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House Passes Health Care Reform
- kgrin 17y agoFor all of the talk about the impact of higher cap gains taxes on startups, the far more important impact is likely to be that potential founders will have a (slightly) easier time leaving their jobs and purchasing insurance on a less-broken individual market.
- mmastrac 17y agoPlus it'll be easier for us to poach employees with families from big companies. I couldn't imagine what it would take to get someone with a preexisting condition at a startup.
- Vivtek 17y agoYou couldn't. I mean, speaking as the father of a child with kidney disease - forget it. Impossible. That freedom, the freedom to start a company even if your children are sick, is granted only to the very rich in this country. Until - I hope - now. It remains to be seen how much hash was made of the bill during the sausage-making process.
- dcurtis 17y agoThis isn't really true. You can incorporate a company and as long as you have two US citizen employees, you can get a company health plan that bypasses pre-existing conditions. (This is true in California by law, but I am not sure about other states)
- abstractwater 17y agoVery interesting. Can you provide a quote/link of the legislation or some other authoritative sources about this?
- 100k 17y agoEnjoy getting screwed by your group rate with a pre-existing condition in a risk pool of that size.
- mediaman 17y agoThis is true only in the most technical sense -- health insurers are known for dropping entire small companies that have unusually high claims. The smaller the company, the faster they'll drop you.
- henrikschroder 17y agoWow, that this problem exists in the US wasn't even on my radar. I could understand that you couldn't do a startup because you might be too sick yourself or have to spend time caring for a sick family member, but the financial aspects of it never crossed my mind. Being from a country with universal healthcare completely moves that out of the picture. Now I understand why you guys on here think this is such a big deal to US startups.
- cperciva 17y agoI couldn't imagine what it would take to get someone with a preexisting condition at a startup. It's easy: Just open an office in Canada. For what it's worth, "pre-existing medical condition" is the #1 reason why Tarsnap is not a YC company.
- mmastrac 17y agoWe (DotSpots) are distributed and I'm up in Calgary, Alberta. Works well for the two of us up in Canada. It let me cofound the company and work for a while with no salary for some time without having to worry about my family's health. Unfortunately it doesn't help much when hiring from the USA - the majority of our company is scattered around the states. Is tarsnap Canadian-founded?
- cperciva 17y agoTarsnap is my (sole-founder) startup, based on Vancouver.
- mmastrac 17y agoGlad to see another Canuck here. If you're ever one province over, give me a shout.
- joegaudet 17y agoTotally Irrelevant, but I come from both these places. Born in Calgary, recently moved to Vancouver. My nascent startup (Matygo) has yet to consider anything along the lines of health and dental etc.
- xal 17y agoThis is off topic but ARG. If you are in canada do not work without paying yourself a salary! If you have any investment rather pay yourself salary and claim 60-80% of your salary back under SR&EDs. Much better use of your money and you can even reinvest the money you took out if you absolutely have to (after deducting income tax that is).
- gte910h 17y agoThe day pre-existing conditions don't matter is the day the us explodes with small businesses.
- waterlesscloud 17y agoThere's a difference between "covered" and "doesn't matter". What I'm not sure about is what, if any, the price difference in premiums will be. Just because they're required to cover you doesn't mean they have to do it cheaply. I do know adults with preexisting conditions will be in some sort of special "temporary pool", whatever that might mean. No clue on the cost.
- jacoblyles 17y agoAs a counterpoint, countries that already have this are far behind the US in small business creation. Despite this supposed handicap, the United States has the most dynamic large economy in the world. It turns out that the government soaking up a large portion of the GDP to pay for expensive public benefits diverts capital away from financing private ventures, and this has a detrimental effect on entrepreneurship. If universal health care were really that important to entrepreneurship, why isn't Silicon Valley in Europe?
- jeremymcanally 17y agoThis sort of economic handwaving makes a lot of assumptions. Silicon Valley isn't in Europe for a lot of reasons, American engineers being the driving force behind it notwithstanding. We have such a strong small business unit because (a) a lot of our economy has always been driven by small business (that "American ingenuity" people always talk about and (b) U.S. laws are very friendly to the small business. And since when does our government really get involved with "financing private ventures"? Banks aren't paying out for insurance (and will probably pay slightly less under this reform), and most VC's will have to pay about 2% more in tax. So maybe 5-10 useless web startups a year won't happen, but I don't think it's going to slow down small businesses at all. Many of the people I know who would start one or join an existing one can't because of health insurance.
