Is Employer-Based Health Insurance A Barrier To Entrepreneurship? (2010) • Hacker News Board

Re: Is Employer-Based Health Insurance A Barrier To Entrepreneurship? (2010)

#71

Post by MrFoof » Sat, Aug 10, 2013, 10:35 PM UTC

jjoonathan wrote: post #8

mjn wrote: post #5

Earlier quoted context omitted.

Once the PPACA exchanges phase in next year, will that ameliorate the problems in your case? They seem like they target this case specifically, essentially trying to turn each state's population into a large risk pool that anyone can buy into, rather than having risk pools be employer-tied.

You beat me to it! (For those who don't know, the PPACA is sometimes called "Obamacare" although it should be noted that the name is more a result of political maneuvering than the result of particularly close affiliation with Obama.) I still think we should go all the way to single-payer. Other countries have had such success with this model that it's becoming very difficult to argue that it's inherently flawed (rat…

Massachusetts already has much of what PPACA provides as "RomneyCare", a.k.a. the Massachusetts Health Connector and MassHealth. It's exactly what allowed me (as a Type II diabetic) to strike out on my own without much concern.

I pay ~$430/mo (early 30s, single) for a high-deductible plan with low co-pays from a major carrier with no co-insurance. Do I wish my costs were less? Yes. Is it better than having to be someone's employee? Hells yes. Providing this to the entire country isn't the ideal solution for everyone, but it's a big step in the right direction.

Re: Is Employer-Based Health Insurance A Barrier To Entrepreneurship? (2010)

#72

Post by sliverstorm » Sat, Aug 10, 2013, 10:36 PM UTC

stretchwithme wrote: post #66

Yes, if insurance had nothing to do with your employer, the employer would be easier to leave. Imagine if your house and car and food were all paid for by your employer. And with a tax subsidy that makes it seem cheaper to do it that way than pay for these things on your own. Yes, leaving an employer would be a complicated choice. I'm also not convinced employer insurance is the deal people think it is. When I left m…

Employer insurance probably isn't a mega steal, but that's why it's called a benefit, not compensation. It's very nice to have.

Re: Is Employer-Based Health Insurance A Barrier To Entrepreneurship? (2010)

#73

Post by [deleted] » Sat, Aug 10, 2013, 10:38 PM UTC

lukifer wrote: post #70

brm wrote: post #4

Yes. It's a hindrance to most life paths that don't involve full-time employment. As someone with a chronic auto-immune condition I'm effectively tethered to an employer or a spouse if I want health coverage. Should I choose pursue an art as my vocation or start a company I'd have to be willing to endure a lag in my insurance until whatever I was pursuing became successful enough that I was eligible to be covered by…

Everyone who has a chronic condition has heard no shortage of "magic bullets" for treating their condition from strangers, so apologies for being that guy . I've read in /r/paleo that some have managed to improve auto-immune conditions through a modified paleo diet: http://paleospirit.com/2013/what-is-the-autoimmune-paleo-pro... Anyway, good luck. Hopefully someday our society views health care as infrastructure rath…

[deleted]

Re: Is Employer-Based Health Insurance A Barrier To Entrepreneurship? (2010)

#74

Post by sliverstorm » Sat, Aug 10, 2013, 10:43 PM UTC

auctiontheory wrote: post #21

Matti wrote: post #14

Looking at the Nordic countries you might possibly make the counterpoint that publicly funded health care implies a taxation model that makes it economically unrewarding to become an entrepreneur.

You imply that entrepreneurs do it primarily to get rich. That may be true for some, but it's not universally true. Many of us want to do interesting work to create something meaningful, while maintaining some control over our own lives. The way the US healthcare system is set up, leaving a big employer is incredibly hard after the age of 30-35. (I've done it myself.) It's also not obvious that Nordic countries (e.g.…

You imply that entrepreneurs do it primarily to get rich.

Watching the ahem measuring contests people get into on HN, only caring about the exit number, I kind of believe it.

Re: Is Employer-Based Health Insurance A Barrier To Entrepreneurship? (2010)

#75

Post by sliverstorm » Sat, Aug 10, 2013, 10:45 PM UTC

nawitus wrote: post #20

Matti wrote: post #14

Looking at the Nordic countries you might possibly make the counterpoint that publicly funded health care implies a taxation model that makes it economically unrewarding to become an entrepreneur.

At least in Finland entrepreneurs are taxed less than many full-time employees. Corporations are taxed at a flat percentage (about 28% of the profits), while income taxes are progressive and up to 50%. In fact, your argument doesn't make much sense. High taxation doesn't logically imply that it's necessarily unrewarding to become an entrepreneur but rewarding to be a full-time employe. You can have high taxes for ent…

A lot of high-earning individuals are actually using the lower tax rate of corporations to lower their tax rate.

So, exactly what happens in the USA. The bottom rung gets no tax, the top rung evades tax, and the middle rung bears the brunt?

