44 ms·

Sputtering Startups Weigh on U.S. Economic Growth

127 points by spuiszis 10y ago

simongray 10y ago
Requires an account.
- swalsh 10y ago
  This is a great chrome extension to solve that problem: https://chrome.google.com/webstore/detail/referer-control/hnkcfpcejkafcihlgbojoidoihckciin https://chrome.google.com/webstore/detail/referer-control/hn...
- delibes 10y ago
  Try going through Google. Seems to work for me: https://www.google.com/search?q=Sputtering+Startups+Weigh+on+U.S.+Economic+Growth https://www.google.com/search?q=Sputtering+Startups+Weigh+on... Many news sites give special favours to search traffic.
- god_bless_texas 10y ago
  use google chrome and click the link in incognito mode
- user5994461 10y ago
  Same. A recurrent issue with WSJ articles.
  - Yhippa 10y ago
    Sometimes the "web" link works. Sometimes it doesn't.
    - user5994461 10y ago
      That's the issue. It's blocking traffic erratically. It doesn't help to go through google, or to go through private browser + Google :(
- ulfw 10y ago
  Frankly this goes to show how Hackernews urgently needs some proper product/ux/ui person to overhaul it. This type of comment shows up like clockwork for every single WSJ link. The web shortcut is clearly not visible/understood. Why not highlight it for known domains like wsj.com and others
  - cylinder 10y ago
    I find it ironic that the site where I see the absolute most complaining about one of the easiest paywalls to bypass is on Hacker News.
  - ninkendo 10y ago
    I'm pretty sure it's not HN's job to work around WSJ's decision to require an account to view their articles. Why don't people just stop submitting WSJ articles?
    - irishcoffee 10y ago
      > Why don't people just stop submitting WSJ articles? Ehrm, huh? That is your proposed solution? Just a SWAG: The articles are interesting. This claim can be backed up by the fact that WSJ articles show up on the front page fairly frequently.
      - ninkendo 10y ago
        I'm not sure what SWAG means but WSJ clearly doesn't want news aggregator visitors to view their articles for free. So the complaints should be directed at the WSJ, not the news aggregator. I don't have a solution I'm just saying it's WSJ's fault here, not HN.
  - goseeastarwar 10y ago
    It's like paying for a WSJ subscription doesn't even cross HN's mind. At some point people should acknowledge the frequency of paywall complaints might mean there's lots of quality content.
cylinder 10y ago
Go on your state's Obamacare exchange. Hypothetically you are a mid 30s individual with a spouse and two young children. Look up 2017 numbers. You are looking at $12,000 - $24,000 per year in premiums alone and then massive deductibles and coinsurance of 30% to actually access services. Who can bootstrap a business like this? So people are staying with their powerful big corporations if they can't get millions in funding for a startup (and outside of tech this is simply not even a consideration). Edit: and if at some point you hire an employee, you will need / want to provide them with health insurance, and it will cost just as much. Large corporations have an advantage in that they negotiate lower premiums in bulk. Add this as yet another barrier to entry, along with their lobbying for protectionism, tax loopholes, their ability to hire huge teams of tax lawyers and accountants, and if you really start to get their attention, they can sue you baselessly by throwing lawyers at you to keep you in court. Merely defending yourself and getting to the point of dismissal is unaffordable for a budding small business. Take a look at S&P500's profit margins. They are at record highs and not coming down as economics teaches us, meaning new entrants are not coming into the market.
- ceejayoz 10y ago
  Here in upstate NY, $20k/year for a mid-30s with family of four gets you a Platinum no-deductible, copay-only plan with a $4k/year out-of-pocket cap (my exact situation - 2016 premium is $1,700/month). Bronze plans are dramatically cheaper, and if you're doing a bare-bones startup you're also likely to be in the income range that gets subsidies.
  - cylinder 10y ago
    Here's a junk Bronze HMO with 50% coinsurance and $5,500 per person deductible in Albany at over $16,000/yr: https://nystateofhealth.ny.gov/individual/searchAnonymousPlan/plan/38594?county=Albany&coverageTier=COUPLE_AND_ONE_DEPENDENT&entityType=INDIVIDUAL&planYear=2017&youPay= https://nystateofhealth.ny.gov/individual/searchAnonymousPla... I am sticking to the major carriers as I'm skeptical of the networks these small no-name providers have. But even if I browse all carriers, the cheapest platinum plan is $20,000/year: https://nystateofhealth.ny.gov/individual/searchAnonymousPlan/plan/43003?county=Albany&coverageTier=COUPLE_AND_ONE_DEPENDENT&entityType=INDIVIDUAL&planYear=2017&youPay= https://nystateofhealth.ny.gov/individual/searchAnonymousPla... Subsidies - let's say you pull $70,000 your first year. Your subsidies will be $4,000 per year, so the platinum plan is still $16,000/yr net. After-tax on $70k is $54,000. That means your healthcare premiums alone are 30% of your post-tax income even with the subsidy! That means only $3,150/mo remains for your rent, transportation, food, utilities, etc...
forgotpwtomain 10y ago
It's just an editorialized presentation of the following: http://www.bls.gov/bdm/entrepreneurship/entrepreneurship.htm http://www.bls.gov/bdm/entrepreneurship/entrepreneurship.htm
johan_larson 10y ago
> Goldman Sachs economists in part blame the cumulative effect of regulations enacted since the Great Recession for reducing the availability of credit and raising the cost of doing business for small firms. Huh? Haven't small firms pretty much always been funded by personal saving of the founders, sweetheart loans from friends and family, and perhaps the odd bank loan secured by the personal assets (read: homes) of the founders? Banks aren't interested in lending directly to businesses until they are large enough to have concrete assets to secure the loans. And they never were.
- jonwachob91 10y ago
  I found this statement amusing too. Somehow, regulations enacted in the 40's took over 60 years to impact the industry? Seriously? The 80's and 90's, under the same regulations, where able to ignore those regulations and have tremendous growth and positive effect on the economy. Sounds like an economist who doesn't actually know what is going on so he's making shit up.
  - gnutun 10y ago
    To be fair, the article was referencing regulations added since the Great Recession, so after 2008.
  - ndonnellan 10y ago
    Great Recession, not Great Depression
    - muzz 10y ago
      that would be 2008, but the graphs start in 1977
- rapala 10y ago
  Depends on the industry. If your firm needs to buy heavy equipment for example, it's relatively common to get a loan for that from a bank.
costcopizza 10y ago
I wonder how much (if any) the lax enforcement of anti-trust law has played into this.
- eeZah7Ux 10y ago
  That, plus patents.
jordache 10y ago
This article was written under the assumption that startups in general = innovation.
- brianwawok 10y ago
  That is generally true. BigCo has billions in profit from existing products. They can't task big risks. What big innovations have the BigCos done in the last X years? Startups do crazy stuff. Many fail. Some succeed. End result: Innovation
  - jordache 10y ago
    it's assuming that the success rate will be so high that it can support a sizable portion of the us economy. a bunch of destined to fail startups employing a handful of people (paid via owernship and future options) hardly contributes to the economy.
  - Qworg 10y ago
    Wait. Why can't they take big risks? They're in a better position to take big bets than anyone else - Google X, Microsoft Research, Facebook's FAIR and others. If they have the right people in house (or can get them), they can take big swings.
    - nkohari 10y ago