- MartinCron 17y agoIt's not just founders, it's a big deal with startup staffing in general. I took an effective pay cut when I went to work for a startup because they weren't big enough to buy health insurance in bulk the way my previous employer could. My CEO wrote about this last year: http://www.benhuh.com/2009/08/01/the-killer-fear-of-guaranteed-healthcare/ http://www.benhuh.com/2009/08/01/the-killer-fear-of-guarante...
- grandalf 17y agoWhy does it matter whether your pay cut was in the form of a perk or salary? Clearly if your startup employer chose to offer you cash instead of a healthcare plan, it did so because it thought you'd value the cash + flexibility more than you'd value the plan. It's simple for any small business to sign up for a group plan for employees... and it's not the cost that is the issue, it's the perceived value of the service.
- MartinCron 17y agoWhat I was trying to express, poorly, is that the same benefits package is much more expensive to the smaller employer than to the larger one. For me, what it meant was that I had to make a (relatively small) sacrifice to take a job. For others, it might be the difference between being able to work at a startup or stay with a soul-crushing big company.
- grandalf 17y agoWhat it boils down to is that startups sometimes pay less than larger, established firms. It doesn't matter how you break down the compensation into salary and perks. So while it's true that someone with a preexisting condition might not be able to take a job IF the compensation wasn't high enough, it's irrelevant whether the compensation includes healthcare or if it doesn't.
- deleted 17y ago[deleted]
- ubernostrum 17y agoIndeed. One of the smartest things in the bill -- and yet one which has received little to no fanfare -- is the mandate for insurance exchanges. In case you haven't followed that, the idea is basically to match up people who are looking for private insurance with companies offering policies, but to build in the ability to lump the customers together into ad-hoc risk pools. For the insurer this is the same as taking on, say, a medium-sized company with X employees, which means the terms offered can be far better than traditional individual policies.
- vishaldpatel 17y agoI wonder if this can then be bundled up into a security :P (pretty evil, I know..)
- jcnnghm 17y agoSo won't that result in somebody that's healthy, like me, having to pay more so somebody that doesn't take care of themselves can afford health care.
- ubernostrum 17y agoA larger risk pool tends to drive premiums down, not up. Of course, this presumes that private insurers determine premiums in a rational manner, which may not be the case (and if it is not the case, then you're going to pay more no matter what).
- anamax 17y ago> For all of the talk about the impact of higher cap gains taxes on startups It's not startups. It's single people making more than $200k or married couples making over $250k. The latter affects more people than the former.
- deleted 17y ago[deleted]
- SlyShy 17y agoI sometimes wonder if these stories belong here, due to the incendiary properties and tangential relationship to start-ups. Not that I don't think Hacker News could handle the discussion more or less maturely.
- curtis 17y agoIf any such story ever belongs on HN, I think you can make a case that this story is it.
- dryicerx 17y agoA startup/small-business related point on the bill is "A tax credit becomes available for some small businesses to help provide coverage for workers." Just trying to make the top story in HN at least a tiny bit relevant to HN...
- tptacek 17y agoFrom my casual read, that's for businesses where the average wage is pretty close to the minimum wage.
- blogimus 17y agoAverage wages need to be $50,000 or less: From WSJ: http://online.wsj.com/article/SB20001424052748704534904575132110999558770.html http://online.wsj.com/article/SB2000142405274870453490457513... Tax credits for businesses: Businesses with fewer than 25 employees and average wages of less than $50,000 could qualify for a tax credit of up to 35 percent of the cost of their premiums.
- cloudkj 17y agoHow does equity figure into the equation? I'm guessing even equity doesn't matter much for startups, since they'll have very low valuation to begin with anyways.
- jrockway 17y agoLike he said, relevant to startups.
- tptacek 17y agoI wonder what the average wage is at YC companies with more than 5 employees.
- jpwagner 17y agoIt's very relevant to HN. Sorry there's no code snippets in it for you...
