Obamacare Could Help Fuel a Tech Start-Up Boom 671
dcblogs writes "The arrival of Obamacare may make it easier for some employees to quit their full-time jobs to launch tech start-ups, work as a freelance consultant, or pursue some other solo career path. Most tech start-up founders are older and need health insurance. 'The average age of people who create a tech start-up is 39, and not 20-something,' said Bruce Bachenheimer, who heads Pace University's Entrepreneurship Lab. Entrepreneurs are willing to take on risks, but health care is not a manageable risk, he said. 'There is a big difference between mortgaging your house on something you can control, and risking going bankrupt by an illness because of something you can't control,' said Bachenheimer. Donna Harris, the co-founder of the 1776 incubation platform in Washington, believes the healthcare law will encourage more start-ups. 'You have to know that there are millions of Americans who might be fantastic and highly successful entrepreneurs who are not pursuing that path because of how healthcare is structured,' said Harris"
but but but but (Score:3, Funny)
Bachmann said Job Killing Regulations!
Re: (Score:3)
yep (Score:5, Interesting)
If th e US has a civilized Health Care system, I would start my own business much easier. Or join a start up without worrying about health care.
Re: (Score:3, Interesting)
That's the problem, employers are starting to stop worrying about healthcare because, hey, the government will do it for you right?
I pretty much didn't like this from the start but I'm no fool, I'll take advantage of any government program I can. But this one sucks. First, my employer dropped 4 of our 6 healthcare options this year because some didn't qualify (they were the super cheap options the younger sales guys usually took) and some because they would have fallen into the "Cadillac" class. So now we c
Re:yep (Score:5, Informative)
Basically you are telling us your employer sucks and really doesn't care about their employees.
Say what you will about Starbucks and their burnt coffee, but here's what Howard Shultz had to say about the subject:
Starbucks wonâ(TM)t use the new law as an excuse to cut benefits or lower benefits for its workers...
http://seattletimes.com/html/localnews/2021922111_westneat29xml.html
Apparently, cutting your employee's health insurance is so low Starbucks will not stoop to it. But there are plenty who will, and it is the sign of a shitty employer.
Re:yep (Score:5, Insightful)
Why should our health care be tied to our employer?
My employer can't tell me what grocery store to shop at, why do they get to dictate my doctor?
Re:yep (Score:5, Interesting)
The idea of your employer being in any way connected to your health care is just vile. I am sorry to hear about your personal situation, most of the analysis I've done shows that the exchanges are competitive with employer-provided health care, and in many cases cheaper with subsidies. If it turns out at the end of the year your employer insurance over-charged, I believe they have to refund you some of your premiums. They can't just pocket the difference and call it a day anymore. This is totally new. How well it will work remains to be seen. There is also the somewhat shady option of just paying the penalty for no insurance, and if something major happens, sign up then since you can't be denied for pre-existing conditions now...
As for the poor, the law was written so that anyone making 138% FPL or less would get Medicaid. From there up to 400% would get subsidies. But half the states aren't doing the Medicaid expansion. This is a pretty big wrench in the cogs, and it remains to be see how it plays out. The idea was to get people with no insurance out of the ER and into preventative medicine, which is much cheaper to provide. Plus the moral arguments about helping the poor and sick, etc.
I've been saying the same thing about the Republicans. If Obamacare is so awful, why not just sit back with a smug grin and let it fail for two years, then rake up in 2016? I have this suspicion they're afraid it might actually work. If all the poor, white people that voted for them suddenly can do see a doctor and get medicine and take care of nagging ailments under the auspices of "Obamacare", that's gonna devastate them at the polls with that demographic.
As it stands for my family, there is myself, my brother, and my nephew who I know off the top of my head could get in on the Medicaid expansion. We currently have no health insurance. My brother actually has diabetes, so he needs it pretty badly. As it stands here in Tennessee, Obama is still evil and those damn liberals, etc., since we STILL won't have coverage in 2014. But if the expansion had went in, the three of us would have Obamacare, and it would be a hard argument for any of us (or my parents) to say Obamacare is bad when we're suddenly getting medical treatment we've needed for a while.
Re: (Score:3)
Are you saying that requiring coverage for contraception and keeping kids on the program until they are 26 raised the rates by 15%. I think your employer is feeding you a line of BS.
drinking the kool aid or... (Score:3)
--------
The problem is the medical system itself uses corrupted, ineffective and extraordinarily cost inefficient methods favored by certain suppliers e.g. the pharmaceuticals.
I have a family member with stage IV cancer, once considered truly hopeless. Cost at this point is normally $1-2 million and certain death, usually
Re:yep (Score:4, Insightful)
Meh, it wasn't that big of a deal when I left corporate employ to buy private medical insurance.
Still have it today. I'm lumped in a category of similar size businesses for actuarial purposes.
And I will pay more under obamacare.
Its not the panacea you think. And its not going to be as cheap as you think.
Forbes [forbes.com] says it will be almost $7500 per year for a family of four. Time [time.com] pretty much concurs.
The only way this proves a boon to entrepreneurship is if they skates on the insurance (refuse to buy) and just pay the fine.
