5 ms·

> but also good health insurance. I'm always amazed how blatantly clear it is that having health insurance tied to employment specifically discourages this kin

by grecy 2y ago

> but also good health insurance. I'm always amazed how blatantly clear it is that having health insurance tied to employment specifically discourages this kind of entrepreneurship, and the ability to "strike out on your own". Literally handcuffs keeping people at their jobs.

matwood 2y ago
Yep. I’ve been saying for awhile now that universal healthcare would likely lead to one of the biggest small business booms ever. Not only does it help people strike out on their own, but makes easier/cheaper for them to hire.
- kingTug 2y ago
  Same for housing. In Tokyo median rent price for a 1BR is $600-$700. No onerous contracts either with month-to-month rental options. The freedom to explore creative and business endeavors without these worries cannot be overstated.
- flippant 2y ago
  On the other hand, it would make it harder for big business to retain talent.
  - grecy 2y ago
    You mean they would have to offer a good job with competitive wages, enjoyable work conditions, good benefits (mat leave, paid time off, sick pay, etc.) and a good career path?
  - protastus 2y ago
    This is a feature, not a bug.
  - aksss 2y ago
    This is why big business is not an ally for anything that makes health care cheaper or easier to engage. It's a great system for them.
    - reducesuffering 2y ago
      JP Morgan, Berkshire Hathaway, and Amazon, all huge employee counts, together seriously tried to tackle healthcare costs in the US.
- GenerWork 2y ago
  I'm going to be honest, I don't believe this at all. It seems like one of those things that everybody says because they want it to be true.
  - therealdrag0 2y ago
    Ya. It sounds good. But then the question is why doesn’t every other country destroy US in entrepreneurship? Why does US still have so many small businesses?
    - deleted 2y ago
      [deleted]
    - GenerWork 2y ago
      Exactly. I'm willing to bet that the US may not be the number one country in terms of entrepreneurship, but it's certainly not at the bottom.
    - matwood 2y ago
      Well obviously there is more to it than just UHC. The US encourages and rewards risk taking, and has a healthy funding culture not found anywhere else, etc... But, I believe if you take how good the US already is with entrepreneurship and then add UHC it would trigger a boom.
rbultje 2y ago
People don't appreciate how expensive health insurance in the US is. A high-quality PPO plan for a whole family on the open market can cost $4k/month.
generic92034 2y ago
On the other hand startup culture and entrepreneurship are much more common in the US, compared with the EU. But the latter does not tie health insurance to employment, in most countries. Probably other factors are more important.
- no_wizard 2y ago
  Doesn't mean Universal Healthcare wouldn't be a net win for entrepreneurship. We should unlock all barriers to entry that we possibly can
  - anoncow 2y ago
    Universal Healthcare in the US will negatively impact entrepreneurship.
    - sanderjd 2y ago
      Why?
      - anoncow 2y ago
        IMO, one of the reasons US has done better with startups is because there are people driven by the difficulty of life. Make life easier and I think some of that drive will go away. US has had a good (although somewhat difficult for the people) balance for some time now. It's just an untested theory of mine.
        sanderjd 2y ago
        Sorry, but this is just total nonsense. Life is much more difficult in most places in the world than it is in the US. We have had more success with entrepreneurship because of a culmination of specific things, not a generalized "difficulty of life", which empirically does not exist. It's also more common for successful entrepreneurs to have grown up without financial distress. Sorry to shatter your dreams, but your theory is very silly.
ilamont 2y ago
It really is a detriment to entrepreneurship in the U.S., as well as early retirement for those who have saved up enough money but are locked into a job until Medicare kicks in at 65. One other observation: During the pandemic my spouse left her job to work with me full time. We had COBRA (health insurance based on her previous plan per federal law) for 18 months, which was great. Then we had to go to the open health marketplace. What a freaking disaster that was. If you make any sort of middle class income, which we did through my business, you don't qualify for any breaks in our state's marketplace (Massachusetts Health Connector). The broker database they had for small businesses insurance was a joke - no one ever returns your call; it seems they are looking for midsized businesses where their commission will be larger. I spent many hours comparing family plans on the Massachusetts Health Connector and eventually decided to bypass the marketplace and purchase insurance directly from the insurance company because it was a little less expensive and had a slightly lower deductible (but was still sky-high compared to COBRA/her previous employer's plan). We got reamed on the monthly insurance cost as well as the crazy-high deductible. She eventually went back to her old employer, and one of the primary reasons was getting access to affordable health insurance without crushing OOP costs.
ThePowerOfFuet 2y ago
This is the whole point.
jhawleypeters 2y ago
What are some good examples of countries with a different healthcare policy and more entrepreneurship, small businesses, and/or craftspeople than the USA?
- ilamont 2y ago
  Taiwan has a solid national health insurance plan. The number of small and medium sized businesses is very high for a country with a working age population of 16 million people: Taiwan boasted more than 1.59 million small and medium enterprises (SMEs), according to the White Paper on Small and Medium Enterprises in Taiwan, 2022. This accounts for more than 98 percent of all enterprises, an all-time high. Further, SMEs employed 9.2 million people, representing more than 80 percent of the total workforce. https://www.moea.gov.tw/MNS/english/news/News.aspx?kind=6&menu_id=176&news_id=103826 https://www.moea.gov.tw/MNS/english/news/News.aspx?kind=6&me... I think the official number undercounts the many micro-businesses that exist around the food industry, markets, and services.
aftbit 2y ago
Alright here are three health care reforms that we could implement without going all the way to Universal Health Care: 1. Anyone who pays cash for a procedure should pay a price that is no more than the lowest price that any insurance company has negotiated for the same service. 2. Anyone who buys a health care plan from the marketplace should get a price that is no more than 10% higher than the cheapest negotiated price any company pays for the same plan. 3. Anyone should be able to deduct the cost of health care for income tax purposes, not just companies that buy health insurance for their employees.
- heyoni 2y ago
  Is that universal healthcare with extra steps? Almost, but on a serious note, why not go all the way with universality?
  - brink 2y ago
    Because universal healthcare is not the best solution, as is becoming increasingly evident in Canada and the UK. We need to fix the price gouging in the medical system by incentivizing competition. With the way things are currently set up in the US, the hospitals are essentially written a blank check any time a patient steps foot on their premises. If we bring competition between the hospitals with price transparency, the prices will fall dramatically.
    - jplrssn 2y ago
      > If we bring competition between the hospitals with price transparency, the prices will fall dramatically. How do you envision this working for say emergency care, where as a patient you may not be in a state to make an informed decision about which hospital to visit?
      - brink 2y ago
        Most ER visits are not life or death situations, and most would make a 20 minute drive over a 10 minute drive if it meant saving $1k. So the incentive is still there. You can say that I'm valuing money over lives in this example, but I think we'd be picking the lesser of two evils, as it's becoming increasingly evident that socialized medicine is stacking up its own body count. Working with society is all about incentives, and universal healthcare doesn't incentivize excellence, it incentivizes complacency.
dboreham 2y ago
This is not an accident.
worstspotgain 2y ago
This is highly dependent on where you live. If you're unprofitable, you can qualify for Medicaid and various state benefits. If you're profitable, there are strategies that can make nearly all health care dollars tax-deductible. It should still cost you less to hire yourself than it'd cost a company to hire someone to compete with you, even before considering things like pass-through taxation and agency problems.