      Public companies often can't take big risks because they have to justify them to their shareholders and consistently meet expectations. The examples you've listed are all just R&D projects, the expense of which are a tiny line item in the budgets of the companies. Conversely, a startup has nothing to lose. Early-stage investors know they're taking a moonshot, and they expect only a few of their bets to succeed, so they will encourage the team to swing hard. That's how startups can disrupt established markets with big players: they have less to lose, and don't need to earn buy-in of a large existing company. They can build what they need as they go. This is also why most acquisitions fail. The team of the acquired company can have difficulty navigating the existing company culture. Often, they're tasked with being a "change agent" only to be identified as a threat by the acquiring company's "immune system" (its existing power structure).
anton_tarasenko 10y ago
Walmart and Amazon alone sell $600bn worth of goods. That's 4% of US GDP. These two pushed thousands of independent retailers out of business due to lower prices (and smaller profit margins relative to revenue). The same happens in transportation, restaurant business, hotel industry. Firms get bigger since 1800. Naturally, the number of new firms decline. In govt stats, it appears as "fewer startups." Meanwhile, the economy grows thanks to productivity gains in big companies. So what do we want: productivity or new small businesses?
- emp_zealoth 10y ago
  No jobs mean you can stuff all your productivity gained in big companies into a trash bin because there wont be demand
- treehau5 10y ago
  I want a new economical system besides crony capitalism. Time to start thinking outside the box.
  - TearsInTheRain 10y ago
    I feel like more aggressive anti-trust action that breaks up huge companies and reduces barriers to entry and we cang et back to the lean, competitive capitalism that leads to growth and innovation
    - dmix 10y ago
      Breaking up big companies is just the first step and relatively a minor one compared to the many barriers to competing with large incumbent firms. Industries with oligopolies where a more aggressive anti-monopoly policy would makes sense are almost always heavily regulated and in bed with the US gov. So that would only be the starting point if you expect them to continue to exist and not just get acquired. This is more of a problem for medium companies wishing to not get acquired, not so much a roadblock from small firms.
  - gwright 10y ago
Spooky23 10y ago
Health insurance and direct regulation is a distraction. The macroeconomic environment where everything relentlessly consolidates is the problem. For software, entire categories are either dependent in advertising and not long term viable or are scoped from a revenue point of view from bundled offerings by Microsoft, Google, Oracle, Salesforce, etc. Every other business is the same way. My neighbors dry cleaning business was forced to use a centralized plant because they just couldn't compete with the scale of the local big consolidated industrial cleaners.
FilterSweep 10y ago
> One key factor intertwined with this loss of dynamism: The U.S. is creating startup businesses at historically low rates. This is one of the outcomes of oligopoly, and a system that encourages oligopoly (see: "legal" tax evasion[0]). Google and Amazon, in particular, have their tendrils extended to many more areas in tech than Search, Affiliate Marketing, good Hardware, and selling products at cheap prices and highly developed operation systems. In fact, one of this year's most successful tech IPO, Twilio, put the disclosure on their filing that their entire business is toast if AWS begins offering a VoIP / SMS delivery service and start undercutting their costs. [0] https://thestack.com/world/2016/05/03/the-tech-giants-inventing-their-own-tax-regimes/ https://thestack.com/world/2016/05/03/the-tech-giants-invent...
jonbarker 10y ago
The percent of the US economy invested in startups is very low, so I disagree with the premise of this headline. If every startup went bankrupt tomorrow, what would that represent in GDP decline? If the US GDP is 18 trillion and the total VC investment in 2015 was around 58 billion, then if only last year's investments all went to zero, it would represent a decline in .3% of US GDP. Of course there is more capital at risk than just last year's investment so let's say last year's 58 billion is only 10% of total capital deployed. OK still just a 3% decline. I think what the article should highlight is how few high growth and cash flow positive startups there are, which I agree is a real problem. Maybe completely eliminate all fees and taxes for LLC formation?
- itissid 10y ago
  Stripe folks are working on a product called Atlas(I think thats the name) that supposed to make the LLC formation much easier. Bless them.
- maxlamb 10y ago
  I think that's the major premise of the article, that the slow growth is due to the fact that percentage of the US economy invested in startups is TOO low.
denim_chicken 10y ago
Collapse is near.
- whataretensors 10y ago
  I don't understand why this sentiment is gaining so much traction lately. I'm not claiming to understand the complex world of economics, but I do recognize great inventions - and our world is full of them. ML is the one I'm most excited about at the moment.
  - daxorid 10y ago
    A few reasons: 1. We are currently inside the second longest bull market in US history. Markets are cyclical. We are far more likely to be toward the end of the bull market than the beginning. 2. Interest rates have begun to normalize, albeit very slowly. 3. Source rock fracturing and enhanced oil recovery has bought us another 20 years of bumpy plateau. We are squandering this by employing civilization's best minds building Tinder, Uber, Snapchat, etc. The last "great inventions" were the microprocessor and the lithium polymer battery. Every disruption in the last forty years has been variations of ever more hedonistic consumerist enablement, while the clock continues to tick on future energy supply.
    - deleted 10y ago
      [deleted]
    - jazzyk 10y ago
      The reason investors are not interested in funding enterprise software (which usually increases productivity, and eventually standards of living) is that big companies have not been interested in optimizing their operations for many years now, because: - business is good due to lowered competition (market consolidation) - cheap/free debt can be used for various forms of financial engineering (stock buybacks, etc), making EPS look good
    - mempko 10y ago
      recessions and depressions usually happen after federal gov decides to reduce deficit spending. I'm curious if there is any indication of this happening. Possibly after elections... EDIT: Judging from this site it seems they plan to reduce deficit spending to about 500bln a year. So yes, I expect a recession if that turns out true. http://www.usgovernmentspending.com/federal_deficit_chart.html http://www.usgovernmentspending.com/federal_deficit_chart.ht... You can see here that every time there was a slowdown in deficit spending or a surplus there was a recession or depression. Notice that before the great depression, there was a long period of surplus and following surplus during Clinton years there was huge issues. Let's hope Hillary does not repeat Bill's mistake. http://www.usgovernmentdebt.us/spending_chart_1900_2021USp_18s2li111tcn_G0f_Budgeted_Federal_Deficits http://www.usgovernmentdebt.us/spending_chart_1900_2021USp_1...
threepipeproblm 10y ago
So while startup hype is at an all time high, the actual level of startups is at an all time low in the US. Reminds me of something Terry Gilliam said... "Usually you spot how societies work by what they glorify: it's usually the thing they're deficient in."
marcamillion 10y ago