And why wouldn't they? The fine is 1/12th of the cost of an actual insurance policy.
Re:yep (Score:4, Insightful)
Market? Are you joking?
With the federal government involved there is no market.
Prices will expand to absorb all available funds.
Re: (Score:3)
Which is why the most vibrant business environment in the world is France.
Oh wait... no it isn't.
Re:yep (Score:4, Insightful)
Might be why, despite 30% of the population smoking (2005), they live 3 years longer than people in the US (20% smokers in 2006). It's not all about money...
Re:yep (Score:5, Informative)
Oh, and they get between 5 and 9.5 weeks holiday, lot's of employment rights and protections and tasty cheese. The last time I saw an American commenting on France's productivity and employment laws it was the head of a tyre company - I think the French pointed out that Michelin is 20 times larger and 35 times more profitable than the US company. Also if you think the French are more concerned about money than quality of life then you have no idea what they are about. At least remember to thank them for scaring the British out...
Re: (Score:3)
Wait, let me get this straight -- your argument is that if we ignore all the negative factors that our system causes, it comes out ahead!
Right. I've got a great strategy to make you rich too. Will pay you $50/day, every day! All you have to do to get this great strategy is subscribe to my service at the low lifetime membership rate of $60/day!
Re: (Score:3)
Many do. Not all, and many of those only offer to help pay for Cobra-ing into your existing plan. That doesn't help if you don't have an existing plan, or if you're in a high risk category (weight, pre-existing conditions, etc). And none of this applies to founding a startup, when you're pre-funding.
Re:yep (Score:5, Insightful)
Well, there's 48 million uninsured in America, by the latest estimates I can find. HHS finds that 129 million americans would be considered to have pre-existing conditions. With about 300 million americans, that's 43%. Assuming that those two are independent (they aren't, you're more likely not to be insured if you have a pre-existing condition) that's 21 million people who are now able to get insurance who couldn't before. As they aren't independent, it's more likely to be 30 million. So 1 in 10 to 1 in 15 people. That's a pretty dramatic positive benefit.
Re: (Score:3, Informative)
Re:yep (Score:4, Informative)
I suggest you look on the exchanges to see if you can get a better rate. In MD the cost depends on the plan you choose, but will be between $100 and $300 a month for an individual. With you, your wife, and one kid it can't be more than 3 times that. Rates in your state may differ, but you may be able to get coverage cheaper by not going through your employer.
Re: (Score:3)
Re:yep (Score:5, Funny)
> He was promised he could keep his insurance if he liked it.
This may come as shocking news to you, but the health insurance rates have been going up for about 20 years or more. And we all know that it is because of Obamacare. It was having a negative impact, decades before it existed.
Re:yep (Score:4, Insightful)
Nope, not at all. A private entity that the government does not set prices on decided to raise prices. This raise was not mandated by the ACA. A second private entity, his employer, decided not to increase his pay to cover that increase. Had there been no government exchange, his options would be to pay for the increase or not have health care. With exchanges his options are to pay for the increase, buy from the exchange which will likely be far cheaper, or not have health care.
In fact his choices are most likely exponentially increased by the existence of exchanges, as its unlikely that his employer offered more than 2 or 3, and may have only offered 1. My state has over 40 options on the exchange.
Re:yep (Score:5, Informative)
Yup, because that raise in premiums was really the effect of the ACA. Newsflash: health insurance premiums rose an average of 13% every year from 1999-2009. Source: http://ehbs.kff.org/pdf/2009/7937.pdf [kff.org]
Also out of pocket costs were increasing 5% a year on top of that. Source: http://www.reuters.com/article/idUSTRE62O1DJ20100325 [reuters.com]
So yeah, I HIGHLY doubt that the ACA caused even a penny of that increase. If it did, it was because some exec there said "Hey, we can claim the ACA is causing us to raise rates and raise them even more than usual."
Re: (Score:3)
Re:yep (Score:4, Interesting)
Ask me in 3-5 years. It hasn't even been fully implemented yet. The majority of it comes into law on Jan 1. How can it be bringing down costs when only a tiny portion of it is running, and the most important part (exchanges) aren't on yet.
Re: (Score:3)
You're on the wrong site anyway. Exchanges are state by state, you should be on the state's website.
Re: (Score:3)
Re: (Score:3)
They pay 100% but what do you pay them?
Unless you are a street sweeper, you're probably coming out ahead avoiding socialism even if you have what appears to be a horrendous insurance bill.
People seem to discount taxes for some strange reason when comparing these things.
Someone does have to pay the bill. There's really no getting around that. Stealing from Paul to pay Mary really doesn't change anything.
That's the ultimate problem with Obamacare: no real attempt to address escalating costs. Just lots of new
Re:yep (Score:4, Interesting)
Nope. I applied multiple times int he last 2 years and get rejected on at least a half dozen times by several companies. In one of the most liberal states in the nation (Maryland). You're just wrong.
