra for it. If you got liver cancer as the result of living a hard and fast life, then yes, you should be compensating everyone else, or at least seeing a private physician instead.
but if healthcare was totally free, what's to stop people from totally trashing their bodies then asking for organ transplants on the public dime?
I guess the government is the entity to stop us. After all, as you point out, once you start using public money to pay for something that makes it everybody's business, right?
So now the government is concerned with how I choose to totally trash my body, because it has an impact on public health costs.
And what part of this was good, again? Yes, the part where we got free stuff from some magic place. As much as we want!
I guess the government is the entity to stop us. After all, as you point out, once you start using public money to pay for something that makes it everybody's business, right?
So now the government is concerned with how I choose to totally trash my body, because it has an impact on public health costs.
And what part of this was good, again? Yes, the part where we got free stuff from some magic place. As much as we want!
No, you'd always be able to see a private physician if you wanted to pay for their services out of your own pocket. If you can afford that, then feel free to treat your body however you want. If you're going to be costing everyone else money because of how you're living your life, then you can pay the difference between the extra costs of your healthcare and the baseline amount spent on the 'average' person.
So what is it about heath care that precludes economies of scale?
Just to run with your nothing is selfish theme which is born of "the fear" whether you are willing to admit it or not.
When was the last cure for a significant disease announced as opposed to a 'treatment' which locks you into a life long drug regimen?
Just to run with your nothing is selfish theme which is born of "the fear" whether you are willing to admit it or not.
When was the last cure for a significant disease announced as opposed to a 'treatment' which locks you into a life long drug regimen?
So what is it about heath care that precludes economies of scale?
There is no fixed-cost capital investment that increases health care productivity dramatically. That is to say, the "health care factory" has not been invented yet.
A hospital of 100 doctors is only (roughly) 100x as productive as 100 doctors individually (unlike manufacturing, where 100 assembly line workers >> 100 blacksmiths).
There is no fixed-cost capital investment that increases health care productivity dramatically. That is to say, the "health care factory" has not been invented yet.
A hospital of 100 doctors is only (roughly) 100x as productive as 100 doctors individually (unlike manufacturing, where 100 assembly line workers >> 100 blacksmiths).
Here's one: I don't want to watch my friends and family get poorer as they pay for my (potential) future illness.
As an immigrant to the US, it took me years to realize that many Americans stayed in shitty jobs because they were afraid to lose their health care.
I second this personal anecdote. I bet other can say the same. I vague recall a study about this, but google fails me.
I second this personal anecdote. I bet other can say the same. I vague recall a study about this, but google fails me.
You sound like a good guy.
I hope you never get sick while uninsured in America.
I too have spent a majority of my life without health insurance. I just haven't been as lucky. The Fear is truly unfortunate, but there's a reason people have it and it's not blind indoctrination.
I too have spent a majority of my life without health insurance. I just haven't been as lucky. The Fear is truly unfortunate, but there's a reason people have it and it's not blind indoctrination.
Me too, and I am sorry for whatever you have had to deal with.
It is an embarrassment that you have had to deal with potentially huge financial repercussions in one of the richest and most technologically advanced countries in the world.
I agree that there are reasons to have the fear. Don't get me wrong, I have Alzheimer's and some interesting cancers in my family history, so I have some of the fear.
I don't exactly know how to phrase this, but did you actually have a choice, either financially or in terms of being true to your desires?
Do you have regrets?
It is an embarrassment that you have had to deal with potentially huge financial repercussions in one of the richest and most technologically advanced countries in the world.
I agree that there are reasons to have the fear. Don't get me wrong, I have Alzheimer's and some interesting cancers in my family history, so I have some of the fear.
I don't exactly know how to phrase this, but did you actually have a choice, either financially or in terms of being true to your desires?
Do you have regrets?
I'm not advocating getting health insurance, exactly, but your life as you know it will end if you get seriously sick or injured. (Exception: if you have millions in the bank you're probably just fine.)
Personally I'm paying for health insurance, but only the bare minimum (rather high deductible). I consider it my rock climbing tax: insurance can give you some freedoms (the freedom to take a bit of extra risk, in this case) as well as take them away.
Personally I'm paying for health insurance, but only the bare minimum (rather high deductible). I consider it my rock climbing tax: insurance can give you some freedoms (the freedom to take a bit of extra risk, in this case) as well as take them away.
Not to be rude, but it doesn't look like you have been paying much attention to what Universal Health Care in the U.S. will actually mean.
I legally have to have, auto, workers comp [...]
And now you will legally have to have health insurance.
Insurance sucks. It costs a fortune, health, auto, liability, property, it's all a bad deal [...]
