6 ms·

How to combat healthcare benefit costs as a startup

12 points by turoczy 16y ago

Jun8 16y ago
Question to people who have small (e.g. <5 people) startups: what system do you use for employee heath care?
- mdda 16y ago
  We use a 'PEO' (ambrosegroup.com). Essentially, they are the 'employer' for all the employees, and provide payroll, medical, dental, 401k, travel accounts, etc - and bill us for the total (plus something for them) every two weeks. For a small startup, it makes a lot of sense - no time is taken up with 'HR' issues. And (from my initial research) the group medical rates that they can get more than make up for their administration cost. Making the payroll, etc, all a free bonus...
- whatrocks 16y ago
  This is a question I would love more clarity on. Especially pre-employee - what do bootstrapped founders typically do for their own healthcare? Do most roll the dice and go without? If so, do you stop going to regular dentist check-ups, etc.?
  - MichaelSalib 16y ago
    If you live in MA, you can purchase health insurance using the state exchange over the web. Minimal prices for a family of two are about $550/month (or were last I checked). Prices/availability can only vary based on age/gender/location so you don't have to worry about being denied coverage for a preexisting condition. You can cancel with one-month's notice. https://www.mahealthconnector.org/portal/site/connector/ https://www.mahealthconnector.org/portal/site/connector/
- brudgers 16y ago
  The ever popular, spouse whose employer provides healthcare. However, three years ago we had private family coverage through BC/BS Alabama. Because BC/BS has ~90% of the private insurance market in the State [Alabama essentially has a single payer system] our premiums were very low compared to much of the rest of the country. They were even lower than the similar coverage offered through the BC/BS plan at my former employer.
tptacek 16y ago
The concern I have with this article is that it dances around the core problem with US health care, which is that the underlying market for health services is --- in most cases --- coupled directly and inextricably with the health insurance establishment. It's all well and good to tell people to fund HSAs or buy health discount cards or get savvier about spending and buy generic meds. But a trip to the emergency room or a serious illness is simply going to max out your deductable, no matter how cost-conscious you are. The core problem is that medical services are priced by colluding hospital chains and insurance companies, and those prices are both (a) deliberately decoupled from the actual economics of providing health care and (b) a fig leaf covering the way hospitals and insurers actually resolve invoices. Unless/until you can extract the insurers from medical pricing, no amount of free market cheerleading is going to fix the problem. We don't have a free market to fall back on.
- gojomo 16y ago
  Can you think of any reforms that would break up the collusion without nationalizing the entire system? (Published price lists with limits on 'negotiated discounts'? Antitrust actions splitting up larger operators? Tax favoritism for processes that make true costs clear, rather than for processes which hide costs through multiple levels of indirection?)
  - tptacek 16y ago
    I'm not averse to nationalizing the entire system, so that's as far as my thinking usually goes.
    - protomyth 16y ago
      The US has two major nationalized health care systems: Veterans Affairs and Indian Health Service. If they can't do these two low population (relatively) systems right, I cannot imagine them getting it right for the whole USA. http://www.guardian.co.uk/world/feedarticle/8557832 http://www.guardian.co.uk/world/feedarticle/8557832
irons 16y ago
The crux of his prescription is to reserve insurance for the catastrophic, low-probability events like getting cancer or hit by a bus, but high-deductible catastrophic plans seem carefully calibrated to make you go bankrupt anyway. Given any other choices at all, I wouldn't trust my heath to one. I reviewed plans with a health insurance broker in Washington state in September, who openly mocked some Regence (Blue Shield) coverage with a fifteen hundred dollar annual limit on "complex imaging", which means MRIs, CAT scans, PET scans, mammography, etc. He said, "Do you have any idea how many scans you'd get if you had cancer?", and that $1500 might cover most of the first one. If you missed that detail and got sick, you might as well not have insurance.
- jon_hendry 16y ago
  P(cancer) >> P(hit by a bus) I know a woman under 40 who had cancer, and a woman under 30 who had cancer. And I may know more, for all I know. Plus plenty of over-50s who've had cancer. And my social sphere is not all that large. I'd have to say cancer is not really a low-probability event.
- orangecat 16y ago
  I reviewed plans with a health insurance broker in Washington state in September, who openly mocked some Regence (Blue Shield) coverage with a fifteen hundred dollar annual limit That's not high-deductible, it's low-benefit. A high deductible plan would have you pay out of pocket up to $5k or $10k, and then cover everything above that. I agree that a plan that caps benefits (at something less than $1 million or so) is practically worthless, because the sort of events you actually want to insure against get expensive really fast.
  - irons 16y ago
    That's not high-deductible, it's low-benefit. I have less experience shopping for group plans, but in the individual market you will die of natural causes before you find a high-deductible, high-benefit plan, let alone one without fatal loopholes.
brudgers 16y ago
>"The second dimension is becoming savvier healthcare consumers." Once you conflate patients with consumers, you have fundamentally moved away from a public health model towards a model where costs are based on what the market will bear rather than the costs associated with providing the service.
klbarry 16y ago
If you're in NYC and an early start-up freelancers union can be useful.
earl 16y ago
I can't believe people aren't tearing this asshole to threads. Between all the bullshit in his article, what he's really saying is this: let's pay less for health insurance by transferring more costs to the individual. I suppose you might support this if you're so deluded as to think lots of people are going to the doctors office because they're bored and have nothing better to do than have time consuming, often humiliating, uncomfortable to painful procedures and tests performed on them on a schedule that's extremely inconvenient. OTOH, those of us whose heads aren't firmly buried up our assholes think that people mostly try hard not to go to the doctor or hospital because the experience sucks, and so the way this Dave asshole is trying to save money is by discouraging you from getting health care you need by making it cost more. ps -- people who don't straightforwardly acknowledge that health insurance isn't insurance, it's group cost pooling, are idiots who should be ignored in the health care debate. It's not insurance and shouldn't be because we can tell that in certain cases people will cost a lot of money to treat. Insurance would leave them out in the cold. Societies with integrity or conscience treat people anyway. Compare to insurance -- if you build a house in a flood zone on the florida cost, you should probably be told hell no -- no company will sell you insurance. If all the women in your family get breast cancer, we should still give you health insurance for when you get breast cancer.
- yummyfajitas 16y ago
  I can't believe people aren't tearing this asshole to threads. Between all the bullshit in his article, what he's really saying is this: let's pay less for health insurance by transferring more costs to the individual. I suppose you might support this if you're so deluded as to think lots of people are going to the doctors office because they're bored and have nothing better to do than have time consuming, often humiliating, uncomfortable to painful procedures and tests performed on them on a schedule that's extremely inconvenient. This has been proven experimentally (by a randomized trial) to be true. When people pay more out of pocket for medicine (95% copay vs 5%), they consume 30% less medicine, but have statistically identical health outcomes. http://www.rand.org/health/projects/hie/ http://www.rand.org/health/projects/hie/ The reason people consume unnecessary medicine is unknown, but the fact that they do so is not in doubt. (I'm not even going to address your claim that "anyone who disagrees with me on the purpose of insurance are idiots".)
cabalamat 16y ago
Relocate to the UK.