Re:yep (Score:5, Informative)
Some citations for my numbers:
http://aspe.hhs.gov/health/reports/2012/pre-existing/ [hhs.gov]
http://www.familiesusa.org/resources/publications/reports/health-reform/pre-ex-conditions-findings.html [familiesusa.org]
Notice that the non-government site posits a much higher number. I have more faith in the HHS numbers though.
Census data for the uninsured numbers: http://www.census.gov/newsroom/releases/archives/income_wealth/cb13-165.html [census.gov]
Logic. If they won't sell it to you if you have a pre-existing condition, then you're more likely to have a pre-existing condition if you don't have insurance than if you do. This is a direct result of Bayes theorem. Look into conditional probability.
Yup, that's a real impartial source there. ROFL. Actual studies, government or by a respected university (public or private) or STFU.
Also, use numbers that aren't most of a decade old and from before the worst financial crisis of the last 60 years.
Mostly because people didn't know about it at first- it wasn't well marketed. But FYI, the Maryland plan was sold out for the year months ago. I tried applying for it and was put on the waiting list. And told not to expect to get it this year (I haven't).
Not a single person will lose insurance due to this law. Blatant fearmongering.
Oh, really? (Score:3)
Not a single person will lose insurance due to this law. Blatant fearmongering.
You are blatantly incorrect. Scores of thousands have already lost their insurance due to this law:
Ten states where Obamacare wipes out existing health care plans [dailycaller.com]
Trader Joe's Invites Part-Timers Losing Company Coverage To Seek Additional Obamacare Subsidy [huffingtonpost.com]
Despite Obama Promise, Many Coloradans Losing Their Health Insurance Plans [thecoloradoobserver.com]
Re: (Score:3)
Previously...I liked contracting 1099. I could get (even with pretty heavy pre-existing conditions 6 years ago) a high deductible medical plan, for emergencies. It was about $1300 deductible, but I also was able to set up a HSA (Health Savings Account, which is not use it or lose it like FSA) and sock away about $3100 pre-tax for me routine care.
This was pretty sweet...however, I hear that Obamacare has started taxing FSA's ...and I'm guessing HSA's now are
Enough with this BS (Score:4, Informative)
My HSA is still tax free. 1099s are mostly a tax dodge, taking advantage of desperate people or both. Companies hire 1099s for what's really full time continuous work and call them 'contractors'. The taxes are lower because you're not hiring an employee you're paying for work. The reason you can't get a 1099 is the gov't is cracking down on that. It's only good for you in the short run. In the long run they'll cut your wages and benefits while underfunding the safety net you'll need sooner or later.
Re:Enough with this BS (Score:4, Informative)
Not a dodge...there are PLENTY of folks out there, working contracting, for real. You have to dot your i's and cross your t's to make sure the IRS doesn't reclassify you.
I personally LOVED this method of work. I paid my taxes, but was able to save money, and write off a ton of stuff. Frankly, I find it is about the best way to actually keep a much of your hard earned dollars as you can. Most of my work with as sub to subs for Federal contracts, very lucrative and definitely can be pretty long term (5 year at a time, then, switch to new prime).
It isn't a dodge, it is a way to keep the money you earn, and legitimate if you play by the rules. If you don't, the IRS will bite you hard on the ass.
I don't mind negotiating my bill rate, I know my numbers....I plan enough for 4x weeks a year for vacation/sick time. I put money back into HSA pre-tax, for my routine medical needs. I put money away for retirement.
I don't understand why they seem to try to make this harder for those that ARE responsible enough to guide their own future.
Anyway...I'm actually kinda hoping Obamacare does entice all businesses to allow more 1099 contracting, just have to make sure it is corp-to-corp to help shield somewhat from being reclassified which costs everyone money.
Re:yep (Score:5, Informative)
Most Silicon Valley startups offer healthcare.........if they don't, they are horrifically underfunded and you should avoid them.
It takes time to obtain funding. The article is talking about the people who take a risk and actually launch startups, and their health insurance during the time that they are pitching their ideas to investors to obtain the funding to offer insurance to new employees, not people like you, who only join after the funding is secured.
Re:yep (Score:4, Interesting)
As a small business owner, I cannot agree. I do have the impression at this point that ACA does not do enough to decouple health care financing from employment, but even so, it looks like ACA will help most small businesses, including mine.
Re:yep (Score:5, Insightful)
I do have the impression at this point that ACA does not do enough to decouple health care financing from employment
Hear, hear! Health care should be completely decoupled from employment. That would be pro-business, and I'm always amazed it hasn't been promoted as such. It works for Canada and many other countries.
Re:yep (Score:4, Insightful)
I do have the impression at this point that ACA does not do enough to decouple health care financing from employment
Hear, hear! Health care should be completely decoupled from employment. That would be pro-business, and I'm always amazed it hasn't been promoted as such. It works for Canada and many other countries.
It would be pro-business, but not pro-insurance-business. The more insurance is decoupled from employment, the less they can charge for premiums and so the less money they make. The insurance industry has a big lobby, and this is the ACA is the one and only issue they are focused on. Other business have to divide their lobbying dollars between different issues.
