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Is employer-based health insurance a barrier to entrepreneurship?

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Re: Is employer-based health insurance a barrier to entrepreneurship?

#131
post #101
post #22

Earlier quoted context omitted.

But they don't want to replace it with anything other than everyone buys their insurance on the open market if they want coverage, which is why unions are against it. If they wanted to move to a full coverage system (single payer?), unions would be happy because everyone has healthcare.

> If they wanted to move to a full coverage system (single payer?), unions would be happy because everyone has healthcare. Citation needed. Yes, the health care employers unions have expressed considerable interest in measures that would increase the demand for their members' services, but you're making a very different claim.

> Citation needed.

Here's a good start:

http://unionsforsinglepayerhr676.org/union_endorsers

Re: Is employer-based health insurance a barrier to entrepreneurship?

#132
post #98

Earlier quoted context omitted.

> Some individuals cannot buy health insurance at all if they have preexisting conditions. That's true only if they let their insurance lapse. As long as they don't do that, they can stay with their current, switch, etc, all without waiting periods or a significant premium relative to "well people". (It's been that way for years.) That's why I wouldn't let insurance lapse if I had a pre-existing condition, so why do…

I have employees who were laid off from their previous jobs. They could not afford to pay the COBRA payment and let their insurance lapse. They are now disqualified from private insurance and have pre-existing conditions that are not covered under our group plan. It is easy to tell people not to let their insurance lapse. If they have no income, this is not feasible. The point of the article is that the current syste…

> It is easy to tell people not to let their insurance lapse. If they have no income, this is not feasible.

If they have no income, health insurance isn't their only problem. There's housing and food as well.

> Plenty of employees in the current system stay with their employer out of fear of losing their coverage instead of pursuing other opportunities.

Lots of things have that effect, including having kids, buying a house, and so on. Many of them have far greater effect than pre-existing conditions, yet ....

There are also people who can't take the leap because taxes keep them from saving enough. Increasing their taxes to pay for other people's healthcare is going to make that worse.

None of the proposals address cost. (No, preventative care doesn't actually reduce costs. It "merely" makes life more enjoyable.) They just cost shift differently.

Re: Is employer-based health insurance a barrier to entrepreneurship?

#133
post #64

Earlier quoted context omitted.

What wrong with a for-profit system? There should be MORE profit, not less. High profits attract entrepreneurs to compete for customers by offering lower prices and innovating - consumers benefit. The current system is the exact opposite - there is relatively little and uncertain profit (and high barriers to entry) in insurance and hospitals, and a ton of government interference and regulation. Few entrepreneurs want…

What evidence is there that few entrepreneurs want to get involved in hospitals? Here's some evidence to the contrary: http://www.bizjournals.com/houston/news/2011/01/18/emerus-ho... http://www.emerus.com/

That's one example. There are 5,500+ hospitals in the US, so one example is hardly representative. There would be many more investments if it was more profitable.

As the link I posted states - many are not profitable and many have a very low profit margin. Higher profits would bring more entrepreneurs and investment.

Re: Is employer-based health insurance a barrier to entrepreneurship?

#134
post #130
post #8

Answer: Hell yes. Self-insurance is absurdly expensive while group insurance outside of an employer or credit union is harder to find than a Republican with a conscience. The lie that "Obama-Care kills small businesses and/or jobs" is a smokescreen for the truth: Healthcare reform would free employees from indentured health care servitude and allow small businesses to hire more competitively, creating more jobs.

This comment is, unfortunately, an illustration of how sites go downhill. It has 19 downvotes, including mine. So how does it have so many points? Because it has twice as many upvotes. When badness arrives in online communities, it arrives first in forms that make people invite it right in.

It's also an illustration of what stops them from going downhill. Replies like neilk's do more to tone down the rhetoric than any voting button could do.

Re: Is employer-based health insurance a barrier to entrepreneurship?

#135
post #64

Earlier quoted context omitted.