So I think this the article perfectly sums up a thesis I have developed about these economics indicators and the way Economic Growth & Productivity is measured. All of this is intuitive, and I have no hard data to back up my theory, so I would love for someone with much more econometric experience than I to prove/disprove this thesis. Thesis: The global economy and US economy in particular is going through a radical productivity growth spurt and shift that is not currently being measured properly. This article is the perfect example of this. You mean to tell me that during a period where there has been an explosion of independent contractors of many different types, we have seen "Startups Weighing on US Economic Growth"? Surely that can't be true and fully reflective of the reality. There are two aspects to this. There is direct job growth within startups (so Employee headcount) and there is the issue of what is a 'new company'. Direct Job Growth. It is hard to argue that the average startup isn't much more productive today than it was 10 years ago, much less 20 years ago. Particularly tech startups. For tech startups it's most glaring, because you have things like AWS, Heroku & the App Stores that allow you to deploy a relatively easily scalable, product that can reach hundreds of thousands/millions of users/customers as a team of 1 - 5. No longer do you NEED someone just to manage 1 server, or even add additional server capacity and deal with Colocation-related issues and all of that stuff. You also no longer need to pay huge licensing fees for development software platforms and developer tools. So the barrier to entry to shipping has dropped to 0, basically. So whenever a startup raises a nominal amount of money, it can go into much more high-value jobs (like customer acquisition and customer support) for which there isn't always a direct correlation between each incremental dollar in revenue earned with the number of people you hire to support that revenue. In some cases there is, but in many cases there isn't. Or rather, the up scale hiring process is horizontal rather than vertical. Each customer support specialist can handle more support tickets today than they used to 20 years ago, for much cheaper. Aka, the support systems that multi-national companies have always used are now available for much cheaper and often much better to startups at $50/employee in many cases. When you think about the various aspects within a growing tech startup, you can see this same principle across all disciplines (even including HR and Employee benefits via services like Zenefits and its competitors). So the productivity that can be bought with each marginal dollar invested in a nascent startup is so much greater as a result of these highly, specialized and in many cases very economical services that can be leveraged from third-party providers, than had been the case 20 years ago....yet these articles and current econometric models would have us believe that productivity growth has flatlined. Really? What is a 'new company'? While there may be significantly less direct job-growth (as a result of the issues I highlighted above), there has been an explosion in the number (and types) of marketplaces that have sprung up that allow customers/users to be independent contractors. Not just typical web dev/writing/etc. But your excess space (AirBnB and all its clones), your excess vehicle (Uber, Lyft and all clones and derivatives), your excess time (Instacart, TaskRabbit, Mechanical Turk, etc.), and any other service that has sprung up that allows random people to do random gigs from a marketplace of gigs of different kinds. So yes, the Ubers of the world no longer add significant employees to their payroll to service increasing revenue as a part of operations, but by creating marketplaces where random people can earn a living, doing things they previously never did (or even considered doing), surely has contributed significantly to economic growth in ways that aren't currently being measured properly. Those people likely haven't registered legal entities, they probably just have a bank account, so they won't show up in "new company" data. But I bet if there was a way to measure those non-registered, independent contractors across all of these problems and you contrast that figure with the same category 20 years ago, you would get a much different picture of the US economy and productivity growth. I could be wrong with all of this, but every time I read one of these articles....that's what jumps out at me. The disconnect between what is being measured and reported in articles like these, and all the products/services we see being launched on TechCrunch, Product Hunt and HN that significantly improve the average person's earning power by both being able to sell said product/service or sign up to be a participant in that marketplace, has always been jarring. Let me know if this makes sense to anyone and if I am missing anything. I would love to crystalize this thesis and ideas some more, to do a full write-up in a blog post so please poke as many holes in this as you can. Thanks!
itissid 10y ago
So many tech firms these days seem to satisfy some tiny facet of a group's demands to have/do stuff. The bigger the group's economic footprint the more the opportunity for business. But it seems to rely on "hierarchies" of social, economic status. But, basically if you have money you can avail a vast majority of today's tech firm's "products". Sad part is that as far as I could read economies promoting this kind of behavior are the only ones doing well, yet even here(in the US) it seems things have worked out at best "average" for a vast majority of people. The ones that actually tried to do better for everyone failed spectacularly(read collectivism and socialism). I always wondered why truly bettering ones self in every way(health, furthering ones own knowledge, exploration, helping others) are goals available only to the select few and not made available to more people more easily? Why are economic efforts geared towards these dwarf in front of more consumerist ones? Why do economics and behavior align in a way that makes it impossible to do better than a narrow predefined narrative someone set for me(or go through immense pain to achieve the one I want)? https://www.youtube.com/watch?v=ilY4hRgfC2Q https://www.youtube.com/watch?v=ilY4hRgfC2Q For example, I was looking at the simple task of affording a house with wife and kids and the only narrative available to have all this are "Zipcode", "School Districts" and "Zoning laws" which puts me in debt for life to get a decent thing choice for those options. Why do smaller economies seem to do better than larger ones(like in europe). It always seems to me that the bigger the group of people that try to align towards a common goal(be it insurance premiums or world peace) the harder it becomes. Why is this so? And yet, in the end, by and far large my experience of living in 3 vastly varied countries in the last 20 or so years still makes US a better place to be. But things could be a bit easier/simple https://www.youtube.com/watch?v=fJRcDHKrSqw https://www.youtube.com/watch?v=fJRcDHKrSqw
- linkregister 10y ago
  I'm interested in your resources but I don't want to make the time investment of watching the Youtube videos you linked. Can you give a short synopsis of them?
daodedickinson 10y ago
A coworker at one of my jobs (I work 4 menial job / gigs, make 17k a year, live in parents basement, have no friends or lover, was top of my class in CS but left after a professor openly helped a student cheat to no consequences and another prof revealed CS grads from my school had less than a 50% postgraduation employment rate for ANY job, much less a CS one) had an idea she wanted to patent that would be helpful but would essentially be a metal pole in a specific shape. I had to be a downer and tell her of this story: http://qz.com/771727/chinas-factories-in-shenzhen-can-copy-products-at-breakneck-speed-and-its-time-for-the-rest-of-the-world-to-get-over-it/ http://qz.com/771727/chinas-factories-in-shenzhen-can-copy-p... You're damned if you put your idea on the net and damned if you don't and it's all getting disheartening. I just want to find a career so I can go out and court someone but even the people with CS jobs that I know are constantly complaining of work / life imbalance and not getting to see their loved ones in person enough. Everytime I try to start studying some topic in the hopes of pursuing a living the shellshock of robophobia and the likelihood I will be too late overwhelms me. I can only cry at that leaked Clinton speech where she says we know what to do with the 120 IQ kids, but not the 100 or 80 kids. Well here I am at 145 mopping floors and literally shoveling shit despite only ever being excellent in school I guess it's just bad genes because my uncle could solve a Rubik's cube blind and built all sorts of electrical contraptions and has been a homeless drunk for decades. Here I am, another sandwich eater in front of thw trash pile as in Godard's weekend.