12 points by turoczy 16y ago

Jun8 16y ago

Question to people who have small (e.g. <5 people) startups: what system do you use for employee heath care?

mdda 16y ago
We use a 'PEO' (ambrosegroup.com). Essentially, they are the 'employer' for all the employees, and provide payroll, medical, dental, 401k, travel accounts, etc - and bill us for the total (plus something for them) every two weeks. For a small startup, it makes a lot of sense - no time is taken up with 'HR' issues. And (from my initial research) the group medical rates that they can get more than make up for their administration cost. Making the payroll, etc, all a free bonus...
whatrocks 16y ago
This is a question I would love more clarity on. Especially pre-employee - what do bootstrapped founders typically do for their own healthcare? Do most roll the dice and go without? If so, do you stop going to regular dentist check-ups, etc.?
- MichaelSalib 16y ago
  If you live in MA, you can purchase health insurance using the state exchange over the web. Minimal prices for a family of two are about $550/month (or were last I checked). Prices/availability can only vary based on age/gender/location so you don't have to worry about being denied coverage for a preexisting condition. You can cancel with one-month's notice. https://www.mahealthconnector.org/portal/site/connector/ https://www.mahealthconnector.org/portal/site/connector/
brudgers 16y ago
The ever popular, spouse whose employer provides healthcare. However, three years ago we had private family coverage through BC/BS Alabama. Because BC/BS has ~90% of the private insurance market in the State [Alabama essentially has a single payer system] our premiums were very low compared to much of the rest of the country. They were even lower than the similar coverage offered through the BC/BS plan at my former employer.

tptacek 16y ago

The concern I have with this article is that it dances around the core problem with US health care, which is that the underlying market for health services is --- in most cases --- coupled directly and inextricably with the health insurance establishment. It's all well and good to tell people to fund HSAs or buy health discount cards or get savvier about spending and buy generic meds. But a trip to the emergency room or a serious illness is simply going to max out your deductable, no matter how cost-conscious you are. The core problem is that medical services are priced by colluding hospital chains and insurance companies, and those prices are both (a) deliberately decoupled from the actual economics of providing health care and (b) a fig leaf covering the way hospitals and insurers actually resolve invoices. Unless/until you can extract the insurers from medical pricing, no amount of free market cheerleading is going to fix the problem. We don't have a free market to fall back on.