What evidence is there that few entrepreneurs want to get involved in hospitals? Here's some evidence to the contrary: http://www.bizjournals.com/houston/news/2011/01/18/emerus-ho... http://www.emerus.com/

That's one example. There are 5,500+ hospitals in the US, so one example is hardly representative. There would be many more investments if it was more profitable. As the link I posted states - many are not profitable and many have a very low profit margin. Higher profits would bring more entrepreneurs and investment.

You are assuming that because the industry has many unprofitable participants, there must be few new entrants. You're guessing. You haven't shown that there are indeed few new entrants, nor have you shown that low profit margins are the main factor that discourages them. Any industry that is as capital intensive as hospitals are will have relatively few new entrants, so a convincing argument of the causal relationship you're claiming will be difficult to make.

I mostly agree with you that healthy profits are desirable if we want to have an effective healthcare system, but I don't think hospital profit has much to do with it. The profit that healthcare technology companies and actual care providers make seems more important.

Re: Is employer-based health insurance a barrier to entrepreneurship?

#136

Earlier quoted context omitted.

Why don't you believe in a free market for health insurance? Forcing people to pay into a health insurance is kind of scammy - let's say that I have a genetic condition that is certain to kill me rapidly at age 30. I want to live my life to the fullest, and I'd rather not be forced to buy health insurance that protects me from things like adult onset diabetes, alzheimer's, cancer, parkinson's, etc, that I'm just not…

> Why don't you believe in a free market for health insurance? There are two main reasons. First of all, as someone mentioned it in another thread here a few days ago, healthcare does not follow the rules of supply and demand, since people would pay anything for survival. You're never going to say that "ah this treatment is a bit overpriced; I think I'll get more value for my money if I'll just die instead". It's rid…

1. Health care does follow the rules of supply and demand. It's erroneous to claim otherwise.

2. Many if not most health care costs are not emergency services, and they include many elective non-emergency procedures, diagnostics, mental health issues, drugs etc. A lot of costs come from behavioral choices and are preventable by responsible individuals.

"Emergency care represents less than 3 percent of the nation’s $2.1 trillion in health care expenditures while covering 120 million people a year."

http://www.acep.org/content.aspx?id=25902

3. Regarding compassion - Hospitals are not staffed with nurses, doctors, advanced medical services based on compassion -- all that costs money, labor and raw materials, and takes investment, education, specializations and entreneurship- all of which are not achieved through compassion.

Economics and finance applies regardless of intention (ie. compassion).

Re: Is employer-based health insurance a barrier to entrepreneurship?

#137
post #79

To give some perspective I now live in the US and have, as best as I can tell, excellent insurance from my employer. I am Australian and have lived in the UK, Switzerland and Germany so I can compare all of these. Australia has a mix of private and public health care. You pay 1.5% of your income as theMedicare levy. If you have sufficient income but no private hospital insurance, you pay a surcharge (1% iirc). The pr…

> Defendants of the current system argue free market but the result is the most expensive health care I've ever seen.

Interesting, but the current system in the US isn't "free market".

It's communistic.

- 80%+ of health care expenditures are made by a 3rd party not the person requesting a service. (employers, insurance, government)

- 40-50% of health care expeditures in the USA are made by the government. (free market usually doesn't mean paid-for/run by government)

- There are thousands of government regulations and incentives which created the current system we have.

That's a free market? You must not understand the free market- either that or you are intentionally misleading people.

Those in favor of a free market, including myself, are NOT defending the current system - they are against a complete government takeover of the system.

Re: Is employer-based health insurance a barrier to entrepreneurship?

#138

Earlier quoted context omitted.

That's one example. There are 5,500+ hospitals in the US, so one example is hardly representative. There would be many more investments if it was more profitable. As the link I posted states - many are not profitable and many have a very low profit margin. Higher profits would bring more entrepreneurs and investment.

You are assuming that because the industry has many unprofitable participants, there must be few new entrants. You're guessing. You haven't shown that there are indeed few new entrants, nor have you shown that low profit margins are the main factor that discourages them. Any industry that is as capital intensive as hospitals are will have relatively few new entrants, so a convincing argument of the causal relationshi…

Investors/entrepreneurs are attracted to businesses that show promise to be profitable, and turn away from making investment in unprofitable businesses.