You have a bad attitude, but the health insurance companies won't have to worry about it much longer. You'll be paying up with the rest of the citizen-units.
Well, you thought you wanted Universal Coverage. You got it. Go America! Land of the free!
I legally have to have, auto, workers comp [...]
And now you will legally have to have health insurance.
Insurance sucks. It costs a fortune, health, auto, liability, property, it's all a bad deal [...]
You have a bad attitude, but the health insurance companies won't have to worry about it much longer. You'll be paying up with the rest of the citizen-units.
Well, you thought you wanted Universal Coverage. You got it. Go America! Land of the free!
Yes, I am going to be pissed if we end up with the Massachusetts solution.
Just curious, are you working a job or are you making a go of it with your software biz?
Just curious, are you working a job or are you making a go of it with your software biz?
There was never any doubt about what "Universal Coverage" would mean, not to me.
The popular view is that health care reform was about taking care of the American People. My view, health care reform was always about taking care of the health care interest groups (insurance at the top of the list).
I don't have a job, but I pay the bills from contracting, not from Homeschool Day Book. (So far I have not marketed it very well and don't have many sales.)
The popular view is that health care reform was about taking care of the American People. My view, health care reform was always about taking care of the health care interest groups (insurance at the top of the list).
I don't have a job, but I pay the bills from contracting, not from Homeschool Day Book. (So far I have not marketed it very well and don't have many sales.)
From doing a lot of customer dinners in the United States with FreshBooks customers, the absolute top of the list with a bullet number one reason Americans don't quit their day job and start freelancing or start a business is lack of health insurance.
I'd bet most of our customers don't have health insurance, and that's why we push them to professional organizations like the Freelancer's Union and AIGA.
My personal beliefs: It seems counterproductive to me to make citizens risk their entire future just because you wanted to be innovative or fill an unserviced need in society.
I'd bet most of our customers don't have health insurance, and that's why we push them to professional organizations like the Freelancer's Union and AIGA.
My personal beliefs: It seems counterproductive to me to make citizens risk their entire future just because you wanted to be innovative or fill an unserviced need in society.
Anecdotally, I can't see how it could not be the case that universal healthcare will promote startups. In '05 and '06, we routinely lost candidates because they were married and required health insurance. If you've never tried to buy private health coverage for a family of 4, you may be laboring under the delusion that it's possible to actually do that.
Is there a difference between starting a company and joining a small startup? Sure. But the same obstacle confronts any family that wants to start a company. How could removing a huge obstacle to entrepreneurship not help?
Is there a difference between starting a company and joining a small startup? Sure. But the same obstacle confronts any family that wants to start a company. How could removing a huge obstacle to entrepreneurship not help?
No question about this. It potentially can help any industry where the healthcare costs are high in relation to other costs, this include heavy manufacturing where there are pensions to pay. All provided the tax burden doesn't out weigh everything else. If the collective tax rate was doubled, then that will kill the start-up market.
When you talk about tax rates and health insurance, it's important to keep in mind the shadow tax paid in the common case by families and businesses that employ them today. Privately-run health insurance is expensive, and there's an inherent adverse selection problem because coverage is discretionary.
hang on there; how come a higher tax rate would kill the startup market? A more complex business tax regime, sure, but you are only taxed on your profits and what you pay yourself. You don't pay much in taxes until your company actually starts making money.
Especially considering that capital gains is treated differently (and taxed less) than income, it seems to me like the most advantageous course to take in a time of high taxation is to start a business, and re-invest as much of your profit as possible. Then, at some point sell it and pay capital gains on your winnings. (or perhaps sit on it until tax rates go down a bit.)
Now, obviously a high tax rate will cause people to spend less, but that's going to hurt all businesses, not just startups. From where I stand, as a small company, it seems that I am much better positioned to compete on price than larger companies in my market.
Especially considering that capital gains is treated differently (and taxed less) than income, it seems to me like the most advantageous course to take in a time of high taxation is to start a business, and re-invest as much of your profit as possible. Then, at some point sell it and pay capital gains on your winnings. (or perhaps sit on it until tax rates go down a bit.)
Now, obviously a high tax rate will cause people to spend less, but that's going to hurt all businesses, not just startups. From where I stand, as a small company, it seems that I am much better positioned to compete on price than larger companies in my market.
Healthcare needs to be an independent insurance that companies will pay you in salary to get on your own.
Right now do companies or governments pay your auto insurance? How about home insurance? Why health insurance? It is a tired and wrong way to do things, it removes the cost of insurance and medical care from the paying customer and it is the major reason there is a huge healthcare bubble in cost. We would see a very fast cost correction in healthcare if we treated it like other insurance.