- taurath 10y ago
  So you left school because one professor didn't have good morals? I mean... just because you have a high IQ doesn't mean you make the right decisions. In fact its a lot easier to fool yourself.
  - daodedickinson 10y ago
    If the administration had responded to the complaints, I would have felt more hopeful. But instead it reinforced all the complaints of graduates who were saying they can't get a CS interview with their BS because of the grade inflation at the school. I was at this school because it is the only one I can afford without loans. So I stopped just short of the CS degree thinking maybe I will transfer to a school that might be able to help students get something in return for their degree, and maybe get a Ph.D. So if I become less depressed about our societal trajectory that is something I may end up doing. But today I am depressed and feel closer to ending up homeless because I got burnt out before getting a job. So today I think about maybe wandering homeless or seeing if there is still some job I could do that doesn't give me the feeling of absolute abjection that interviews do. At least I'm not Sufiah Yusof although maybe I would be if my parents had been more organized. I was successful in school mostly due to terror of my parents but now they feel bad about how they raised me and they don't push me at all. I keep hoping that some positive form of motivation will emerge for me but whenever I feel good about an idea, I feel awful about it the next day. I never know who I'm going to be tomorrow, or in the morning who I'll be tonight. I hoped university would be very demanding but they've been less so than my HS was. It's not like I'm more moral than that lecturer, I have no follow-through on anything and being on the debate team in particular turned me into a wandering sophist. So I agree.
madengr 10y ago
Did anyone else read "sputtering startups" and think physical vapour deposition?
gumby 10y ago
The article is absurd and not even supported by its own data! The fact is startups and small businesses have always been a small fraction of the economy both by employment and contribution to GDP. When I say "always" I actually mean the modern economy of the last 75 years at least. I was very surprised when I learned this but the data go back at least to the end of WWII, which is far back as I looked. Pre-depression there was still a lot of small / disorganized (unincorporated) business and a lot of agricultural employment. The large companies are the large employers; next are "small businesses" which are franchises (e.g. a lot of people are employed selling MacDonalds hamburgers who aren't technically employees of the MacDonalds company). There article even points out that new businesses account for only a tiny percentage of jobs; they compare company creation to the 1980s but don't account for company failure. And how many of those companies grew significantly? The vast majority of operating companies formed in the US, and I suspect most countries, are small businesses (shops, restaurants etc).
- muzz 10y ago
  > The vast majority of operating companies formed in the US, and I suspect most countries, are small businesses (shops, restaurants etc) My understanding is most of these are retail (think mom-and-pop shops), construction, and professional services (think solo-practicing doctors, lawyers, accountants, etc). The fact that I can join Google instead of incorporating Muzz's Software Consulting Services should be a good thing, not a bad thing.
  - gumby 10y ago
    I am not sure I understand your comment. The article claimed that the change in the number of startups had a materially bad impact on the economy. I claim that small business and startups, collectively, have only a small impact on the economy -- and that the article's data didn't support its conjecture. Of course Google, Apple, GE, Exxon (Standard Oil) and Boeing were all startups at some point, so without startups you don't have an economy, but the breakout in terms of affecting employment is in the large companies. So yes, google hiring is good for you and is believed by many to be good for the economy in general.
whybroke 10y ago
Consider also how much of payroll goes directly through you or your employee to rent or mortgage in the areas where software talent lives and you can see why the bootstrapping startups that caused the the tech revolution in the first place are infidelity harder now. You must either bear the productivity hit of a pure virtual workplace or you must comply to the nearly arbitrary success formulas of VCs.
bojl 10y ago
As a CS student interested in tech and entrepreneurship, I and so many of my peers won't be able to start our own ventures because of student loans. And by the time i've paid off my loans I'll probably have other responsibilities I'll need to take care of.
GarrisonPrime 10y ago
As a physician, I am blown away by the fact that almost no one is talking about the true problem: American health care is artificially hyper-inflated, expense-wise. Sooooo much waste. Sooooo much inefficiency. The problem is the cost is too high! So why, oh why oh why, is NO ONE TALKING ABOUT FIXING THE ARTIFICIALLY HIGH PRICES? Because those who make money off the system are controlling the narrative. They are more than happy to have the population "empowered" by increasing insurance coverage. More money for them. More reason and excuse to increase the costs even further. There is zero reason why a doctor's visit can't cost $100. Maybe less. Break something and need a few x-rays? $100 each, max, including development and reading costs, everything. Need an appendix or tonsils removed? $500 would cover pretty much everything. Sure, such things aren't cheap, but they're survivable. But as soon as we somehow decided we needed "insurance" for such routine expenses, the costs shot up and never looked back. The actual consumers of health care never see the price tag, and - surprise, surprise - the costs have no real reason to stay held back. The systems have no incentive to stay efficient and accountable.
- deleted 10y ago
  [deleted]
- pcurve 10y ago
  How do you propose we start to tackle the problem? I'm no stranger to the issue, having worked many years in the same dirty industry as you, but on pharmacy benefits side. It's not just one particular group getting rich in this sector; healthcare is a giant gravy train for everybody: you, me, insurance companies, pharmacists, hospital systems, drug makers, diagnostic tool makers, dme makers. Everybody is getting rich. Where do you even start?
  - dredmorbius 10y ago
    Capitated coverage with outcomes metrics. You're rated on what you acheive, not what you spend (as a healthcare provider).
  - GarrisonPrime 10y ago
    Massive education of the consumer is where I think the weak point is. Every aspect of our society minimizes or ignores the fact that our bodies need occasional attention. The public at large needs to be told the reality that maintenance is incredibly important. Getting teeth cleaned every 6-12 months, getting a colonoscopy at age 50 and every decade thereafter, getting your eyes examined every year or two - these should be seen as routine and just as expected as needing to mow your lawn or buy another gallon of milk. The idea that we don't need to budget for such things and just rely on "insurance" is asinine. I encourage everyone I know to budget and save for predicable expenses, have savings, and only use insurance for catastrophic coverage.