A major part of the ACA is that medical insurance companies must spend a certain percentage of their premiums on medical care. If they don't, they have to return it to their customers. This is to significantly reduce premiums in the long term and to make sure that those dollars are going towards actual medical care. Of course, that goes contrary to insurance companies' practices, which is to maximize premiums and minimize the percent spent on actual medical care in order to maximize profit, which is their obligation to their shareholders, evilness doesn't even enter the equation. So you can sure as hell bet insurance companies are going to be doing whatever they can politically to push back on that. You can also sure as hell bet that they'll do their best to artificially jack up premiums in the short term in order to make the ACA look bad.
Re: (Score:3)
And there is a potential problem.
If you own both the hospital chain AND the insurance company, you can jack up prices at the hospital and still pay 85% of inflated premiums to your other hand.
I think they need to have a restriction on owning an insurance company AND any kind of medical care facilities to prevent this obvious abuse (already used in other ways as a tax avoidance strategy in other kinds of businesses)
Re:yep (Score:4, Insightful)
It wouldn't be pro-business; it would be pro-small business and pro-new business, but it wouldn't be pro-large business at all; after all, health care is one of the levers they use to press your nose to the grindstone.
Re:yep (Score:4, Insightful)
Comment removed (Score:5, Insightful)
Re: (Score:3)
Also worth noting that this is elective surgery. Non-essential care. I don't care that you have to wait a couple months to get a nosejob. I *do* care that even with fairly good private insurance (though Cigna) in the US, it cost me $300 to get a prescription for antibiotics for a simple infection because there was a three month wait (minimum) to see a freakin' general practice physician. For what would have been a 10 minute appointment at the most. Ended up going with some company that outsources the doctor
Re: (Score:3)
Re: (Score:3)
As someone with an independent insurance plan in an evil Red State, I find this false dichotomy absurd. My non-employer plan has always been competitive with anything I've seen an employer offer. You don't have to be married to your employer or the government. Trading dependence on one for dependence on the other really doesn't solve anything.
Health insurance as it has evolved in the US and Europe is a scam as it makes people think things are free when they are quite the opposite. It all invites abuse and a
Re: (Score:3)
Congrats on being healthy.
Re:yep (Score:5, Insightful)
You know that one of the top reasons people give for not quitting their job is that they need to provide health insurance for their family, right? And if they're getting health insurance from an employer they're not likely to give it up and take a chance.
You bet being able to get reasonable insurance on your own is going to have more people quitting jobs to start a new business.
I started a business when my daughter was 4 years old. The only reason I was able to do it was because that was when my wife went back to work and got insurance for us through her job. Now I have a business that provides insurance to my family and the families of my three employees (two full-time, one part-time).
It's really not that hard when you think about it beyond "Goddamn Obama/DNC!". Put aside your AM radio thinking for a minute and think about how people actually live.
Re: (Score:3)
I don't know if ACA is necessarily going to resolve this issue but I do know its the best effort I've seen in my adult lifetime.
Better than merely doing nothing? I don't buy it. There's some deep problems with it such as large incentives for demand and cost increases and the unconstitutionality of various parts of the law.
I have personally seen benefits already (22 year old son who can be on my insurance, sick aunt who can't be denied because of pre-existing conditions). So, it's better than the previous status quo. If they repeal it, the two people just mentioned are screwed. I imagine that the rollout today is going to be a huge CF, but the complaints that 'Obamacare has already failed' by Cruz and others is just crap.
The problem I see is that the people opposed to the law are not proposing anything. Literally, noth
Re:yep (Score:4, Interesting)
They just sold everyone else's souls. As I see it, everyone who brags here about how they're getting cheap health care due to this law at everyone else's expense is betraying the rest of their society.
No, you've got that backwards -- the rest of society is betraying *them* slightly less.
Why is some CEO's right to get a gold-plated cellphone or even your right to spend $20 at the movie theater worth more than their right to maybe live without being in constant pain -- or to live at all?
Not that I'm a fan of Obamacare...it's a corporate handout, nothing more; what we really need is a single-payer system...but saying you're being "betrayed" because someone doesn't want to have to choose between food and healthcare is frankly kind of disgusting.
Re: (Score:3)
Re:yep (Score:5, Interesting)
*shrugs*
I know GPs who have done a stint in the US and moved back here to practice. When I ask them, the answer boiled down to "Money aint everything kid."
I guess a few years later I can understand. My (US citizen by birth) wife and I are here in Canada with our daughter. I've had offers to go down to the US at substantial salary increases. I run them by my wife and she thumbs down them all. "Not worth it - after you calculate in health care and private school for the kid, the extra money goes quick".
At one point she was paying 500$/mo out of her 10$/hr job for health insurance. Her huge crime? She was born with a congenital heart defect (e.g. a preexisting condition).
Incidentally - her Dad was a vet. They went bankrupt on her infant open heart surgery.
I don't know if Obamacare is the right answer or not, but I gotta tell you folks, I wouldn't trade ya. Sorry.
Min
Re: (Score:3)
Exactly! (Score:5, Insightful)
One of the things the haters don't get is how big an implicit tax we pay because we don't have universal health care. Other countries pay far less per person, with far less risk. You may not be thinking about it when you're 20 something and healthy, but in a moment you can lose everything because you're not covered.
