Small business asks the right questions on health care

Small business asks the right questions on health care

Summary: Small businessmen, at least, are asking the right questions.


Fred Blankenhorn, 1920-1999My dad was a small businessman. (Here he is on his favorite beach.)

We had health care but I know he also paid for a lot of things out of pocket, like eyeglasses, dental visits and my own ADHD.

These days there are more costs than ever. Preventive drug therapy for my hypertension. Acne drugs for the kids. If you're diabetic your costs have doubled in six years.

Small businesses can't afford these costs. This has been true for years.

During this decade many let their workers be subsidized by large businesses that do pay. It's not really health care, but when these employees go to an emergency room the costs are shifted onto paying customers.

It hurts, but this subsidy has become crucial. Thus many small businessmen have a natural affinity for the Republican Party, which would place the payment burden on individuals, not business. It eases the guilt and maintains the cost advantage.

It's expected this preference to avoid costs will hold this year.

But now, many of these small businessmen can't even afford to cover themselves or their families. They can't afford real coverage in the individual market. And so many are rethinking their support for the subsidy.

They are asking the hard question most voters avoid. Who will pay for the care we all need?

Small businesses can't afford it. Big businesses are finding it increasingly hard to take, partly because they're picking up the cost of so many uninsured.

Government can bear it, as it is borne elsewhere, but with that comes taxes, and questions of control over what we all think should be personal decisions, taken out of the insurance market and placed into the public square.

The point is there are no easy answers, and there won't be even after November 4.

Small businessmen, at least, are asking the right questions.

Topics: Software, CXO, Enterprise Software, Health, IT Employment, SMBs

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  • Step one

    At least let the government pick up the tab for mandated emergency care provided [i]gratis[/i] to those who can't pay for it rather than shifting it to those who can, barely, but don't have insurance.

    Keep in mind that insurance companies, thanks to their negotiating power, don't pay for that cost-shifting but only for the cost of the services their covered patients [u]do[/u] receive. I've been in position this year to compare what the providers would have charged me without insurance and what they actually charged my carrier, and it's pretty close to 3:1.

    Dumping that on the next-to-bottom rung of the population is insane.
    Yagotta B. Kidding
    • Government does provide coverage...

      ... to employees and through the Medicare/Medicaid programs. Not to mention the various state programs intended to supplement federal funding.

      The rates for these programs are often less than medical care providers prefer to receive.

      So that next-to-bottom rung group is probably supporting the government as well.

      Much saner, no?!
      Anton Philidor
      • They <b>are</b> the bottom rung, Anton

        [i]Government does provide coverage to employees and through the Medicare/Medicaid programs. Not to mention the various state programs intended to supplement federal funding.[/i]

        The next rung up consists of those who are employed but don't have employer-supplied health care. That includes small businesses that don't have enough employees to get the risk-pooling breaks that larger employers do, so they pay essentially individual rates for each employee. That's hideously expensive, and since many of their employees are in low tax brackets the tax exemption isn't worth much.

        So they go bare and take their chances.
        Yagotta B. Kidding
    • A little de-programming is in order

      Let's rephrase your post in truth instead of indoctrination.

      "At least let the taxpayer pick up the tab for government-required
      emergency care provided at taxpayer expense for those the
      government has declared cannot pay for it."

      Do you see how stupid your argument is, now that we've actually
      phrased it correctly?
  • The disconnect is unreal

    If your dad was a small businessman, ALL of his health care was
    out of pocket. Who do you think paid the health care premiums?

    For crying out loud. It's like talking to a rutabaga.
  • Your first mistake: assumption of 'need'

    You make the following statement:

    "Who will pay for the care we all need?"

    First of all-- "need" is a very difficult line to draw. For example, if the cost of treating one 75 yr old who just suffered a heart attack is equivalent to the cost of removing 50 sets of tonsils from kids who suffer from chronic throat illnesses, who deserves it more? The higher number of people with a higher probability of living longer, or the one man who needs the most intensive care now but is likely to not live for very long anyway?