127 points by spuiszis 10y ago

simongray 10y ago

Requires an account.

swalsh 10y ago
This is a great chrome extension to solve that problem: https://chrome.google.com/webstore/detail/referer-control/hnkcfpcejkafcihlgbojoidoihckciin https://chrome.google.com/webstore/detail/referer-control/hn...
delibes 10y ago
Try going through Google. Seems to work for me: https://www.google.com/search?q=Sputtering+Startups+Weigh+on+U.S.+Economic+Growth https://www.google.com/search?q=Sputtering+Startups+Weigh+on... Many news sites give special favours to search traffic.
god_bless_texas 10y ago
use google chrome and click the link in incognito mode
user5994461 10y ago
Same. A recurrent issue with WSJ articles.
- Yhippa 10y ago
  Sometimes the "web" link works. Sometimes it doesn't.
  - user5994461 10y ago
    That's the issue. It's blocking traffic erratically. It doesn't help to go through google, or to go through private browser + Google :(
ulfw 10y ago
Frankly this goes to show how Hackernews urgently needs some proper product/ux/ui person to overhaul it. This type of comment shows up like clockwork for every single WSJ link. The web shortcut is clearly not visible/understood. Why not highlight it for known domains like wsj.com and others
- cylinder 10y ago
  I find it ironic that the site where I see the absolute most complaining about one of the easiest paywalls to bypass is on Hacker News.
- ninkendo 10y ago
  I'm pretty sure it's not HN's job to work around WSJ's decision to require an account to view their articles. Why don't people just stop submitting WSJ articles?
  - irishcoffee 10y ago
    > Why don't people just stop submitting WSJ articles? Ehrm, huh? That is your proposed solution? Just a SWAG: The articles are interesting. This claim can be backed up by the fact that WSJ articles show up on the front page fairly frequently.
    - ninkendo 10y ago
      I'm not sure what SWAG means but WSJ clearly doesn't want news aggregator visitors to view their articles for free. So the complaints should be directed at the WSJ, not the news aggregator. I don't have a solution I'm just saying it's WSJ's fault here, not HN.
- goseeastarwar 10y ago
  It's like paying for a WSJ subscription doesn't even cross HN's mind. At some point people should acknowledge the frequency of paywall complaints might mean there's lots of quality content.

cylinder 10y ago

Go on your state's Obamacare exchange. Hypothetically you are a mid 30s individual with a spouse and two young children. Look up 2017 numbers. You are looking at $12,000 - $24,000 per year in premiums alone and then massive deductibles and coinsurance of 30% to actually access services. Who can bootstrap a business like this? So people are staying with their powerful big corporations if they can't get millions in funding for a startup (and outside of tech this is simply not even a consideration). Edit: and if at some point you hire an employee, you will need / want to provide them with health insurance, and it will cost just as much. Large corporations have an advantage in that they negotiate lower premiums in bulk. Add this as yet another barrier to entry, along with their lobbying for protectionism, tax loopholes, their ability to hire huge teams of tax lawyers and accountants, and if you really start to get their attention, they can sue you baselessly by throwing lawyers at you to keep you in court. Merely defending yourself and getting to the point of dismissal is unaffordable for a budding small business. Take a look at S&P500's profit margins. They are at record highs and not coming down as economics teaches us, meaning new entrants are not coming into the market.

ceejayoz 10y ago
Here in upstate NY, $20k/year for a mid-30s with family of four gets you a Platinum no-deductible, copay-only plan with a $4k/year out-of-pocket cap (my exact situation - 2016 premium is $1,700/month). Bronze plans are dramatically cheaper, and if you're doing a bare-bones startup you're also likely to be in the income range that gets subsidies.
- cylinder 10y ago
  Here's a junk Bronze HMO with 50% coinsurance and $5,500 per person deductible in Albany at over $16,000/yr: https://nystateofhealth.ny.gov/individual/searchAnonymousPlan/plan/38594?county=Albany&coverageTier=COUPLE_AND_ONE_DEPENDENT&entityType=INDIVIDUAL&planYear=2017&youPay= https://nystateofhealth.ny.gov/individual/searchAnonymousPla... I am sticking to the major carriers as I'm skeptical of the networks these small no-name providers have. But even if I browse all carriers, the cheapest platinum plan is $20,000/year: https://nystateofhealth.ny.gov/individual/searchAnonymousPlan/plan/43003?county=Albany&coverageTier=COUPLE_AND_ONE_DEPENDENT&entityType=INDIVIDUAL&planYear=2017&youPay= https://nystateofhealth.ny.gov/individual/searchAnonymousPla... Subsidies - let's say you pull $70,000 your first year. Your subsidies will be $4,000 per year, so the platinum plan is still $16,000/yr net. After-tax on $70k is $54,000. That means your healthcare premiums alone are 30% of your post-tax income even with the subsidy! That means only $3,150/mo remains for your rent, transportation, food, utilities, etc...

forgotpwtomain 10y ago

It's just an editorialized presentation of the following: http://www.bls.gov/bdm/entrepreneurship/entrepreneurship.htm http://www.bls.gov/bdm/entrepreneurship/entrepreneurship.htm

johan_larson 10y ago

> Goldman Sachs economists in part blame the cumulative effect of regulations enacted since the Great Recession for reducing the availability of credit and raising the cost of doing business for small firms. Huh? Haven't small firms pretty much always been funded by personal saving of the founders, sweetheart loans from friends and family, and perhaps the odd bank loan secured by the personal assets (read: homes) of the founders? Banks aren't interested in lending directly to businesses until they are large enough to have concrete assets to secure the loans. And they never were.

jonwachob91 10y ago
I found this statement amusing too. Somehow, regulations enacted in the 40's took over 60 years to impact the industry? Seriously? The 80's and 90's, under the same regulations, where able to ignore those regulations and have tremendous growth and positive effect on the economy. Sounds like an economist who doesn't actually know what is going on so he's making shit up.
- gnutun 10y ago
  To be fair, the article was referencing regulations added since the Great Recession, so after 2008.
- ndonnellan 10y ago
  Great Recession, not Great Depression
  - muzz 10y ago
    that would be 2008, but the graphs start in 1977
rapala 10y ago
Depends on the industry. If your firm needs to buy heavy equipment for example, it's relatively common to get a loan for that from a bank.

costcopizza 10y ago

I wonder how much (if any) the lax enforcement of anti-trust law has played into this.

eeZah7Ux 10y ago
That, plus patents.

jordache 10y ago

This article was written under the assumption that startups in general = innovation.