- eserorg 17y agoPre-Market U.S. Stock Futures: http://money.cnn.com/data/premarket/ http://money.cnn.com/data/premarket/
- jrockway 17y agoOf course. Money that goes to ensuring your employees don't die is money that won't go to the investors as dividends, which means the stock goes down. In the long run, a healthier workforce should increase productivity, and then stocks will go up.
- jerf 17y agoIt will be interesting to see how the markets react to this. My personal theory, which I haven't seen anyone else state, is that the reason we heard from the bond raters last week about how the US might lose its AAA status is an oblique threat to so downgrade our rating if this bill passes. Even if we merely apply the conservative "three times more than the government says it will cost" we're stacking on another staggering amount of debt and entitlement on an economy that can't take it. (Given our current entitlement loadout even if our economy were to start rebounding tomorrow at record pace we're still in deep trouble in the not-so-distant future... and that's before we handed out yet more entitlements.) I'm not ready to "predict" it, but I wouldn't be surprised we lose it in the near future, as in, single-digit weeks. They'll be right, too. An entity deep in debt whose only priority is to pile it on even deeper is an entity that is not going to be cleaning up its finances anytime soon. We'll have earned it.
- luigi 17y agoAnother way this bill affects readers of HN: Parents can keep children up to 26 years old on their health insurance. Previously, the age limit was determined by individual insurance companies or individual states.
- ronnier 17y agoI'd be ashamed to be in my 20's and be on my parents insurance plan.
- Xichekolas 17y agoSo you'd be ashamed to be in grad school? (Or doing a startup right out of college?) Often the insurance offered by a parent's plan blows away what can be had through the University. Of course, you can buy individual insurance fairly cheaply... unless you aren't in perfect health, or are a girl.
- ronnier 17y agoLast year I finished my graduate degree in computer science. I worked a full-time job while doing that (also during undergrad). I'm actually pretty proud of it. I finished up grad school with a lot of work experience, zero debt and had insurance the entire time.
- Xichekolas 17y agoAnd you should be proud of that. I'm currently a CS grad student, with zero debt, working as a GTA/GRA (depending on the semester). I get my insurance through the University for an awesome $94 a semester, but if I were still young enough, I'd definitely opt for my parents insurance, and I wouldn't be ashamed of it. It would just make financial sense.
- robryan 17y agoNot everyone would be able to do this though. Working more than part time I'd feel that I couldn't put enough time into my education. I know some people are better at quickly being able to switch tasks and work effectively in short blocks but not all.
- hzlz 17y ago[I posted this on the other thread, which seems to have been deleted as a dupe. Sorry if it's against protocol to re-post. But I tried to find both sides, good-and-bad wrt startups.] Some discussion of the impact on startups in the thread at http://news.ycombinator.com/item?id=1208019 http://news.ycombinator.com/item?id=1208019 While it didn't discuss all of these, it seems to me that the things that will directly impact startuppers: Pros - Community rating, no recision, etc will make it easier for people with pre-existing conditions to get coverage. For people who have pre-existing conditions (or who have kids who have pre-existing conditions) and don't have a spouse at a bigco and want to do startups, it makes it possible. - Might also make it easier for bootstrappers to get coverage. Cons: - The new taxes are concentrated on capital gains, so will tax startups and angel investors most of all. [This bill proposes a 3.8% increase on cap gains. The administration is also planning to change the regular cap gains from 15 to 20%, so if everything passes the rate will go from 15% to 23.8%, or a 58.6% increase.] - Shifts costs from the older to the younger, so most startups here will pay more. - In realistic scenarios, will probably increase the deficit, affecting interest rates. But that's long-termand not clear. Pro or con, depending on what you think: - Mandatory coverage will require that you have coverage during a bootstrapping phase. A mix of good and bad for startups, depending on where you are in the process.
- jbarciauskas 17y agoI've heard this a number of times but not heard it detailed: in what way are the CBO estimates unrealistic? What more realistic assumptions would you make, and what is their effect on the deficit? Also how is it shifting costs from the older to the younger? It seems more that it is shifting costs from the near-bankrupt uninsured to those who make significant portions of their income from capital gains, i.e. the wealthy.