This is a basic economics principle - I'm not assuming anything. I cited hospitals as an example to illustrate this, because there are many stats, such as what I posted (not an assumption, but a study), which show it's not a very profitable business (relative other businesses) - and btw, neither is health insurance.

If you disagree, then look it up in a basic economics or finance textbook, here are a few explanatons of the relationship of investment, profitability and ROI:

"In other words, profit-seeking businesses operating in the private sector of the economy will be prepared to go ahead with an investment if they believe that the project will over its projected lifetime yield a real rate of return greater than if the money tied up in an investment project had been invested in the next best alternative way."

Macroeconomics - Capital Investment http://tutor2u.net/economics/revision-notes/a2-macro-capital...

"The owners of a company and the company’s creditors share a similar goal: to increase wealth. They are thus very concerned about profitability in all phases of operations.

Creditors are specifically concerned that the company use its resources profitably so that it can pay interest and principal on its debt. Owners are concerned that the company be profitable so that stock values will increase. Company managers must show they can manage the owners’ investment and produce the profits that owners and creditors demand. Because top management must meet the profit expectations of company owners, it passes down to the lower levels of management those profitability goals, which are then spread throughout the company. All managers, therefore, are expected to meet profitability goals, which are often increased and tightened as each level of management seeks a margin of safety."

PDF - The Importance of Return on Investment: ROI http://media.wiley.com/product_data/excerpt/50/04712037/0471...

Re: Is employer-based health insurance a barrier to entrepreneurship?

#139

Earlier quoted context omitted.

What wrong with a for-profit system? There should be MORE profit, not less. High profits attract entrepreneurs to compete for customers by offering lower prices and innovating - consumers benefit. The current system is the exact opposite - there is relatively little and uncertain profit (and high barriers to entry) in insurance and hospitals, and a ton of government interference and regulation. Few entrepreneurs want…

"What wrong with a for-profit system? There should be MORE profit, not less. High profits attract entrepreneurs to compete for customers by offering lower prices and innovating - consumers benefit." That ideal doesn't exist, and probably can't, in the real world. In most situations, the easiest/fastest/cheapest way to 'profit' is by getting more customers' money, and spending less of it. When 'spending less' means cu…

> That ideal doesn't exist, and probably can't, in the real world.

Yes it does, and it's a reality throughout the economy not just an ideal.

> Hospitals are often losing money because they're covering the cost of procedures for people who can't pay.

No, that's not true. The costs of unpaid bills is very low and not a major cost.

> When 'spending less' means customers get less care

That's not the case. Look at the horrible reputation of the VAs and government medical facilities vs. privately run.

My grandfather had free VA due to his military service, but bought additional medical insurance so he could go to a non-VA hospital instead-- the reputation of VA hospitals has been horrible.

Also there are many top-quality for-profit hospitals, some of the most respected in my area are for-profit hospitals. But also many doctors in practice for themselves provide excellent services as a for-profit practice.

> Long and short, hospitals and medical entities exist to help people with their most basic needs

That's why profitability is important, because it drives down costs and encourages innovation, as opposed to lack of profitability.

> Seeing 'for profit' companies making a profit from misery, illness, sickness and death isn't something that is going to sit well with most people.

Profitable companies help people every day, they make a profit providing a valuable service which is complex and requires a lot of investment and expertise.

They provide advanced medical services and pharmaceuticals and they save millions of people's lives. If you claim otherwise then you are simply clueless.

Profit is what lowers costs and drives innovation and investment. I don't know why you would be on an entrepreneur forum if you think profit is bad-- without profit there would be no entrepreneurship.

Re: Is employer-based health insurance a barrier to entrepreneurship?

#140
post #99

Earlier quoted context omitted.

Let's please not have political discussions on HN.

> Let's please not have political discussions on HN. It's interesting that you chose to respond to the person who demonstrated "dems good, republicans bad" was wrong instead of the person who just asserted "dems good, republicans bad".

I got here after both people posted. I posted below both people to indicate that I wanted the convo thread killed. I downvoted both people.
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