The entrepreneurial case for national healthcare

From my post in October 2008 about my election issue wishlist:

Universal Healthcare. Everyone I know that freelances
or works a day job and wishes they could quit and follow their dreams
of launching a company complains about the lack of healthcare. Whenever
I used to talk about freelancing at tech conferences, the first
question was always about healthcare coverage. I've heard that in
places like Berlin where you don't have to worry about where your
healthcare is coming from or how much it costs, up to 35% of working
age adults are freelancers. It may sound crazy and anti-capitalist to
consider healthcare for all, but if we flipped a switch tomorrow and
everyone had health coverage I swear a million small businesses would
launch overnight. I know lots of people that keep a job just to get
healthcare that are wasting their creative talents because they had a
cancer scare or were born with a defect or otherwise are deemed
uninsurable on their own.

I remembered this because I'm hearing about an ongoing debate about National Healthcare and seeing an economy growing in fits and starts but one that could use a shot in the arm. I still believe we are losing a great deal of innovation, we are living in a world without inventions, and we're stagnating in an economy that could benefit from entrepreneurial expansion. The global economy is constantly changing and though the US used to export things, we now just export ideas, and America could continue to lead with ideas and innovation if the business environment was a welcome place for new entrepreneurs wanting to jump in.

I still know scientists, programmers, designers, photographers, and musicians that hold jobs and dream of someday walking away to work on their real dreams, but the question of how on earth will they pay for healthcare (stories like this are abundant when you consider 50% of bankruptcies arise from healthcare bills) is a major hurdle.

I don't see how someone could be strongly pro-business and not see an upside to extending the already existing national healthcare for seniors down to age zero. How many more Googles, Facebooks, and Twitters are we missing with the way things are?

Published by mathowie

I build internet stuff.

8 replies on “The entrepreneurial case for national healthcare”

  1. Someone I know runs a family-owned business; she has insurance for herself and her husband who own the business, her son who is a manager and her < 10 employees (not sure how many of them actually take it).
    She's also from an ethnic group that typically votes Democrat and is generally pretty civic-minded (boy, that's a sticky one to add, but I think it's relevant).
    She's constantly complaining about the cost of their health plan, yet she's against the current reform because she has a very high personal income and thinks her taxes will be raised to pay for it.
    She may be right, but the benefits to her business would most probably far outweigh any additional taxes she would pay.
    I don't get people.


  2. You’re totally right, and I think about the same point all the time. Not only is lack of health care keeping people from doing their own thing, it’s keeping people from starting small companies. Trying to start Pyra today and offering health coverage to everyone would eat up so much money it would be hard to build a sustainable business. The alternative of not offering health care coverage to employees is immoral in my mind.
    I don’t understand why this issue is missing from the discussion. I’d gladly pay another 1% (2%, 5%, what would it need to be?) to cover Medicare for everyone. That’s a heck of a lot better than the 10%+ of my income I currently spend on private insurance for my family, a cost that’s increased each year by more than 15%.


  3. As a Canadian I keep making this point to my American friends. Having health insurance that’s independent of your employment means complete freedom to quit your day job, change companies, change careers, start your own business, or just follow your bliss.
    It still sucks to be poor here — it’s certainly not a life of luxury “living off the state” as some would argue it — but it sucks a bit less than it does in the States — having this burden removed means you get the care you need when you need it, and you have a fairer chance at making something worthwhile of yourself and your life.
    It doesn’t guarantee outcomes; it cannot stop you from overeating, getting cancer or diabetes, nor can it ensure that you will be a happy person, good parent or become rich; it just gives you access to the same physical and mental health resources, and the same quality of care, no matter what your level of income.
    Whether it be in a single-payer system like ours, a government-backed public/private risk pool, or merely a very well-regulated private system with subsidies for the poor — it cannot help but be a boost to entrepreneurship and innovation. It’s why international companies keep moving to Montreal and Vancouver, for instance…
    (personally, I’m a fan of HR676. I think needs a much better website and social media campaign, though.)


  4. The only reason its so expensive in the first place is because there is too much health insurance. Imagine having auto insurance that paid for predictable things like oil changes, inspections, and tire rotations, etc. Imagine how much more those things would cost if the government or third-party insurer paid for them instead of us, because companies could charge whatever they liked. Imagine how much worse customer service would become, since they would get paid the same amount no matter what. And imagine the oversupply of mechanics and the unnecessary over-demand for auto repairs such a situation would generate. That is our current health care system. We need less insurance that only covers low-probability catastrophic events, and just pay the rest out of our pockets. Besides, our government can’t even afford to keep promises to buy our junk cars so we can exchange them for pickup trucks and hummers (which are indeed on the list of qualifying vehicles for “cash for clunkers”). Health care costs are stifling business and extending them further isn’t going to help us at all.


  5. “We need less insurance that only covers low-probability catastrophic events, and just pay the rest out of our pockets.”
    This is idiotic. Do you know how many more “catastrophic” events will need to be covered because people will not get the preventive care they need when it matters?
    “Catastrophic” is amputating the leg of a diabetic, fitting a prosthesis, and months and months of rehab. Preventive care informs people of lifestyle changes (diet, exercise) to address pre-diabetic conditions before full-fledged type 2 diabetes develops.
    More coverage and more preventive medicine when it can make a difference will lower costs.
    And for pay the rest from our pockets, seriously? Where’s everyone getting this money? People aren’t saving for retirement, you think they’re going to save for health care? They can’t even pay off their credit cards.
    Health care is a moral right and the idea that somehow only the fiscally responsible deserve it is despicable.


  6. Another way to get the same result would be to remove the favorable tax treatment given to employers for health insurance. Since the cost of insurance figures into the cost of making hires, that cost will almost entirely go back into wages — and employees are sure to opt for higher wages in lieu of fringe benefits — so most all employers will stop offering insurance and their employees would get a sufficient ‘raise’ to use on insurance (or other necessities). We end up in the same place, i.e., there would no longer be a need to worry about whether your employer covered you.
    This would be a big change, but so is a federal government health insurance plan for everyone. Furthermore, consider this: Matt Haughey here is saying in effect: Because a bad government tax policy made us tie health insurance to employment, the government should now just run all the health insurance. Wouldn’t it simpler to just undo the bad tax policy?
    Here’s a Boston Globe article on the relevant history:


  7. “Wouldn’t it simpler to just undo the bad tax policy?”
    Not really. That just turns back the clock to a time that pre-dates those systems that actually work most of the time for most people in other countries.
    Universal healthcare frees people from crappy jobs, the whims of insurance companies, and the ongoing fear of arbitrary ruination. It widens the window of startup entrepreneurship from those without commitments, kids, or a sense of their own mortality.
    I have seen too many hard-working people in the US holding bakesales to pay medical bills. This is a moral issue, and a reflection of a country’s moral foundations; if the will isn’t there, then there are other countries that will allow me to work for myself without the ongoing fear that riding a bike, playing a team sport, walking a trail or just tripping up on the street might end up ruining me.


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