brianwawok 10y ago
That is generally true. BigCo has billions in profit from existing products. They can't task big risks. What big innovations have the BigCos done in the last X years? Startups do crazy stuff. Many fail. Some succeed. End result: Innovation
- jordache 10y ago
  it's assuming that the success rate will be so high that it can support a sizable portion of the us economy. a bunch of destined to fail startups employing a handful of people (paid via owernship and future options) hardly contributes to the economy.
- Qworg 10y ago
  Wait. Why can't they take big risks? They're in a better position to take big bets than anyone else - Google X, Microsoft Research, Facebook's FAIR and others. If they have the right people in house (or can get them), they can take big swings.
  - nkohari 10y ago
    Public companies often can't take big risks because they have to justify them to their shareholders and consistently meet expectations. The examples you've listed are all just R&D projects, the expense of which are a tiny line item in the budgets of the companies. Conversely, a startup has nothing to lose. Early-stage investors know they're taking a moonshot, and they expect only a few of their bets to succeed, so they will encourage the team to swing hard. That's how startups can disrupt established markets with big players: they have less to lose, and don't need to earn buy-in of a large existing company. They can build what they need as they go. This is also why most acquisitions fail. The team of the acquired company can have difficulty navigating the existing company culture. Often, they're tasked with being a "change agent" only to be identified as a threat by the acquiring company's "immune system" (its existing power structure).

anton_tarasenko 10y ago

Walmart and Amazon alone sell $600bn worth of goods. That's 4% of US GDP. These two pushed thousands of independent retailers out of business due to lower prices (and smaller profit margins relative to revenue). The same happens in transportation, restaurant business, hotel industry. Firms get bigger since 1800. Naturally, the number of new firms decline. In govt stats, it appears as "fewer startups." Meanwhile, the economy grows thanks to productivity gains in big companies. So what do we want: productivity or new small businesses?

emp_zealoth 10y ago
No jobs mean you can stuff all your productivity gained in big companies into a trash bin because there wont be demand
treehau5 10y ago
I want a new economical system besides crony capitalism. Time to start thinking outside the box.
- TearsInTheRain 10y ago
  I feel like more aggressive anti-trust action that breaks up huge companies and reduces barriers to entry and we cang et back to the lean, competitive capitalism that leads to growth and innovation
  - dmix 10y ago
    Breaking up big companies is just the first step and relatively a minor one compared to the many barriers to competing with large incumbent firms. Industries with oligopolies where a more aggressive anti-monopoly policy would makes sense are almost always heavily regulated and in bed with the US gov. So that would only be the starting point if you expect them to continue to exist and not just get acquired. This is more of a problem for medium companies wishing to not get acquired, not so much a roadblock from small firms.
- gwright 10y ago

Spooky23 10y ago

Health insurance and direct regulation is a distraction. The macroeconomic environment where everything relentlessly consolidates is the problem. For software, entire categories are either dependent in advertising and not long term viable or are scoped from a revenue point of view from bundled offerings by Microsoft, Google, Oracle, Salesforce, etc. Every other business is the same way. My neighbors dry cleaning business was forced to use a centralized plant because they just couldn't compete with the scale of the local big consolidated industrial cleaners.

FilterSweep 10y ago

> One key factor intertwined with this loss of dynamism: The U.S. is creating startup businesses at historically low rates. This is one of the outcomes of oligopoly, and a system that encourages oligopoly (see: "legal" tax evasion[0]). Google and Amazon, in particular, have their tendrils extended to many more areas in tech than Search, Affiliate Marketing, good Hardware, and selling products at cheap prices and highly developed operation systems. In fact, one of this year's most successful tech IPO, Twilio, put the disclosure on their filing that their entire business is toast if AWS begins offering a VoIP / SMS delivery service and start undercutting their costs. [0] https://thestack.com/world/2016/05/03/the-tech-giants-inventing-their-own-tax-regimes/ https://thestack.com/world/2016/05/03/the-tech-giants-invent...

jonbarker 10y ago

The percent of the US economy invested in startups is very low, so I disagree with the premise of this headline. If every startup went bankrupt tomorrow, what would that represent in GDP decline? If the US GDP is 18 trillion and the total VC investment in 2015 was around 58 billion, then if only last year's investments all went to zero, it would represent a decline in .3% of US GDP. Of course there is more capital at risk than just last year's investment so let's say last year's 58 billion is only 10% of total capital deployed. OK still just a 3% decline. I think what the article should highlight is how few high growth and cash flow positive startups there are, which I agree is a real problem. Maybe completely eliminate all fees and taxes for LLC formation?

itissid 10y ago
Stripe folks are working on a product called Atlas(I think thats the name) that supposed to make the LLC formation much easier. Bless them.
maxlamb 10y ago
I think that's the major premise of the article, that the slow growth is due to the fact that percentage of the US economy invested in startups is TOO low.

denim_chicken 10y ago

Collapse is near.

whataretensors 10y ago
I don't understand why this sentiment is gaining so much traction lately. I'm not claiming to understand the complex world of economics, but I do recognize great inventions - and our world is full of them. ML is the one I'm most excited about at the moment.
- daxorid 10y ago
  A few reasons: 1. We are currently inside the second longest bull market in US history. Markets are cyclical. We are far more likely to be toward the end of the bull market than the beginning. 2. Interest rates have begun to normalize, albeit very slowly. 3. Source rock fracturing and enhanced oil recovery has bought us another 20 years of bumpy plateau. We are squandering this by employing civilization's best minds building Tinder, Uber, Snapchat, etc. The last "great inventions" were the microprocessor and the lithium polymer battery. Every disruption in the last forty years has been variations of ever more hedonistic consumerist enablement, while the clock continues to tick on future energy supply.
  - deleted 10y ago
    [deleted]
  - jazzyk 10y ago
    The reason investors are not interested in funding enterprise software (which usually increases productivity, and eventually standards of living) is that big companies have not been interested in optimizing their operations for many years now, because: - business is good due to lowered competition (market consolidation) - cheap/free debt can be used for various forms of financial engineering (stock buybacks, etc), making EPS look good
  - mempko 10y ago
    recessions and depressions usually happen after federal gov decides to reduce deficit spending. I'm curious if there is any indication of this happening. Possibly after elections... EDIT: Judging from this site it seems they plan to reduce deficit spending to about 500bln a year. So yes, I expect a recession if that turns out true. http://www.usgovernmentspending.com/federal_deficit_chart.html http://www.usgovernmentspending.com/federal_deficit_chart.ht... You can see here that every time there was a slowdown in deficit spending or a surplus there was a recession or depression. Notice that before the great depression, there was a long period of surplus and following surplus during Clinton years there was huge issues. Let's hope Hillary does not repeat Bill's mistake. http://www.usgovernmentdebt.us/spending_chart_1900_2021USp_18s2li111tcn_G0f_Budgeted_Federal_Deficits http://www.usgovernmentdebt.us/spending_chart_1900_2021USp_1...