- hzlz 17y agoI don't want to get into politics on either side, and there are several factors: - The first is the "doc fix". Basically, there's a 21% automatic cut in the payments to doctors in Medicare. That would lower the payouts to the point where doctors would often lose money seeing a patient, and doctors would stop seeing Medicare patents. Like with the AMT, each year congress approves a temporary fix. It is likely that, while under CBO rules the score assumes there won't be more temporary fixes, there actually will be. - There are several areas where the bill promises unspecified future cuts. The CBO numbers takes them at their word. Consensus is that these cuts won't actually happen. - ~$53B comes from the fact that Social Security will take in more money because more companies will pay people wages so they can buy health care on their own instead of the company paying for it. However, it doesn't count the fact that SS will have to pay out correspondingly more. - The CBO looks at a 10-year horizon. Most of the costs are scheduled not to start immediately, but to ramp way up later. There are a bunch of other 'hacks' in the CBO scoring to keep the cost near the promised $900bn. Both sides do it, but they discovered a bunch of new tricks this time around. It means that, going forward, CBO numbers on large bills (from both sides!) are probably worse-than-meaningless. On the older-to-younger q, it's mostly about how community-rating is implemented.
- patrickgzill 17y agoI think the Amish will suddenly start gaining a lot of new, adult members. This bill is an abomination.
- grandalf 17y agoOne thing that bothers me about taxes is that they are around 20-30% of profits. If you take on a business partner and give him/her 20%, you expect something in return. What do we get for our taxes? Wars and social programs that will be bankrupt long before we can benefit from them. (roads, etc., are < 1%). I would be OK with paying the taxes for social programs if I thought those programs would be sustainable into my old age, but they aren't and nobody seems to care, even though this is widely known. So when you write the IRS a big check, you are paying for old people, and when you are old you will not receive the same treatment. By the way, most of the cost of healthcare is in areas where the money has very little yield, such as end of life care for the elderly, bypass operations, stents, and statins. If people actually had the opportunity to consider the value of healthcare, reform would be nothing like what it is now. Next time you see an old person eating bacon and eggs in a restaurant, picture that person's bypass operation, years of statins, and excessive end of life care that you are paying for... and think to yourself how perverse "reform" is. Meanwhile, there are millions of so-called "illegal immigrants" who can't even call the police if they are assaulted or abused (for fear of deportation) being left out of the reform. Most of your income taxes go to wars and medicare, and most of the healthcare reform goes to the practitioners who practice useless surgeries and interventions on a vulnerable population of elderly. The "reform" bills don't change anything, they just transfer even more of the wealth of young people to the elderly and their exploiters.
- deleted 17y ago[deleted]
- jeremymcanally 17y agoThe idea behind a big piece of the reform is to reward doctors who push preventative care over pills, surgeries, and continued treatment. Therefore (ideally) we will see less and less of these preventable surgeries since doctors and hospitals are striving to reduce their preventable and recurring care for patients (i.e., they get cash if they reduce it).
- gojomo 17y agoCan you provide a reference for this "cash benefits for doctors who reduce long-term costs" portion of the bill?
- abrown28 17y agowell... 234 years was a good run.
- marshallp 17y ago234 was a good run ... of not being a country civilized enough to look after it all it's sick
- rajat 17y agoWhy should the average 20-30+ year old even carry insurance? The penalty is only $250 a year, rising to $750 in a few years. They can't deny you insurance based on pre-exiting issues. So why not just pay the penalty, which can be substantially less than the policy, until you have an issue?
- waterlesscloud 17y agoIt's a very good question. Of course, if the healthy behave that way, it drives up the premiums for everyone else.
- chancho 17y ago$750/year is about the cost of so-called "catastrophic" insurance: high deductible, low monthly. Worthless for the kind of chronic ailments that old people suffer, invaluable for things like car accidents or leukemia. Only an idiot would rather pay the fine than buy this kind of insurance.
- waterlesscloud 17y agoMy understanding is that this type of insurance is not an option under this law.
- rajat 17y agoCatastrophic insurance, with a high deductible, is what I carry. They are going to be grandfathered, but no new policies of this kind will be allowed under this law. An all encompassing health insurance, with the kind of deductible they have legislated, is not cheap.
