What Startups Need To Know About Health Insurance in 2013

> Republicans are anti-public health care because public care sets in motion a process that moves care decisions into federal bureaucracies, which is absolutely a problem that Canada and the UK have.

I thought that it was supposed to be state bureaucracies, rather than federal? Isn't that why states are supposed to set up their exchanges? (And the feds will only step in if they don't?)

Regardless, republicans say a lot about wanting a small government that gets out of the way, but their actions speak much, much louder than words, and they are not aligned with the "small government" mantra.

Disclaimer: In Employee Benefits in Canada.

Canada's private health care insurance is very broad, and while you aren't necessarily incorrect about anything you are only giving part of the picture.

The "Employer sponsored" extended health coverage you are referring to is Group Insurance. It is a form of insurance that can be offered to all people aligned to an entity (employer, trust, association, etc) that removes the requirement for personal health questionnaires and medical assessments. The coverage you are offered by your employer as "mandatory" is guaranteed to you so long as you remain connected to the entity in question. There is a huge advantage to this and this is the reason it has become the de-facto standard for private insurance in Canada.

Of course the trade off is that the entity qualifying as a "group" needs to have an overwhelming percentage (often 100% if it is small) participating in the plan to mitigate the risk. Insurance breaks down if the only people buying it are high users.

That said, Private Insurance (i.e. not Group) is most certainly available and affordable in Canada. With private insurance however your rate is going to be based on your own individual heath assessment and life situation. That means that while your Extended Health rates might be lower, as a single 30 year old male your Life Insurance rates will be higher than a Female's, for instance.

Overall, for a majority of people Group Insurance has the benefit of spreading the fluctuating lifetime rates out so that they are predictable and more equitable. You aren't going to be 30 forever, after all.

People can and do waive their employer sponsored insurance all the time (with the exception of participation minimums). In addition, employers have started to introduce "flexible" group insurance that allows limited plan choices, based on fixed credits.

Not much beyond that is fixed in these group plans, so the variance in plans, costs, and overall benefit to the employee from one employer to the next can be huge. It is an effective enticement to have a good benefit plan, hence the interview question. There is also nothing at all forcing an employer to offer any extended coverage.

Personally, I think Canada is right on the money with regards to how we handle private health care services and insurance. Keep in mind that self management also presents a fair amount of improperly covered people. People are simply too ignorant of the situation. At least under an employer sponsored plan a trained professional is designing a plan that meets as many of the needs of the employer's workplace as they feel is required.

Kaiser is basically the public health care system of other countries, but paid for and run by a non-profit corporation. :)f

I've heard good and bad things, though (compared to Blue Shield).

Indeed, and that is perhaps one of the two coherent claims made by republicans against a decent public options (single payer or otherwise).

Coherent Claim 1: The existence of a public option harms the viability and structure of a private option

Coherent Claim 2: A healthy, careful individual should not be forced to subsidize an individual who does not take care of their own health - but is forced to by a public option.

Both claims are a matter of opinion; It is my opinion that it is no different than police, school or war. (1: The existence of police harms private security; the existence of public schools harms private schools; the existence of the US army harms private mercenaries. 2: I should not be forced to pay for protecting someone who does not make an effort to protect themselves; I shouldn't be forced to subsidize teaching to anyone; I shouldn't pay for a war I didn't ask for).

I'm not sure why health care, which is sometimes (literally) a matter of life and death, and about which one has much less control than anything else, would not get a public option when schools do. And I have yet to find a republican who was coherent about why, if public healthcare is a problem, should we not also abolish police departments and public schools. But I guess one might exist.

The bigger problem with the republican standpoint, is that the coherent arguments aren't even made all that often; instead they tend to spread FUD with arguments that are easy to refute if you just care to look at examples - see, e.g. : http://news.ycombinator.com/item?id=4888507