threepipeproblm 10y ago

So while startup hype is at an all time high, the actual level of startups is at an all time low in the US. Reminds me of something Terry Gilliam said... "Usually you spot how societies work by what they glorify: it's usually the thing they're deficient in."

marcamillion 10y ago

So I think this the article perfectly sums up a thesis I have developed about these economics indicators and the way Economic Growth & Productivity is measured. All of this is intuitive, and I have no hard data to back up my theory, so I would love for someone with much more econometric experience than I to prove/disprove this thesis. Thesis: The global economy and US economy in particular is going through a radical productivity growth spurt and shift that is not currently being measured properly. This article is the perfect example of this. You mean to tell me that during a period where there has been an explosion of independent contractors of many different types, we have seen "Startups Weighing on US Economic Growth"? Surely that can't be true and fully reflective of the reality. There are two aspects to this. There is direct job growth within startups (so Employee headcount) and there is the issue of what is a 'new company'. Direct Job Growth. It is hard to argue that the average startup isn't much more productive today than it was 10 years ago, much less 20 years ago. Particularly tech startups. For tech startups it's most glaring, because you have things like AWS, Heroku & the App Stores that allow you to deploy a relatively easily scalable, product that can reach hundreds of thousands/millions of users/customers as a team of 1 - 5. No longer do you NEED someone just to manage 1 server, or even add additional server capacity and deal with Colocation-related issues and all of that stuff. You also no longer need to pay huge licensing fees for development software platforms and developer tools. So the barrier to entry to shipping has dropped to 0, basically. So whenever a startup raises a nominal amount of money, it can go into much more high-value jobs (like customer acquisition and customer support) for which there isn't always a direct correlation between each incremental dollar in revenue earned with the number of people you hire to support that revenue. In some cases there is, but in many cases there isn't. Or rather, the up scale hiring process is horizontal rather than vertical. Each customer support specialist can handle more support tickets today than they used to 20 years ago, for much cheaper. Aka, the support systems that multi-national companies have always used are now available for much cheaper and often much better to startups at $50/employee in many cases. When you think about the various aspects within a growing tech startup, you can see this same principle across all disciplines (even including HR and Employee benefits via services like Zenefits and its competitors). So the productivity that can be bought with each marginal dollar invested in a nascent startup is so much greater as a result of these highly, specialized and in many cases very economical services that can be leveraged from third-party providers, than had been the case 20 years ago....yet these articles and current econometric models would have us believe that productivity growth has flatlined. Really? What is a 'new company'? While there may be significantly less direct job-growth (as a result of the issues I highlighted above), there has been an explosion in the number (and types) of marketplaces that have sprung up that allow customers/users to be independent contractors. Not just typical web dev/writing/etc. But your excess space (AirBnB and all its clones), your excess vehicle (Uber, Lyft and all clones and derivatives), your excess time (Instacart, TaskRabbit, Mechanical Turk, etc.), and any other service that has sprung up that allows random people to do random gigs from a marketplace of gigs of different kinds. So yes, the Ubers of the world no longer add significant employees to their payroll to service increasing revenue as a part of operations, but by creating marketplaces where random people can earn a living, doing things they previously never did (or even considered doing), surely has contributed significantly to economic growth in ways that aren't currently being measured properly. Those people likely haven't registered legal entities, they probably just have a bank account, so they won't show up in "new company" data. But I bet if there was a way to measure those non-registered, independent contractors across all of these problems and you contrast that figure with the same category 20 years ago, you would get a much different picture of the US economy and productivity growth. I could be wrong with all of this, but every time I read one of these articles....that's what jumps out at me. The disconnect between what is being measured and reported in articles like these, and all the products/services we see being launched on TechCrunch, Product Hunt and HN that significantly improve the average person's earning power by both being able to sell said product/service or sign up to be a participant in that marketplace, has always been jarring. Let me know if this makes sense to anyone and if I am missing anything. I would love to crystalize this thesis and ideas some more, to do a full write-up in a blog post so please poke as many holes in this as you can. Thanks!

itissid 10y ago

So many tech firms these days seem to satisfy some tiny facet of a group's demands to have/do stuff. The bigger the group's economic footprint the more the opportunity for business. But it seems to rely on "hierarchies" of social, economic status. But, basically if you have money you can avail a vast majority of today's tech firm's "products". Sad part is that as far as I could read economies promoting this kind of behavior are the only ones doing well, yet even here(in the US) it seems things have worked out at best "average" for a vast majority of people. The ones that actually tried to do better for everyone failed spectacularly(read collectivism and socialism). I always wondered why truly bettering ones self in every way(health, furthering ones own knowledge, exploration, helping others) are goals available only to the select few and not made available to more people more easily? Why are economic efforts geared towards these dwarf in front of more consumerist ones? Why do economics and behavior align in a way that makes it impossible to do better than a narrow predefined narrative someone set for me(or go through immense pain to achieve the one I want)? https://www.youtube.com/watch?v=ilY4hRgfC2Q https://www.youtube.com/watch?v=ilY4hRgfC2Q For example, I was looking at the simple task of affording a house with wife and kids and the only narrative available to have all this are "Zipcode", "School Districts" and "Zoning laws" which puts me in debt for life to get a decent thing choice for those options. Why do smaller economies seem to do better than larger ones(like in europe). It always seems to me that the bigger the group of people that try to align towards a common goal(be it insurance premiums or world peace) the harder it becomes. Why is this so? And yet, in the end, by and far large my experience of living in 3 vastly varied countries in the last 20 or so years still makes US a better place to be. But things could be a bit easier/simple https://www.youtube.com/watch?v=fJRcDHKrSqw https://www.youtube.com/watch?v=fJRcDHKrSqw

linkregister 10y ago
I'm interested in your resources but I don't want to make the time investment of watching the Youtube videos you linked. Can you give a short synopsis of them?