gojomo 16y ago
Can you think of any reforms that would break up the collusion without nationalizing the entire system? (Published price lists with limits on 'negotiated discounts'? Antitrust actions splitting up larger operators? Tax favoritism for processes that make true costs clear, rather than for processes which hide costs through multiple levels of indirection?)
- tptacek 16y ago
  I'm not averse to nationalizing the entire system, so that's as far as my thinking usually goes.
  - protomyth 16y ago
    The US has two major nationalized health care systems: Veterans Affairs and Indian Health Service. If they can't do these two low population (relatively) systems right, I cannot imagine them getting it right for the whole USA. http://www.guardian.co.uk/world/feedarticle/8557832 http://www.guardian.co.uk/world/feedarticle/8557832

irons 16y ago

The crux of his prescription is to reserve insurance for the catastrophic, low-probability events like getting cancer or hit by a bus, but high-deductible catastrophic plans seem carefully calibrated to make you go bankrupt anyway. Given any other choices at all, I wouldn't trust my heath to one. I reviewed plans with a health insurance broker in Washington state in September, who openly mocked some Regence (Blue Shield) coverage with a fifteen hundred dollar annual limit on "complex imaging", which means MRIs, CAT scans, PET scans, mammography, etc. He said, "Do you have any idea how many scans you'd get if you had cancer?", and that $1500 might cover most of the first one. If you missed that detail and got sick, you might as well not have insurance.

jon_hendry 16y ago
P(cancer) >> P(hit by a bus) I know a woman under 40 who had cancer, and a woman under 30 who had cancer. And I may know more, for all I know. Plus plenty of over-50s who've had cancer. And my social sphere is not all that large. I'd have to say cancer is not really a low-probability event.
orangecat 16y ago
I reviewed plans with a health insurance broker in Washington state in September, who openly mocked some Regence (Blue Shield) coverage with a fifteen hundred dollar annual limit That's not high-deductible, it's low-benefit. A high deductible plan would have you pay out of pocket up to $5k or $10k, and then cover everything above that. I agree that a plan that caps benefits (at something less than $1 million or so) is practically worthless, because the sort of events you actually want to insure against get expensive really fast.
- irons 16y ago
  That's not high-deductible, it's low-benefit. I have less experience shopping for group plans, but in the individual market you will die of natural causes before you find a high-deductible, high-benefit plan, let alone one without fatal loopholes.

brudgers 16y ago

>"The second dimension is becoming savvier healthcare consumers." Once you conflate patients with consumers, you have fundamentally moved away from a public health model towards a model where costs are based on what the market will bear rather than the costs associated with providing the service.

klbarry 16y ago

If you're in NYC and an early start-up freelancers union can be useful.

earl 16y ago

I can't believe people aren't tearing this asshole to threads. Between all the bullshit in his article, what he's really saying is this: let's pay less for health insurance by transferring more costs to the individual. I suppose you might support this if you're so deluded as to think lots of people are going to the doctors office because they're bored and have nothing better to do than have time consuming, often humiliating, uncomfortable to painful procedures and tests performed on them on a schedule that's extremely inconvenient. OTOH, those of us whose heads aren't firmly buried up our assholes think that people mostly try hard not to go to the doctor or hospital because the experience sucks, and so the way this Dave asshole is trying to save money is by discouraging you from getting health care you need by making it cost more. ps -- people who don't straightforwardly acknowledge that health insurance isn't insurance, it's group cost pooling, are idiots who should be ignored in the health care debate. It's not insurance and shouldn't be because we can tell that in certain cases people will cost a lot of money to treat. Insurance would leave them out in the cold. Societies with integrity or conscience treat people anyway. Compare to insurance -- if you build a house in a flood zone on the florida cost, you should probably be told hell no -- no company will sell you insurance. If all the women in your family get breast cancer, we should still give you health insurance for when you get breast cancer.

yummyfajitas 16y ago
I can't believe people aren't tearing this asshole to threads. Between all the bullshit in his article, what he's really saying is this: let's pay less for health insurance by transferring more costs to the individual. I suppose you might support this if you're so deluded as to think lots of people are going to the doctors office because they're bored and have nothing better to do than have time consuming, often humiliating, uncomfortable to painful procedures and tests performed on them on a schedule that's extremely inconvenient. This has been proven experimentally (by a randomized trial) to be true. When people pay more out of pocket for medicine (95% copay vs 5%), they consume 30% less medicine, but have statistically identical health outcomes. http://www.rand.org/health/projects/hie/ http://www.rand.org/health/projects/hie/ The reason people consume unnecessary medicine is unknown, but the fact that they do so is not in doubt. (I'm not even going to address your claim that "anyone who disagrees with me on the purpose of insurance are idiots".)

cabalamat 16y ago

Relocate to the UK.