by grecy 2y ago

matwood 2y ago

Yep. I’ve been saying for awhile now that universal healthcare would likely lead to one of the biggest small business booms ever. Not only does it help people strike out on their own, but makes easier/cheaper for them to hire.

kingTug 2y ago
Same for housing. In Tokyo median rent price for a 1BR is $600-$700. No onerous contracts either with month-to-month rental options. The freedom to explore creative and business endeavors without these worries cannot be overstated.
flippant 2y ago
On the other hand, it would make it harder for big business to retain talent.
- grecy 2y ago
  You mean they would have to offer a good job with competitive wages, enjoyable work conditions, good benefits (mat leave, paid time off, sick pay, etc.) and a good career path?
- protastus 2y ago
  This is a feature, not a bug.
- aksss 2y ago
  This is why big business is not an ally for anything that makes health care cheaper or easier to engage. It's a great system for them.
  - reducesuffering 2y ago
    JP Morgan, Berkshire Hathaway, and Amazon, all huge employee counts, together seriously tried to tackle healthcare costs in the US.
GenerWork 2y ago
I'm going to be honest, I don't believe this at all. It seems like one of those things that everybody says because they want it to be true.
- therealdrag0 2y ago
  Ya. It sounds good. But then the question is why doesn’t every other country destroy US in entrepreneurship? Why does US still have so many small businesses?
  - deleted 2y ago
    [deleted]
  - GenerWork 2y ago
    Exactly. I'm willing to bet that the US may not be the number one country in terms of entrepreneurship, but it's certainly not at the bottom.
  - matwood 2y ago
    Well obviously there is more to it than just UHC. The US encourages and rewards risk taking, and has a healthy funding culture not found anywhere else, etc... But, I believe if you take how good the US already is with entrepreneurship and then add UHC it would trigger a boom.

rbultje 2y ago

People don't appreciate how expensive health insurance in the US is. A high-quality PPO plan for a whole family on the open market can cost $4k/month.

generic92034 2y ago

On the other hand startup culture and entrepreneurship are much more common in the US, compared with the EU. But the latter does not tie health insurance to employment, in most countries. Probably other factors are more important.