- chancho 17y agoAh, I wasn't aware. (Shows what I know about this bill.) While catastrophic insurance is a good deal for young unmarried people, part of me thinks it's not how health insurance is supposed to work. If you're not spreading the cost of caring for old/sick people among young/healthy people then what's the point? The other part of me thinks it's just a handout to the insurance industry and people such as yourself shouldn't have to pay a dime for someone else's overpriced cholesterol drugs or 3D ultrasound.
- defen 17y agoSo I opposed this bill, but now I have an honest question: Rationally speaking, shouldn't I cancel my health insurance? I'll pay the fine, which is way less than my current premiums, and I'll just wait until something goes wrong to buy insurance, since I can't be turned down.
- blasdel 17y agoThe ban on pre-existing condition screening doesn't kick in until ¿2014? There's a temporary public option for the people who would otherwise still be fucked until then. I'm not sure if you'll be able to get that on short notice.
- rsheridan6 17y agoThat's really not very far away. Few young healthy people are going to develop cancer or something nasty and expensive like that in the next three and a half years.
- MartinCron 17y agoHealthy young people get in horrible car accidents all the time.
- grandalf 17y agoQ: How much would it cost to insure against such catastrophic outcomes (with a $100 deductible and coverage enough for all hospital bills and recuperation)? A: About $20 per month per person. You're right this is the biggest risk young people face... the rest of their premium is just going to the old folks and their exploiters.
- rsheridan6 17y agoWhat percentage of healthy young people get in car accidents that require them to pay large medical bills, excluding those that are paid by the other driver's insurance? I doubt it's a very large percentage. The fact that something happens "all the time" in a nation of 300 million does not mean that it's likely to happen to you.
- aresant 17y agoI promise +1 Karma to the first person that puts together an infographic actually explaining where, exactly, $100 billion a year of tax payer money is going to go, and what we are going to get in exchange. I am all for affordable healthcare for everybody, just desperately afraid of how the gov't typically overspends.
- robryan 17y agoIt seems worrying that the best solution to a more efficient and cost effective system they come up with involves spending a lot more money now. Looking at American policies from an outside perspective, it seems the government is unwilling to be the one that will actually suggest that maybe the answer to many current budget problems is to spend less.
- Adam503 17y agoNo. The best most cost effective solution to health care is single payer government operation of the health care system. It's a tried and proven over decades to cut the cost of health care all over the rest of the industrialized world. For some ludicrous reason, the beloved-by the British UK model of health care is called "communism" if it's even mentioned here When did Great Britain turn communist? I completely missed that event.
- chipsy 17y agoIt's a form of "slippery slope" argument: Increased government powers mean that more people are fundamentally beholden to the state for their well-being. If the state fails, these people will be very unhappy. Thus a socialist policy in a republic can, over time, act to distort policy to massively favor the whims of bureaucrats. In the _worst case scenario_ the bureaucrats might be radicals who want to install a communist system. But I don't think this is true of either the European socialist states, or of U.S. liberals. You can cherry pick examples of radical elements, Fox News style, but they aren't the main concern here - economic risk is the big one. A tightly integrated state can operate more efficiently than one that tries to regulate companies from afar, but if it goes down due to a "black swan" event, recovery is going to be more difficult.
- tbrooks 17y agoIn order to bring down the cost of health care, the government would have to operate the system more efficiently than the market does. I can't think of anything the government operates more efficiently than the market does.
- tdoggette 17y agoBut the government's not running the system, contrary to what you may have heard from the people that got the GOP talking points memo. The bill keeps the private-insurer system in place.
- tbrooks 17y agoSo how will the government lower costs without sacrificing quality of care?
- tdoggette 17y agohttp://voices.washingtonpost.com/ezra-klein/2010/03/the_five_most_promising_cost_c.html http://voices.washingtonpost.com/ezra-klein/2010/03/the_five... Ezra Klein knows what he's talking about (though he is coming from a pro-reform standpoint).
- mediaman 17y agoI'm generally pro-private sector, but the stats on our health care insurance system are astounding. The OECD averages (which are primarily statist health care systems) about 8.9% of GDP spent on health care. The US averages 16%. US has fewer doctors per capita, lower physician visit frequency, lower life spans, and more uninsured. I'll grant you that the private sector is more efficient than the government sector in the vast majority of cases. The health care insurance system is not one of them.