Re:Exactly! (Score:5, Insightful)
Yes it does. It requires insurance companies to accept people with pre-existing conditions (which can include mere weight), which is a major problem for anyone trying to buy individual coverage. It also provides rebates for people who make under a certain threshold, reducing costs.
It's not perfect by a long shot, but it's better than what we had.
Re: (Score:3, Interesting)
It also creates the exchanges, which ensure that you, as an individual can purchase healthcare at group rates.
Can't say that we've seen a tech boom here in Massachusetts, things were moving along rather well anyway, but speaking as someone doing a startup, right now, in the state, with access to exchanges...it's awesome.
Re:Exactly! (Score:4, Insightful)
Yup. My state exchange opens tomorrow. For the first time in 2 years, I'll have insurance (due to my weight no insurance provider was quoting me prices below 500 a month). That literally is the difference between life and death if I get seriously ill- it will be a huge weight off my shoulders.
Re: (Score:3)
Actually, obese people cost less in medical care over their lifetimes, they die earlier. So you can thank me for saving you money.
Every person has a right to medical care. If you had any humanity you would be ashamed.
Re: (Score:3)
Every person has a right to medical care.
While I don't actually agree with this, that battle was lost in the 80s under Reagan. Obamacare is much better than what we have had since then - uninsured people showing up at the ER. You couldn't devise a more expensive way to do it if you assigned a congressional blue-ribbon panel to come up with one.
That you will be paying into the system instead of using the ER for your inevitable health problem (we all get them) means we are all better off than we were before.
Re: (Score:3)
Citations:
http://www.nytimes.com/2008/02/05/health/05iht-obese.1.9748884.html [nytimes.com]
http://www.forbes.com/sites/timworstall/2012/03/22/alcohol-obesity-and-smoking-do-not-cost-health-care-systems-money/ [forbes.com]
In the forbes study, here were the lifetime costs (in euros, the study was EU)
Healthy: 281,000
Obese: 250,000
Smokers: 220,000
Re:Exactly! (Score:5, Insightful)
And if you had any sense of decency, you would feel that bankrupting people or dooming they to die because of pre-existing conditions was morally wrong.
Re: (Score:3)
I don't agree that bankrupting people was morally wrong. If someone is looking for charity, it seems reasonable to make sure that they are actually needy.
That said, the universal mandate is a pretty pragmatic way to avoid the need for the charity in the first place. It shifts the moral argument over to: is it right to force people to buy something? But we've been taxing people against their will since the dawn of human civilization, so I think I know the answer to that: it doesn't matter :)
Re:Exactly! (Score:5, Insightful)
Is it right to make people buy national defense?
Is it right to make people buy a national highway system?
Is it right to make people buy federal inspections to ensure safe water supplies and food?
Here's the answer... unless you are an anarchist, it is perfectly alright to make people take responsibility for themselves and not allow them to shift the cost of their health care onto the rest of the public by getting it for free from emergency room services, who then bill the rest of us with insurance to make up for it. It is perfectly reasonable to make the public participate in a program which will allow people to feel like visiting the doctor before they start an epidemic will not bankrupt them.
Re: (Score:3)
Is it right to ...
Who cares? There are thousands of years of history behind the people doing the taxing. It's a lost cause, right or wrong. I don't worry myself much about it.
not allow them to shift the cost of their health care onto the rest of the public by getting it for free from emergency room services
Prior to the 80s, we had that little conundrum settled by simply not providing the care at all. Can't pay? Go somewhere else. No more freeloading. It was cold and heartless, and so justifiably abandoned - but abandoned in the most expensive possible way. It might have been Ronald Reagan, champion of the free market, but he f'd that one up. I'm not sure
Re:Exactly! (Score:5, Insightful)
You'll be paying exactly $0 for my insurance. I'll be paying for it, and I don't qualify for (or deserve to qualify for) reduced rates due to income. What this law does is force them to sell it to me, for the same rate they were quite happy to sell it to my employer at 3 years ago when I last worked for a company that provided insurance. Instead you'll be forcing them to do what insurance is supposed to do- mitigate risk of a population by spreading it between all of them, whereas before you only got that benefit if you qualified for a group plan.
Re: (Score:3)
Yes, because the premium price you pay every month is the full and total cost of your policy... we'll just ignore the massive subsidizes to other people in the group (who I am paying for through increased taxes) who in turn bring down your costs a bit.
Again, you made the choice to go without insurance and now are making me pay for your mistakes.
Re: (Score:3)
In that case you weren't getting the main advantage of insurance- spreading the risk. Instead you had to pay 3-10 times the amount if you had a pre-existing condition. Why?
Getting insurance to cover a pre-existing condition isn't "spreading the risk", it's pushing the cost for a known condition off on other people. When you've already got it, it is no longer a risk, it's a given. At that point you're buying "discount health care", not "insurance". The costs to treat you are the same, you're just hoping other people will help foot the bill.
Re: (Score:3)
Except for two things
1)When they qualified for a group plan, they insurance company was happy to insure them for that price. That means that its profitable to insure them for that much. The insurance company just doesn't want to, because they can make more money without doing so. Boohoo, poor insurance companies.