daodedickinson 10y ago

A coworker at one of my jobs (I work 4 menial job / gigs, make 17k a year, live in parents basement, have no friends or lover, was top of my class in CS but left after a professor openly helped a student cheat to no consequences and another prof revealed CS grads from my school had less than a 50% postgraduation employment rate for ANY job, much less a CS one) had an idea she wanted to patent that would be helpful but would essentially be a metal pole in a specific shape. I had to be a downer and tell her of this story: http://qz.com/771727/chinas-factories-in-shenzhen-can-copy-products-at-breakneck-speed-and-its-time-for-the-rest-of-the-world-to-get-over-it/ http://qz.com/771727/chinas-factories-in-shenzhen-can-copy-p... You're damned if you put your idea on the net and damned if you don't and it's all getting disheartening. I just want to find a career so I can go out and court someone but even the people with CS jobs that I know are constantly complaining of work / life imbalance and not getting to see their loved ones in person enough. Everytime I try to start studying some topic in the hopes of pursuing a living the shellshock of robophobia and the likelihood I will be too late overwhelms me. I can only cry at that leaked Clinton speech where she says we know what to do with the 120 IQ kids, but not the 100 or 80 kids. Well here I am at 145 mopping floors and literally shoveling shit despite only ever being excellent in school I guess it's just bad genes because my uncle could solve a Rubik's cube blind and built all sorts of electrical contraptions and has been a homeless drunk for decades. Here I am, another sandwich eater in front of thw trash pile as in Godard's weekend.

taurath 10y ago
So you left school because one professor didn't have good morals? I mean... just because you have a high IQ doesn't mean you make the right decisions. In fact its a lot easier to fool yourself.
- daodedickinson 10y ago
  If the administration had responded to the complaints, I would have felt more hopeful. But instead it reinforced all the complaints of graduates who were saying they can't get a CS interview with their BS because of the grade inflation at the school. I was at this school because it is the only one I can afford without loans. So I stopped just short of the CS degree thinking maybe I will transfer to a school that might be able to help students get something in return for their degree, and maybe get a Ph.D. So if I become less depressed about our societal trajectory that is something I may end up doing. But today I am depressed and feel closer to ending up homeless because I got burnt out before getting a job. So today I think about maybe wandering homeless or seeing if there is still some job I could do that doesn't give me the feeling of absolute abjection that interviews do. At least I'm not Sufiah Yusof although maybe I would be if my parents had been more organized. I was successful in school mostly due to terror of my parents but now they feel bad about how they raised me and they don't push me at all. I keep hoping that some positive form of motivation will emerge for me but whenever I feel good about an idea, I feel awful about it the next day. I never know who I'm going to be tomorrow, or in the morning who I'll be tonight. I hoped university would be very demanding but they've been less so than my HS was. It's not like I'm more moral than that lecturer, I have no follow-through on anything and being on the debate team in particular turned me into a wandering sophist. So I agree.

madengr 10y ago

Did anyone else read "sputtering startups" and think physical vapour deposition?

gumby 10y ago

The article is absurd and not even supported by its own data! The fact is startups and small businesses have always been a small fraction of the economy both by employment and contribution to GDP. When I say "always" I actually mean the modern economy of the last 75 years at least. I was very surprised when I learned this but the data go back at least to the end of WWII, which is far back as I looked. Pre-depression there was still a lot of small / disorganized (unincorporated) business and a lot of agricultural employment. The large companies are the large employers; next are "small businesses" which are franchises (e.g. a lot of people are employed selling MacDonalds hamburgers who aren't technically employees of the MacDonalds company). There article even points out that new businesses account for only a tiny percentage of jobs; they compare company creation to the 1980s but don't account for company failure. And how many of those companies grew significantly? The vast majority of operating companies formed in the US, and I suspect most countries, are small businesses (shops, restaurants etc).

muzz 10y ago
> The vast majority of operating companies formed in the US, and I suspect most countries, are small businesses (shops, restaurants etc) My understanding is most of these are retail (think mom-and-pop shops), construction, and professional services (think solo-practicing doctors, lawyers, accountants, etc). The fact that I can join Google instead of incorporating Muzz's Software Consulting Services should be a good thing, not a bad thing.
- gumby 10y ago
  I am not sure I understand your comment. The article claimed that the change in the number of startups had a materially bad impact on the economy. I claim that small business and startups, collectively, have only a small impact on the economy -- and that the article's data didn't support its conjecture. Of course Google, Apple, GE, Exxon (Standard Oil) and Boeing were all startups at some point, so without startups you don't have an economy, but the breakout in terms of affecting employment is in the large companies. So yes, google hiring is good for you and is believed by many to be good for the economy in general.

whybroke 10y ago

Consider also how much of payroll goes directly through you or your employee to rent or mortgage in the areas where software talent lives and you can see why the bootstrapping startups that caused the the tech revolution in the first place are infidelity harder now. You must either bear the productivity hit of a pure virtual workplace or you must comply to the nearly arbitrary success formulas of VCs.

bojl 10y ago

As a CS student interested in tech and entrepreneurship, I and so many of my peers won't be able to start our own ventures because of student loans. And by the time i've paid off my loans I'll probably have other responsibilities I'll need to take care of.

GarrisonPrime 10y ago

As a physician, I am blown away by the fact that almost no one is talking about the true problem: American health care is artificially hyper-inflated, expense-wise. Sooooo much waste. Sooooo much inefficiency. The problem is the cost is too high! So why, oh why oh why, is NO ONE TALKING ABOUT FIXING THE ARTIFICIALLY HIGH PRICES? Because those who make money off the system are controlling the narrative. They are more than happy to have the population "empowered" by increasing insurance coverage. More money for them. More reason and excuse to increase the costs even further. There is zero reason why a doctor's visit can't cost $100. Maybe less. Break something and need a few x-rays? $100 each, max, including development and reading costs, everything. Need an appendix or tonsils removed? $500 would cover pretty much everything. Sure, such things aren't cheap, but they're survivable. But as soon as we somehow decided we needed "insurance" for such routine expenses, the costs shot up and never looked back. The actual consumers of health care never see the price tag, and - surprise, surprise - the costs have no real reason to stay held back. The systems have no incentive to stay efficient and accountable.

deleted 10y ago
[deleted]
pcurve 10y ago
How do you propose we start to tackle the problem? I'm no stranger to the issue, having worked many years in the same dirty industry as you, but on pharmacy benefits side. It's not just one particular group getting rich in this sector; healthcare is a giant gravy train for everybody: you, me, insurance companies, pharmacists, hospital systems, drug makers, diagnostic tool makers, dme makers. Everybody is getting rich. Where do you even start?
- dredmorbius 10y ago
  Capitated coverage with outcomes metrics. You're rated on what you acheive, not what you spend (as a healthcare provider).
- GarrisonPrime 10y ago
  Massive education of the consumer is where I think the weak point is. Every aspect of our society minimizes or ignores the fact that our bodies need occasional attention. The public at large needs to be told the reality that maintenance is incredibly important. Getting teeth cleaned every 6-12 months, getting a colonoscopy at age 50 and every decade thereafter, getting your eyes examined every year or two - these should be seen as routine and just as expected as needing to mow your lawn or buy another gallon of milk. The idea that we don't need to budget for such things and just rely on "insurance" is asinine. I encourage everyone I know to budget and save for predicable expenses, have savings, and only use insurance for catastrophic coverage.