Re: Is Employer-Based Health Insurance A Barrier To Entrepreneurship? (2010)

#76

Post by stretchwithme » Sat, Aug 10, 2013, 10:49 PM UTC

sliverstorm wrote: post #72

stretchwithme wrote: post #66

Yes, if insurance had nothing to do with your employer, the employer would be easier to leave. Imagine if your house and car and food were all paid for by your employer. And with a tax subsidy that makes it seem cheaper to do it that way than pay for these things on your own. Yes, leaving an employer would be a complicated choice. I'm also not convinced employer insurance is the deal people think it is. When I left m…

Employer insurance probably isn't a mega steal, but that's why it's called a benefit, not compensation. It's very nice to have.

eh. its oversold

Re: Is Employer-Based Health Insurance A Barrier To Entrepreneurship? (2010)

#77

Post by mjn » Sat, Aug 10, 2013, 11:26 PM UTC

jaibot wrote: post #57

zanny wrote: post #41

Earlier quoted context omitted.

The kind of sentiment that breeds that ignorant opinion is propegated by those that don't want to see single payer because it hurts their profits. The health insurance / for profit hospital / big pharma lobbies are aburdly massive, and like many (most nowadays) industries, they abuse their wealth to exploit faulty political process to see what they want instituted brought into law and to keep advances that invalidate…

If you have a plan to fix the entire American political system, I will happily listen. I just spent 2.5 years working tech in US politics and it did not fill me with optimism. When you have eliminated the implausible, whatever remains, however distasteful, must be endorsed.

I recall even Ted Kennedy somewhat later in life commenting that not reaching a compromise with Nixon's health-care proposals in the '70s, flawed as they were, was one of his major regrets, because the end result of holding out for proper reform was that here we were decades later, and nothing had gotten passed at all.

The Nixon proposal is an interesting one in retrospect. In some ways it's "left" of PPACA, despite at the time being opposed by Democrats, who preferred a real public plan and criticized Nixon's as a sellout to insurance companies. Although it wasn't single-payer, one of Nixon's proposed compromises would've actually included a public plan as an opt-in possibility (but not the default), reminiscent of the "public option" that more liberal Democrats unsuccessfully tried to include in PPACA.

Re: Is Employer-Based Health Insurance A Barrier To Entrepreneurship? (2010)

#78

Post by tzs » Sat, Aug 10, 2013, 11:43 PM UTC

zanny wrote: post #41

jaibot wrote: post #32

Earlier quoted context omitted.

It may become easier to reform healthcare if/when people see that PPACA doesn't Ruin Everything Forever.

The kind of sentiment that breeds that ignorant opinion is propegated by those that don't want to see single payer because it hurts their profits. The health insurance / for profit hospital / big pharma lobbies are aburdly massive, and like many (most nowadays) industries, they abuse their wealth to exploit faulty political process to see what they want instituted brought into law and to keep advances that invalidate…

Single payer is not necessary to have a good health care system. Proof: Switzerland [1].

[1] http://www.pbs.org/wgbh/pages/frontline/sickaroundtheworld/c...

Re: Is Employer-Based Health Insurance A Barrier To Entrepreneurship? (2010)

#79

Post by tocomment » Sun, Aug 11, 2013, 12:11 AM UTC

mjn wrote: post #69

Daniel_Newby wrote: post #58

Earlier quoted context omitted.

Government officials find something popular, promise unlimited amounts of it to get votes, then create a program to deliver it with total disregard for economic consequences. Last decade they bought votes with easy mortgages. After all, even an idiot could see that home ownership was a sound investment. They won two or three rounds of elections with mortgage policy. This decade it is health care for all! Even an idio…

As far as "ludicrous end-of-life-procedures for old people", I agree Americans spend far too much on those, but the bulk of that is people who are 65 or older, which is outside PPACA's purview, since they are already covered by Medicare [1]. If you want to argue for Medicare to reform how it treats end-of-life coverage, I'd support that, but anyone who argues that Medicare should spend less on end-of-life heroics run…

To eliminate the problem of end of life heroics would it be possible to add something to Medicare like you get x dollars you can leave to your family if you forgo the heroics. Where x is day 10% of the cost of the heroics?

Then people have an incentive to save money but death panels aren't needed.

Of course this is assuming the heroics rarely work.

Re: Is Employer-Based Health Insurance A Barrier To Entrepreneurship? (2010)

#80

Post by mjn » Sun, Aug 11, 2013, 12:25 AM UTC

jdminhbg wrote: post #42

mjn wrote: post #29

Earlier quoted context omitted.

Is taxation actually higher in the Nordic countries for entrepreneurs? If you bootstrap yourself to $100k as a 1-man company in the Valley, the taxes come out to something like: $7,000 CA income tax $14,000 self-employment payroll tax $16,000 federal tax (after deducting eligible portions of the above two) ------- $37,000 (37%) In Copenhagen, it would come out to [1]: $8,000 labor-market contribution (AM-bidrag) $24,…

You are missing 25% VAT in Denmark, vs 7.5%-10% sales tax in California.

True, although a VAT is complex in its effects. Since it's applied throughout the supply chain on added value, not only at the point of sale, it acts partly as a sales tax, partly as a corporate tax, and in some cases as an excise tax. It may push up final prices to consumers, but it may also push down wages, or push down corporate profits, or have effects anywhere else through the supply chain, depending on each party's pricing power at various stages.

How it impacts an individual also depends on how they spend their money. I spend a large proportion of my money on rent, airfare, and foreign trips, none of which incur Danish VAT, so it hits relatively little of my spending.