    The facts are unfortunate, but there is NOT enough money to treat EVERYONE of all ailments they have-- especially not at today's costs. Whether it be insurance companies, or the government, or a doctor-- somebody, somewhere along the line has to decide on the definition of that word "need" and somebody is going to be told "no."

    No here is the crux of the healthcare debate: how do we decide that? Who is high enough to decide that? The truth is, nobody really. In the analogy above you could be choosing between your father and watching your 10 year old constantly suffer-- how do you choose? The fact is, we have a moral obligation to provide equal coverage to everyone. If there are those who can afford to pay for higher QoS-- then more power to them.

    For example: a two tier system would fix this, by satisfying those wanting minimum coverages provided by the government. For example, you need a CAT scan for free? Wait 3 months (like many Canadians) until the next appointment-- or, pony up the cash for an appt tomorrow. Like this, private enterprises are free to turn their profits, and the public at large has "free" access to health care. Now, if they want better quality? Pay up. This is the free market way, is it not? But it also gives those who can't pay a crack at the care we have a moral obligation to provide too. Providers of paying customers could even make a claim to the base pay rate, and then customers supplant that for a higher place in the queue!

    One thing we MUST get rid of though, is pre-existing conditions. To be human is to be one giant WALKING pre-existing condition. And yes, while it does serve a purpose (to prevent Joe from walking around not paying into the system until he NEEDS the system), the scope of that purpose has been GROSSLY abused by insurance companies by going back 20 years into someone's medical history JUST to decide if they'll insure you-- not your rate, but outright rejection. Again, a two tier system would eliminate ths problem because everyone would be paying into the minimum coverage system at all times via a flat tax, while allowing people to elect for higher coverages levels when necessary.

    Of course, insurance companies would be cut out of existence, so they will vehemently fight anything that would cut the middle man out.

    So while the disconnect between need and want is very vivid, there is no 100% way to fix this problem without someone, somewhere not getting the coverage they may "need."
  • Rethink the 'Insurance' approach

    To me, asking a health insurance company to cover routine health CARE is a lot like asking your auto insurance company to pay for your oil changes and gas. No one would consider such a proposition.

    Reserve health insurance for the really unexpected catastrophic health events, such as heart attack or cancer. That's the classic use of compensate one in the unlikely event something bad may occur.

    The need for routine health care is not an unlikely event. Everyone needs it occasionally.

    We need to make a choice, as a society, first of routine health care a right? And secondly, if it is, how do we, as a society, deliver it in a cost effective manner, and then pay for it.

    Let's separate 'health insurance' from 'health care' and recognize them as two separate issues.

    Food for thought, I hope.
    • interesting thought, but...

      Your analogy is interesting, however, I think if you research the 'origin' of HMO's you'll find their philosophy based on the idea of - if we pay for folks to have PREVENTATIVE care (checkups, teeth cleaning etc), it will reduce the cost of everyone's health care overall. Diseases will be diagnosed sooner and warning signs will be recognized and acted upon.

      I suspect that if you remove the motivation to seek routine exams (eg. stop paying for them), many people won't see a physician or dentist or specialist until their symptoms are unbearable and hence, their health very deteriorated.

      Certain diseases or disorders are much more prevalent in lower socio-economic statuses, the same groups who are the most likely to be uninsured.
      • You may have missed my point

        I did not say 'stop paying for it'.

        My gist was that the current system of having insurance companies buy health care on our behalf, by definition, means that less than 100% of your money is going to be spent on actual care. As it turns out...a great deal less.

        It makes NO sense to me, to have a third party procure things for me, in the name of 'insurance', that I am 100% certain to need. We cannot 'insure' against things that are a 100% certainty.

        What the insurance companies are is 3rd party for-profit health care buyers.

        There must be a different and better way to pay for the part of health care that is considered basic, normal, everyday treatment and diagnosis.

        Use insurance for the big stuff.