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Comment by jdminhbg | Hacker News Reader

This is only a good point if you assume that the current proposals magically provide free health care to you when you quit your job.

"Universal coverage" as currently being debated just mandates that you purchase coverages and penalizes you with a tax if you don't; even with a "public option" you still have to pay for said option.

If you want to argue that tax-supported single-payer systems give you more freedom to quit your job and start a startup, fine, but nothing currently proposed in the US does that.

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You obviously have not experienced how bad the situation is. For many people it is literally impossible to get health care coverage if their job does not provide it.

The difference between paying $0 and $200/month (especially when the first option is tax-subsidized) is trivial compared to the current situation where any "insurance" individuals are graced with being allowed to purchase can be revoked arbitrarily.

So, please, get your facts straight.

I have experienced it, because I quit my job and got my own health coverage to work as a freelancer.

If you think that $200 a month is what mandated insurance will cost a family of 4 who aren't Medicaid-poor, I don't know what to tell you.

Curious, could you please share how you are covered and the cost? COBRA, Freelancer's Union, something else?

Tangent: COBRA is a really bad idea too. First, COBRA is probably more expensive than health care you acquire yourself, because most employers acquire highest-common-denominator coverage and hide the expense in payroll and benefits accounting. Second, COBRA has a ticking time limit on it, which is exactly what you don't want with health insurance (and why you never want month-to-month or temporary coverage). You might as well not insure yourself if any catastrophic event is as likely to bankrupt you with insurance as without it, which is what happens when something bad happens in the latter part of your COBRA term.

COBRA is a ticking time bomb. But it does have the nice property that it keeps your "continuous coverage" which is very important in the face of any pre-existing conditions. That can be a very big deal.

We had COBRA coverage when we started Matasano. Continuous coverage or not, insurance company beaurocrats refused coverge for us. I'm not sure what continuous coverage does for you once you obtain coverage, but in Illinois it doesn't do a thing to help you get it in the first place.

I have a high-deductible plan from Assurant, with prices roughly equal to what they quote here (low $100s): http://www.assuranthealth.com/corp/ah/healthplans/individual...

Mandated insurance with guaranteed-issue is a tax on the young and healthy to subsidize the old and sick. My plan, for example, is illegal in NY and NJ which have strong community rating requirements.

You can certainly think that taxing single 20somethings to subsidize families and the elderly is a good decision as a matter of policy, but it's not going to do a whole lot to increase entrepreneurship.

What mandatory insurance scheme is not a tax on the fortunate to subsidize the unfortunate?

Without a mandate, how do you provide any reasonable coverage to the unfortunate without falling prey to adverse selection?

This argument just doesn't seem well thought out.

What mandatory insurance scheme is not a tax on the fortunate to subsidize the unfortunate?

If you make healthy people buy fairly priced catastrophic coverage so that if they have an accident they don't declare bankruptcy and stick the rest of us with the bill, that's not a subsidy. It becomes a subsidy when you force them to pay the same rates as less healthy people, or force them to buy comprehensive policies that go beyond the coverage that they actually need.

I can't agree more. If we must discuss things at the heartless, what's-in-it-for-us level: Just because you may get sick doesn't mean you'd be a bad entrepreneur. One of the best mobile programmers I know has gout, and it's pretty difficult for him to get coverage.

If it was $1200 a month with guaranteed-issue, that would at least be something a family could budget for. But it's not, right now. It's $1200 except your wife can't get coverage at all despite no major medical problems, or your daughter is excluded from virtually all care because of a hospital visit years ago.

Financially-savvy young entrepreneurs with families would obviously be better off with high-deductable plans and HSAs, which cost significantly less than $1200/year. But again, they can't do that, because private health insurance isn't guaranteed-issue.

yep, the "revoked arbitrarily" aspect seems to not be well understood by most.

"If you want to argue that tax-supported single-payer systems give you more freedom to quit your job and start a startup, fine, but nothing currently proposed in the US does that."

I think people have missed this point. It's not as if there's a single-payer proposal working its way through Congress, although I think there ought to be. Health insurance sucks; even people who have it are often reluctant to visit the doctor in case it impacts its future coverage although this may result in a loss of economic productivity. A single-payer system will not deliver the desired results to everyone all of the time, but at least it won't treat people as if past illness were somehow a breach of contract.

Certainly, singe-payer means everyone paying a bit more tax to subsidize the least healthy, and if taxes are high enough the risk-/reward ratio of individual private enterprise becomes uneconomic. But if the required tax increases are modest, the benefits for job mobility and general financial security (vs medically-related bankruptcy) will more than outweigh the cost.

Right now an individual's medical problem all too often becomes a financial and legal problem as well. It seems to me that decisions with legal and financial aspects which must be taken in order to obtain medical treatment are made under duress. I had to have emergency medical attention last year and I really wonder about the enforceability of contracts I signed while puking and under the influence of morphine. And I had a good experience overall (no complications, not huge unexpected bills, quick recovery). Given how Kafkaesque the situation is for a good outcome, I shudder to think what it must be like for someone with a deadly or chronic condition.

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