- tbrooks 17y agoI would argue that government involvement in the private sector is why our system is broken. I don't mean for this to sound snarky, but what nation runs a better health care system than the US? The quality (for the cost) of medical care in the US is far better than any other nation. Both Canada and Britain have gov't health programs. 25% of the people in Canada wait 6 months or more for surgery, in Britain that number is higher. In the US, only 5% wait that long. The waiting time for an MRI in Canada is 10 weeks.
- aresant 17y agoAn interesting aside - house dems tacked onto this bill an overhaul of student lending which eliminated $60b of private lending in exchange for a wholly gov't controlled program: http://www.washingtonpost.com/wp-dyn/content/article/2010/03/21/AR2010032103548.html http://www.washingtonpost.com/wp-dyn/content/article/2010/03...
- deleted 17y ago[deleted]
- haupt 17y agoWhat's interesting to me is that the thing passed with absolutely no Republican support whatsoever. This insane partisanship cannot last.
- beilabs 17y agoAs an outsider (Irish) I find it interesting that this occurred. Usually at least one backbencher in Ireland would support the opposing view based on their own such morales. Was this down to pressure from their own party, their constituency or just pure spite to derail something that was not their own idea in the first place? I'm not pro/against the issue; I have no stake in US healthcare.
- haupt 17y agoTraditionally the Republicans are just contrary to anything the Democrats propose (as far back as I can remember). All of the Republicans I know personally are pro-lifers and this bill specifically addresses the use of government funds with respect to abortion. So it's probably a bit from each category.
- tokipin 17y agoit was party, based on what they saw as a far-right "grassroots movement" called the Tea Party. they chose the strategy to completely go against democrats to try to deprive them of any victories, in order to keep the population angry ("congress can't do shit in the worst economy since the great depression") and use that anger to sling shot back into majority control the funny thing is the Tea Party is partly artificial it will be interesting to see how this plays out for the rest of the year, especially when people notice that massive balls of communist fire aren't raining down on the nation
- waterlesscloud 17y agoThere's also the possibility that they believe it's bad legislation. And the the democrats voted for it as a partisan measure. Just throwing that out there. I've never understood why it's only the opposition that can be partisan and not the majority.
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- InclinedPlane 17y agoMissing in this thread so far is a discussion of whether or not this bill is even remotely constitutional. Not only does it seemingly institute a poll tax, it stretches the "commerce clause" of the constitution beyond all reasonable limits, it violates the 10th amendment, and article 2 section 8. But I suppose all of that will become irrelevant in our glorious new future where the life of every citizen of the US is dependent on the efficiency, fiscal discipline, and humane kindness of federal and state bureaucracies. Indeed, this is a future I think we all look forward to, as all of these glorious institutions have provided a hearteningly robust history exemplifying all of those qualities to the fullest. Haven't they?
- jrockway 17y agothe life of every citizen of the US is dependent on the efficiency, fiscal discipline, and humane kindness of federal and state bureaucracies How? Get some cash, find a doctor, and give him cash to fix you. Nothing is stopping you from doing that under the new system. it violates the 10th amendment, and article 2 section 8 No, it doesn't. You can argue that the 10th amendment didn't go far enough, but that is orthogonal. The new healthcare regulations are not unprecedented; consider agencies like the FAA and the FCC (shouldn't each state regulate their airspace and radio spectrum), FHA (shouldn't each state build their own expressway system?), etc. Basically, your argument makes about as much sense as "income tax is illegal", and regardless of how you feel, the constitutional law is not on your side. Were you really making so much money on capital gains that this is going to affect you negatively in any way?