I truly believe if health insurance moves like retirement, away from the employer, then we will have a much more agile workforce and the walls to move around more and be more entrepreneurial will be removed.
Right now do companies or governments pay your auto insurance? How about home insurance? Why health insurance? It is a tired and wrong way to do things, it removes the cost of insurance and medical care from the paying customer and it is the major reason there is a huge healthcare bubble in cost. We would see a very fast cost correction in healthcare if we treated it like other insurance.
I truly believe if health insurance moves like retirement, away from the employer, then we will have a much more agile workforce and the walls to move around more and be more entrepreneurial will be removed.
Your analogies are all faulty. You can avoid paying car insurance by not driving. You can avoid paying homeowner's insurance by renting. There is nothing you can reasonably do to ensure that you won't break your leg, lose your appendix, or develop a lymphoma.
Meanwhile, you can't simply buy health insurance. Under our current system, any insurer can refuse to cover you for any number of reasons, or assign calamitously high premiums to you. The medical pretexts required to do this are numerous and opaque. Ask any 30 year old woman who's tried to buy health insurance if you need convincing.
Many people with families simply cannot start or join startups in this climate, because there is no feasible way for them to cover their family. Without health insurance, you can be bankrupted by relatively minor health events; more importantly, you put your family at risk for receiving inferior care, particularly on the preventative side.
Meanwhile, you can't simply buy health insurance. Under our current system, any insurer can refuse to cover you for any number of reasons, or assign calamitously high premiums to you. The medical pretexts required to do this are numerous and opaque. Ask any 30 year old woman who's tried to buy health insurance if you need convincing.
Many people with families simply cannot start or join startups in this climate, because there is no feasible way for them to cover their family. Without health insurance, you can be bankrupted by relatively minor health events; more importantly, you put your family at risk for receiving inferior care, particularly on the preventative side.
Of course if you are a risk then you should pay more. The
correct answer is for those people to rely on public charity to help with their medical bills. What you're advocating is just forcing people to subsidize others. At least with private charity people: 1st are thankful, and realize that others are helping them, and 2nd are controlling how their money is spent.
Insurance shouldn't cover preventive care, it should be insurance. You don't have car insurance that covers getting your oil changed, why should your health insurance cover your doctor visits?
Insurance shouldn't cover preventive care, it should be insurance. You don't have car insurance that covers getting your oil changed, why should your health insurance cover your doctor visits?
This is incoherent. I literally don't know what you're responding to. Charity? Subsidizing others?
It really sounds like you're arguing against the entire concept of insurance here. The idea of managing risk by pooling it dates back to the 14th century; if you want to argue against it, consider time travel.
As to your second graf --- again, what are you talking about? Oil changes don't mitigate the risk of car accidents, which is why your insurance company will give you a break for not getting tickets or driving a safer car, but won't give you a break for changing your oil.
It really sounds like you're arguing against the entire concept of insurance here. The idea of managing risk by pooling it dates back to the 14th century; if you want to argue against it, consider time travel.
As to your second graf --- again, what are you talking about? Oil changes don't mitigate the risk of car accidents, which is why your insurance company will give you a break for not getting tickets or driving a safer car, but won't give you a break for changing your oil.
>>Under our current system, any insurer can refuse to cover you for any number of reasons, or assign calamitously high premiums to you.
If you can't afford insurance, then you rely on charity. To force lower insurance prices than their risk demands is subsidizing them.
Yes the oil, example isn't the best. How about getting the breaks fixed.
If you can't afford insurance, then you rely on charity. To force lower insurance prices than their risk demands is subsidizing them.
Yes the oil, example isn't the best. How about getting the breaks fixed.
You don't think the market would adjust and return to independent groups, companies, systems that organize just like employee groups with employers? Because health insurance is tied to employment some magical force makes insurance companies just cover people?
In my case at least unemployed people or retired people could still keep their healthcare they have always had. Changing jobs and health care is a big pain that prevents innovation and tying healthcare to employment allows price fixing/inflation.
The arguments you put against not tying it to employment are the same arguments for the current setup. They only hide the cost so that it is inflated.
In my case at least unemployed people or retired people could still keep their healthcare they have always had. Changing jobs and health care is a big pain that prevents innovation and tying healthcare to employment allows price fixing/inflation.
The arguments you put against not tying it to employment are the same arguments for the current setup. They only hide the cost so that it is inflated.
Right and if you notice there is accident medical in auto insurance, because we HAVE to drive and we can't let the heath uninsured drag the whole system down if they get in a wreck.
Lack of universal coverage is also driving up the cost of automobile insurance.
Lack of universal coverage is also driving up the cost of automobile insurance.
If you start with 3 other co-founders, you can get the same deal (mostly) that your employer gets.