2)And why should people who have hereditary conditions, accidents, or just the bad luck to have cancer be uninsurable and have to live in pain or die?
Not for medical device startups (Score:2, Informative)
I've worked in the medical device start-up world for about 10 years now. The 2.3% tax imposed by Obamacare has really hurt. Because it's a tax on gross, not net, it makes it much harder for small companies to turn a profit. So funding has been drying up.
At least in the US. Because of the way the tax is calculated, imported products have an advantage. So funding is shifting OUS.
The Real Problem Isn't Health Coverage (Score:2, Interesting)
That simply doesn't wash. While I certainly want everyone to have coverage and to get the best treatment, the fact is, BY LAW in the United States, no hospital can refuse to provide essential care. I have a friend who had breast cancer, and who went through the entire course of treatment without paying a penny. I have another who suffered kidney failure and went through years of dialysis -- without paying a dime.
The real killer is *being*out*of*work. You're so sick, you can't work, so you have no income. Fo
Re: (Score:2)
The problem is, if you are paying them as much as you can afford on bills that are 20x your likely annual income, you are never gonna be able to do anything else. No savings, no investment.
Re:The Real Problem Isn't Health Coverage (Score:4, Informative)
I have a friend who had breast cancer, and who went through the entire course of treatment without paying a penny.
AND
I have another who suffered kidney failure and went through years of dialysis -- without paying a dime.
you are lying. Stop it. That not how it works. They only have to be sure you aren't dying right at that moment.
" provide essential care."
Incorrect, emergency care not essential care.
" If they take you to court, you can tell the judge: I was out of work for a year, I can afford to pay them $25 a month and that's it. The judge will almost always agree."
This is why hospitals have started selling their debt to 3rd parties. These 3rd parties can claim more, sue you, destroy your credit, garnish you wages.
"I've been in court and have watched it happen.
since everything else you say is factually wrong, I'm not going t believe this either.
I am a Former ER billing specialist, Now ER nurse.
Wrong. Wrong. Wrong. (Score:5, Informative)
Read the laws again. The law merely requires facilities that accept Medicare and provide emergency care to provide "stabilizing" treatment to emergency conditions without regard to ability to pay. Once you are stable, it is perfectly legal to toss you out the door. Your friend likely found a facility that was willing to cover her cancer under their charitable care program (some level of unpaid care is required in most states for non-profit hospitals.) If your friend had needed a transplant, she would have discovered the limits of that care. (People routinely die due to inability to get transplants covered; they are just too expensive for most hospitals to write off.) Dialysis is ALWAYS covered by Medicare as soon as four months elapse, no matter your age. But you need to find somebody to cover those four months, unless you want to head to the ER every time you crash. This is by no means guaranteed. You most certainly can be refused "essential" care, as long as you are not in danger of dying right there in the lobby. (As in, they'll treat you if you are about to fall into a diabetic coma, but aren't at all required to provide you with a monitor and strips (much less insulin) long-term to keep it from happening again.)
Next, there is no law saying that hospitals (or anybody) cannot collect on debt as long as you are making minimal payments. They can pursue debt collection equal to the efforts of any other unsecured creditor. And yes, if you show up and offer up what you can, the judge may take you up on your payment plan... but that's not set in stone and varies widely by state.
And yes, being out of work drives people to bankruptcy, but so do unaffordable co-pays and deductibles, policies with horrible annual limits, policies with limited coverage, unaffordable drugs, sudden catastrophe without insurance (it doesn't take much), etc. The paths to medical bankruptcy are many.
Re:The Real Problem Isn't Health Coverage (Score:4)
My son needed a surgery the cost 15K.
You could have gotten insurance that would cover precisely that sort of bill for a lot less than $1500/month.
The problem is that you don't even know that such plans exist: These days they are called "Catastrophic Coverage" but they used to be called "Major Medical" -- typically you will pay the first $1000 or so of any illness out of pocket, and the rest is on the insurance company.
The people with these plans often create Health Savings Accounts for dealing with routine healthcare costs.. and these have serious tax advantages.
But no.. people are too ignorant to know whats available, so they demand PelosiCare, so that some fuckers in an insurance company can get a percentage of the cost of every single doctors visit... Its people like you that ruined this country. You wanted something that was already available, and voted to get the government to provide it for you at 10 times the price.
Re: (Score:3)
You still can. It's called... *drumroll* - catastrophic coverage. It's provided on the exchanges (at least CA has it).
*drumroll* - we call it catastrophic coverage, but your first 3 visits per year to your primary care doctor are included.
Sorry pal, thats catastrophic coverage plus comprehensive coverage.. so none of the advantages of an actual catastrophic plan (very low premiums because only catastrophe is covered)
What prevents you from still enrolling in one?
sigh... so now I've got to pay for two plans, instead of one? I get it... you want me in that exctra one because you cannot budget for yearly visits to your doctor but somehow can find the money to pay for
Sounds plausible (Score:5, Insightful)
I can't begin to imagine how many people I've worked with over the years that have only worked somewhere because of the health benefits. Make the health benefits no longer an issue and you gain better competition in the market for where people can work. Remove the barrier and all of a sudden a lot of places that previously would not have attracted enterprise class talent open up.