no_wizard 2y ago
Doesn't mean Universal Healthcare wouldn't be a net win for entrepreneurship. We should unlock all barriers to entry that we possibly can
- anoncow 2y ago
  Universal Healthcare in the US will negatively impact entrepreneurship.
  - sanderjd 2y ago
    Why?
    - anoncow 2y ago
      IMO, one of the reasons US has done better with startups is because there are people driven by the difficulty of life. Make life easier and I think some of that drive will go away. US has had a good (although somewhat difficult for the people) balance for some time now. It's just an untested theory of mine.
      - sanderjd 2y ago
        Sorry, but this is just total nonsense. Life is much more difficult in most places in the world than it is in the US. We have had more success with entrepreneurship because of a culmination of specific things, not a generalized "difficulty of life", which empirically does not exist. It's also more common for successful entrepreneurs to have grown up without financial distress. Sorry to shatter your dreams, but your theory is very silly.

ilamont 2y ago

It really is a detriment to entrepreneurship in the U.S., as well as early retirement for those who have saved up enough money but are locked into a job until Medicare kicks in at 65. One other observation: During the pandemic my spouse left her job to work with me full time. We had COBRA (health insurance based on her previous plan per federal law) for 18 months, which was great. Then we had to go to the open health marketplace. What a freaking disaster that was. If you make any sort of middle class income, which we did through my business, you don't qualify for any breaks in our state's marketplace (Massachusetts Health Connector). The broker database they had for small businesses insurance was a joke - no one ever returns your call; it seems they are looking for midsized businesses where their commission will be larger. I spent many hours comparing family plans on the Massachusetts Health Connector and eventually decided to bypass the marketplace and purchase insurance directly from the insurance company because it was a little less expensive and had a slightly lower deductible (but was still sky-high compared to COBRA/her previous employer's plan). We got reamed on the monthly insurance cost as well as the crazy-high deductible. She eventually went back to her old employer, and one of the primary reasons was getting access to affordable health insurance without crushing OOP costs.

ThePowerOfFuet 2y ago

This is the whole point.

jhawleypeters 2y ago

What are some good examples of countries with a different healthcare policy and more entrepreneurship, small businesses, and/or craftspeople than the USA?

ilamont 2y ago
Taiwan has a solid national health insurance plan. The number of small and medium sized businesses is very high for a country with a working age population of 16 million people: Taiwan boasted more than 1.59 million small and medium enterprises (SMEs), according to the White Paper on Small and Medium Enterprises in Taiwan, 2022. This accounts for more than 98 percent of all enterprises, an all-time high. Further, SMEs employed 9.2 million people, representing more than 80 percent of the total workforce. https://www.moea.gov.tw/MNS/english/news/News.aspx?kind=6&menu_id=176&news_id=103826 https://www.moea.gov.tw/MNS/english/news/News.aspx?kind=6&me... I think the official number undercounts the many micro-businesses that exist around the food industry, markets, and services.

aftbit 2y ago

Alright here are three health care reforms that we could implement without going all the way to Universal Health Care: 1. Anyone who pays cash for a procedure should pay a price that is no more than the lowest price that any insurance company has negotiated for the same service. 2. Anyone who buys a health care plan from the marketplace should get a price that is no more than 10% higher than the cheapest negotiated price any company pays for the same plan. 3. Anyone should be able to deduct the cost of health care for income tax purposes, not just companies that buy health insurance for their employees.

heyoni 2y ago
Is that universal healthcare with extra steps? Almost, but on a serious note, why not go all the way with universality?
- brink 2y ago
  Because universal healthcare is not the best solution, as is becoming increasingly evident in Canada and the UK. We need to fix the price gouging in the medical system by incentivizing competition. With the way things are currently set up in the US, the hospitals are essentially written a blank check any time a patient steps foot on their premises. If we bring competition between the hospitals with price transparency, the prices will fall dramatically.
  - jplrssn 2y ago
    > If we bring competition between the hospitals with price transparency, the prices will fall dramatically. How do you envision this working for say emergency care, where as a patient you may not be in a state to make an informed decision about which hospital to visit?
    - brink 2y ago
      Most ER visits are not life or death situations, and most would make a 20 minute drive over a 10 minute drive if it meant saving $1k. So the incentive is still there. You can say that I'm valuing money over lives in this example, but I think we'd be picking the lesser of two evils, as it's becoming increasingly evident that socialized medicine is stacking up its own body count. Working with society is all about incentives, and universal healthcare doesn't incentivize excellence, it incentivizes complacency.

dboreham 2y ago

This is not an accident.

worstspotgain 2y ago

This is highly dependent on where you live. If you're unprofitable, you can qualify for Medicaid and various state benefits. If you're profitable, there are strategies that can make nearly all health care dollars tax-deductible. It should still cost you less to hire yourself than it'd cost a company to hire someone to compete with you, even before considering things like pass-through taxation and agency problems.