Also HSA's and high deductible health plans are likely to cost less than paying out for "Universal" coverage. Best yet, is that these solutions don't suffer from a tax-drag on entrepreneur ship that the article is so concerned with.
Also HSA's and high deductible health plans are likely to cost less than paying out for "Universal" coverage. Best yet, is that these solutions don't suffer from a tax-drag on entrepreneur ship that the article is so concerned with.
that works as long as your 3 co-founders are relatively healthy and have been healthy their whole lifes, if one of them develops a problem you can expect your premium to skyrocket into unaffordability
Group health care plans (what your employer gives you) are given largely without consideration for the health of the individuals involved. Basic tests, like making sure you don't have a major heart problem and pee tests are involved but thats it. Friends of mine who have a business with only 3 employees listed me as one of their employees to get the number up to four. Some how I was registered whilst living in another country.
And I believe there are already laws on the books about pre-existing conditions (assuming you have continuous coverage)
And I believe there are already laws on the books about pre-existing conditions (assuming you have continuous coverage)
How would you go about finding such coverage (for 3 founders)?
Just call an insurance broker. I recently went shopping for health care coverage expecting the worst and was pleasantly surprised how close the quotes were to my employer provided plan.
I took away from it a feeling that I am less stuck than I thought I was, even before universal health care.
I took away from it a feeling that I am less stuck than I thought I was, even before universal health care.
Doesn't seem to in Europe.
Apples-to-oranges. Most European countries have many other obstacles to starting a business. It can be almost impossible to fire workers. Some places have mandatory short work weeks. France apparently has special police that monitor them! There have been onerous regulations about running small businesses from your house. The tax code is different and often less favorable to small businesses. And the cultural climate is "famously" hostile to entrepreneurs.
You can't extrapolate the outcome of universal health care in the States from Europe's experience. The conclusion that universal health care would hurt entrepreneurship (or even fail to help it) remains counterintuitive.
You can't extrapolate the outcome of universal health care in the States from Europe's experience. The conclusion that universal health care would hurt entrepreneurship (or even fail to help it) remains counterintuitive.
The same applies to Canada. I don't think canadians are more enterprenual than americans
I don't think canadians are more enterprenual than americans
Perhaps not; but we might be even less entrepreneurial without universal health care. I know I would never have started working on tarsnap if I was living in the US.
Perhaps not; but we might be even less entrepreneurial without universal health care. I know I would never have started working on tarsnap if I was living in the US.
I'd have been in a lot of trouble. I was very sick in my early 20s and from a not so well-off background. The doctor that got me back on track is world-renowned and I was able to waltz right in his office and see him for "free" like anyone else. If I lived in (most?) states I'd probably never even think of quitting my job.
[deleted](1)
nor as in Canada!
An additional problem is that large numbers of people are 'job-locked' by their need to have a regular paycheck.
I wonder if people would also be encouraged to start businesses if we came up with a universal paycheck program.
[edit: could anyone downmodding me explain why? Just curious.]
I wonder if people would also be encouraged to start businesses if we came up with a universal paycheck program.
[edit: could anyone downmodding me explain why? Just curious.]
I downmodded you because at a glance fell into the category of 'dumb joke'. The conversation at the top of the page is interesting, and I want to keep this at the bottom so as not to interrupt distract from the useful discussion. If you intend this as a real insight, please flesh it out with more explanation.
You sound a little trollish: "universal paycheck program" sounds like a thinly veiled dig at "socialism"
(For the record: I upvoted you)
(For the record: I upvoted you)
My specific point: people are "job-locked" by a desire to keep getting the compensation that their job provides. One form of compensation is medical insurance, another form is pay.
Is there any legitimate reason to single out medical insurance as a particular cause of job-lock, rather than pay, corporate gym membership, etc?
Is there any legitimate reason to single out medical insurance as a particular cause of job-lock, rather than pay, corporate gym membership, etc?
Sounds too much like welfare in thread that is already driving the free market "I'll get mine" types insane already.
Up through the fist half of the 20th Century, medical expenses were generally paid individually, or through mutual-aid groups such as churches or fraternal societies. This began to change when the government instituted wage freezes. In that environment the only way for an employer to attract superior talent was to offer non-salary benefits, and the tax advantages of health care made that an attractive one.
Thus, American employers began to offer health insurance as a way to better compensate their workers when the government was trying to interfere with the labor market. As the practice became more common, it increasingly became a point that job hunters would look for. And the rest is history.
If you think that the results of this meddling are undesirable, then you might think twice about giving the same meddlers the authority to muck things up further.
Edit: here's a bit on FDR's wage freeze and its effect on health insurance: http://faculty.smu.edu/tmayo/health%20care%20timeline.htm