The fact that some of these places are starts ups is largely incidental. Think of it this way, something like 40% of fortune 500 companies were started by immigrants. Why? Because they were hardworking and didn't have anything holding them back.
I know I've turned down employment opportunities for a lack of viable health insurance for my family, I have to imagine that I'm far from the only one. What happens when people are no longer held back by this very practical concern and can go for broke like the immigrant entrepreneur?
Actually (Score:5, Interesting)
If you say, have some disease, and it is cured, and you want health coverage, you are stuck in your present job with it's present health coverage. Change jobs, and ooopsies, it's a preexisting condition. So a friend of my spouse who had breast cancer, is stuck in her job. Because if it recurs, which isn't likely at this point, but possible, she is bankrupt.
And despite all the hate, there is a lit fuse in the present system. People without health care do get treatment for their illnesses and minor issues. They go to the Emergency room. There, they get the most expensive treatment available to people - emergency room care. Before my father passed away last year, he was in the emergency room three times. And it was a little strange. Most of the people there just seemed to have minor problems, like sore throats, colds, sick kids. I'd asked about that, and the eanswer was "it's poor folk with no insurance." But rest assured that it is paid for, by your's and my premiums, and by Government.
The problem is, as insurance costs go up, and people drop off the rolls, the emergency room will become more and more used for more and more people. A real positive feedback loop, Eventually no one except people who can pay for their medical bills out of hand will afford health insurance. Then, unless we are going to force peole to go without medical treatment, we'll have a bizzare form of universal coverage. Not a good idea at all.
Reading the opposition plan, it is some bafflegab about doing the same thing as we are doing now, except for more bafflegab about affordability.
Had this freedom in Canada for a long time (Score:5, Informative)
Healthcare is one major reason I decided to move back to Canada and work in a self employed situation. Here people can work two part time jobs if they want, or start a business and not worry about having to buy into basic health care plans. Many companies do offer supplementary insurance though. Even our own family company is thinking of doing that.
Obviously freedom means different things to different people. Guess at least half the republican party sees things differently.
Tech Startup? (Score:3)
Overly simplistic argument (Score:4, Insightful)
Obamacare slightly reduces the cost of insurance for older people (like me) but then materially increases the cost for young males and in other ways in practice. Ever look at the demographics of a tech startup beyond a founder? At my startup, we pay for good insurance for our employees and while maybe my individual insurance is slightly cheaper, that is apparently buried in the noise floor of the increasing costs for the total employee pool. And the small difference in individual cost for older individuals does not materially alter the risk calculus for the individual in terms of whether they'll start a tech company.
It would be nice to see a little honesty that the law as written will be terrible for a lot of people. Including, empirically, tech startups. The percentage increases per employee are not small at all going forward and I know a lot of tech startups that are trying figure out if and how they can bury those new costs. I'm sure there are many policies that would reduce the direct costs for startups but this wasn't it, and predictably so. Perhaps media spin artists can contrive politically palatable scenarios where it reduces some startup's cost slightly while out here in the real world there has been a substantial increase in the cost of providing health insurance at tech startups.
Consequently, the idea that this reality will fuel a tech startup boom is some pretty strained reasoning. It may have some benefits but this won't be one of them. Obamacare might have helped some people but tech startups do not seem to be among them.
Absolutely ridiculous (Score:4, Interesting)
Most people are healthy and only need to learn to stay healthy. Most are better off with a medical savings account than with medical insurance. Why give money away for someone else to make billions off of it while you get little more than weak promises that in the event something bad happens, you might get minimal care?
We live in such a debt financing society we've all completely forgotten how to save money for bad days. Does a credit card really substitute for a savings?
Re: (Score:3, Informative)
Because if something major does happen, an MSA won't cover it. I had a bout of pneumonia. That cost me 5 weeks in the critical-care unit in an induced coma, a month of inpatient rehab, another 6 months of outpatient physical therapy, plus a year of IV therapy to fix the immune-related problem triggered by something (they're still not sure what) during my stay in the CCU (which still hasn't completely resolved the problems, but they're down to the point where the pain can be managed by medication). The hospi
Re:Absolutely ridiculous (Score:4, Interesting)
The answer to this is a MSA + a high deductible insurance plan. You use the MSA to cover smaller expenses and the insurance plan for situations like yours (which sounds like it was bad).
The added benefit of an MSA is that it causes people to shop around a little.
Insurance is not a bad thing by any stretch. Even that dream of single payer is really just an national insurance plan. It starts to get problematic when large numbers of people want insurance to cover smaller issues ("insurance covers birth control? I want my Viagra free!"). This leads to the costs going up on everyone.
From a UK perspective. (Score:4, Insightful)
All of you guys arguing about a system that makes healthcare available to those who don't have it - assume the vulnerable as it seems they are most likely to benefit - sounds like base savagery. I can't begin to imagine that you think the free market is a better fit for such a basic human requirement.