- InclinedPlane 17y agoHow? Get some cash, find a doctor, and give him cash to fix you. Nothing is stopping you from doing that under the new system. I find it intriguing that your purported solution to the limitations of this legislation is the very antithesis of the program itself. This seems like a weakness in the reasoning behind the plan. Not to mention that the problem is more that the quality of care, at any price, will degrade and that we will all become less wealthy as our government takes more of our money and spends it ever less efficiently. Also, each state does own, build, and operate their own expressway systems. How exactly do you imagine the FHWA operates? There is not some federal agency that builds interstates across the nation, ignoring state boundaries. Rather, the FHWA provides a set of standards, design advice, and substantial federal funding to local agencies which then make their own decisions on building their own roads. The US government doesn't own and didn't authorize or oversee the construction of, say, I-5 or I-95 they merely coordinated with local governments to do so. This is how a healthy cooperation across local and federal government works. Anyone who doesn't recognize that this bill represents an unprecedented leap in the involvement of the federal government in every individual's business and livelihood is living in a fantasy world. Were you really making so much money on capital gains that this is going to affect you negatively in any way? This is a specious argument. They came for X, and I did nothing... Principles matter. Extorting taxes out of others to pay for your own healthcare may seem just fine and dandy an idea if no one you or I know would pay those taxes, but it's a bad idea on principle. To adapt a common phrase, those who sacrifice liberty for universal healthcare deserve neither.
- jacoblyles 17y agoIt's going to be interesting to see if the Supreme Court finds that the Constitution allows the Federal government to force people to buy health insurance. With a 4 liberal, 4 conservative, and 1 swing vote split, they could go either way. One thing's for sure, this bill will be challenged.
- btilly 17y agoThe court is not all about politics. The whole thing is about regulating a commercial transaction (buying health insurance) and taxes (aka fees). Both are areas that there is a lot of precedent saying that Congress is within its rights.
- grandalf 17y agoWe should all be wary of the mandate. The uninsured used to be victims, and soon they will be criminals.
- andybak 17y agoYou've got some incredibly complex proposals being thrown into an incredibly complicated system (and by that I mean the entirety of the social, political and economic realm - not just health-care). The law of unintended consequences is going to play out here massively. Not only is it an intractable problem to predict the outcome from our perspective but it will be near-impossible for historians in decades hence to look back and separate which of their present society's ills were caused by this bill or by the million other factors that occurred in the intervening years.
- DanielBMarkham 17y agoI have been biting my tongue on other venues regarding this bill, which is a good sign it's probably not a good idea to discuss here. Having said that, I'll put on my business hat and begin adapting. What's this mean for my startup? 1) Those of you who say the country is waiting for affordable insurance until startups take off are smoking crack. It's a great benefit, sure, but young folks don't need health insurance and startups are lucky to keep the lights on, much less pay fines to have everybody insured. The process of getting new employees may greatly be enhanced, but we need a thousand pre-employee startups for every one looking for employees, so that's where to look for impact, not with insurance. Not sure there is any impact at all for dirt-poor young startups. It should be interesting how the income requirements work -- can you get 15K in investments and keep that for operating? Or does that make you rich enough to start having to pay fines? Having said all of that (which you might hate), it's a great thing to keep your insurance. 2) Those of you saying that it's the end of Western free civilization are completely overstating the case as well. It's going to add 16 thousand new IRS agents, sure, and there will undoubtedly be new regulatory burdens associated with hiring employees and growing. The key metric to watch here is public debt. We're in a debt explosion and, to some, this just pours gasoline on the fire. If that assumption is true, and I believe it is, then watching the national debt rating could be an early indicator that different business configurations might be better than locating and operating in the states. (That doesn't mean you can't start out here, just once in growth mode getting the hell out of Dodge might be worth it) If the country is going broke, sooner or later somebody is going to come looking for any profits you might be making. I'm not saying it is or it isn't. I'm saying that it looks like a legit concern to me -- you can do the math. 3) Medical and insurance discussions will now become political ones. In other words, somebody has to say "no" in order for any kind of health service plan to work without going broke. It used to be those people were the insurance companies. It was a lot of fun hating the insurance companies. Now that we're regulating the insurance companies like utilities, however, that person is going to be some bureaucrat somewhere. Your best access to him, if you have an employee with a complaint or are looking for some kind of change, is probably through your Congressman, giving your local Congressional weasel even more power than he currently has. This means all startups, from dollar one, need to have some face time with their Congressperson if at all possible. Increasingly he/she is the guy who influences more and more details of operating -- bandwidth availability, insurance standards (now), investment criteria, etc. I hope that sounded reasonably neutral. I certainly didn't feel angry while writing it. While the immediate impacts are very low, over time I think this is a major change in the country's direction. Small business guys need to pay attention.