Re: (Score:2, Funny)
Ok, I almost need healthcare after trying to read this.
Re: (Score:3)
true, but they are specifically target a demographic that has traditionally been held back by needing health care.
Frankly, I suspect its' why large corporations don't get behind universal health care. They can't trap employees. At least that's the only reason I can think of since a good national health care system would save them money, and be consist and predicable in the books.
Obviously there could be another reason and I simple didn't find it.
Re:Really (Score:5, Insightful)
Oh, sure. And we had prosperous booms without computers, too. That people succeeded without something isn't evidence that having it won't help them.
Re: (Score:3)
http://www.businessweek.com/smallbiz/content/dec2010/sb20101210_839038.htm [businessweek.com]
Taxes (Score:5, Insightful)
Re: (Score:3)
Not if the healthcare focuses on patching symptoms instead of curing disease, and not if the education mostly brainwashes the students into obedient drones.
Re: (Score:3)
..speaking of which, does TFA bother to address what happens to costs once the start-up grows beyond 49 employees?
Re: (Score:2)
If the VCs said they were interested but didn't put any money down, it's because they weren't really interested. Canadian politeness, eh?
Re:One of the most obvious and false tropes (Score:4, Informative)
That is a load of bull. Any startup would have to have 50+ employees before being required to offer health care. And then the cost under ACA is much less. Stop spreading your misinformed lies.
Re:Unmitigated bullshit (Score:5, Insightful)
Like any other form of tax, Obamacare's net results will be negative in employment
As a truism, that's bullshit. And it's not even entertaining bullshit.
Let's pretend it was taken to it's logical extreme, aka a society with zero taxes. Also known as a society with no roads, no enforced laws, no food inspection, no building codes, etc. You really thing that's a better functioning society with increased employment? Now, obviously a society at the other extreme (100% taxes) is equally dysfunctional. Arguments can be made for lower taxes (and certainly better spent taxes), and arguments can be made for raising taxes in some circumstances (certainly worked in California lately), but to say lower taxes are always better is so stupid it's not even wrong.
Re:Unmitigated bullshit (Score:5, Informative)
Reagan and Bush both proved that taxes are already too high. They both lowered taxes and the result was an increase in funding to the government.
Only in your imagination. The only time the deficit has gone down (in fact completely eliminated) was during the high tax years of Clinton. The economy did great and unemployment went to a record low.
Re:Unmitigated bullshit (Score:4, Informative)
Reagan and Bush both proved that taxes are already too high. They both lowered taxes and the result was an increase in funding to the government.
Only in your imagination.
No, the original comment was correct. Federal revenue did go up [heritage.org]... but spending went up even more.
The only time the deficit has gone down (in fact completely eliminated) was during the high tax years of Clinton. The economy did great and unemployment went to a record low.
Don't forget that those were also the years when the GOP took over Congress and restrained spending, a little bit, for a little while.
Re: (Score:3)
At a state level, Nevada, where I live, is ranked third by the Tax Foundation [taxfoundation.org] in "state business tax climate" for 2013, and conversely 47th in tax collected per person. We have no corporate income tax, no personal state income tax. We ranked 46th in federal aid in 2011 (same source), so it's not like Nevada is a "donor" state.
So, free of all of those taxes, Nevada's unemployment rates should be pretty good, because taxes are the worst thing for a regional economy, right? Except, in August, the state had
Re:Unmitigated bullshit (Score:4, Interesting)
Because they'll actually be able to buy coverage (Score:4, Informative)
If you have a "serious" pre-existing condition (and the criteria for what that means is VERY broad), absent Obamacare, it's VERY difficult (and in many cases impossible) to obtain insurance. And what insurance is available is often utterly unaffordable and or horrible. (Any pre-existing condition you have will usually be outright excluded, along with childbirth.)
With Obamacare, those in excellent health will indeed pay more for coverage, but those in anything less than excellent health will now be able to obtain usable insurance outside of an employer group plan.
Re: (Score:3)
"People who get sick' aren't really a small subset.
How many people do you think live to old age without ever having to see a doctor?
And yet, the "younger crowd" seem to support Obamacare. Either they're wrong or you are. PPP shows that the 18-34 group are most likely to support Obamacare of all age demos.
Re:What a joke... (Score:4, Insightful)
The theory is: We already subsidize health care for everyone. Get sick and collapse on the sidewalk? They take you to the hospital. If you have money or insurance, you pay. If you are a homeless person with nothing, the hospital eats the cost. Well, they actually spread the expense across all the paying customers.
Wandering in (or being carried into) an ER is an extremely inefficient way to handle most medical issues. It would be more efficient to get people into a clinic for some treatment before they become an emergency. So Obamacare is aimed at getting the above subsidy to the people at a point that would buy them better and cheaper care.
Now, the reality is that every special interest has gotten their fingers in the legislation. So its probably rife with loopholes and opportunities for abuse. We will have to audit it carefully, plug the loopholes as they are discovered and throw some scam artists in prison to keep the program from bleeding money. It can be done, but only by people willing to work on it. Jumping up and down and whining will just play into the hands of the crooks.