Working in a small business can make you sick

Working in a small business can make you sick

Summary: This argument has the benefit of truth behind it. Small businesses can't get good group rates. Their profit margins are often razor-thin. The owners often go without coverage themselves to keep the doors open.


Carolyn KepcherOne of the biggest problems with linking health care access to employment is it's unfair to employees of a small business.

This must be true, because whenever the subject of insuring everyone, or mandating employer coverage, comes up, small business starts whinging they can't afford it.

The whole argument is laid out here by Carolyn Kepcher (right), best known as the co-star fired by Donald Trump once he realized she was kith, not kin.

These days she bills herself as the "go-to source for working women" but working women apparently can't go to the doctor. Not if they're in a small business.

In a New York Daily News column she insists the coverage mandates of HealthyNY are "especially hard for small businesses to absorb."

Her polemic conflates HealthyNY, a voluntary program also open to the self-employed, and a 2006  San Francisco ordinance aimed at mandating employee coverage.

By describing $3-4 per check "health care surcharges" on San Francisco restaurant bills, she uses an argument against one coast to attack a program on the other. Neat trick.

The solution she proposes is "consumer-directed health plans," essentially non-insurance insurance, combining Health Savings Accounts with very high-deductible insurance plans. Works great if you don't get sick. Very Republican.

All this echoes the long-time arguments of the National Federation of Independent Businesses. Big businesses can take care of their people, small ones can't, and if you make them they'll never get big.

This argument has the benefit of truth behind it. Small businesses can't get good group rates. Their profit margins are often wafer-thin. The owners often go without coverage themselves to keep the doors open.

But is that an argument for impoverishing those with the get-up-and-go to work in (or own) a small business, or does it say something about the whole idea of health care as a business perk? 

We report, you decide. Catch Carolyn on Fox Business. She'll be the one spinning, empowering women by arguing against their health care.

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

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  • Small Bus. healthcare

    I have coverage through my employer (a four employee company). He pays half, I pay the other half. It's $2750 a year vs. $5400, so it's better than nothing!
    • An ideological response is...

      that you actually pay all of that, because the employer's contribution is money that would otherwise go to you in wages.

      There are no such things as business taxes you know.
  • One of two things has to happen

    And this is the case for small, medium, and large companies: Either the employer has to pay the their employees a wage they can live on and health care themselves, or the employer has to pay can live on and the employee pays for health care. If the employee has to pay it, then the wage they need to live on goes up by the same amount as their health care premiums. So the employer ends up paying either way, so you may as well get the discounts from a group policy.

    Employers who do not offer health coverage or offer enough compensation to cover health coverage will soon find themselves without employees anyway. Or at least good employees, and I know because I work for a small company that they cannot afford to keep bad employees around.
    Michael Kelly
    • Or...

      we can share the burden through taxes. This will reduce costs for large businesses more than for small businesses which aren't bearing them, and impose more costs on individuals.

      But we can do that.
  • RE: Working in a small business can make you sick

    This article is impressive in its lack of a point. I don't mean that so much in the sense that it is literally pointless, but that it has intentionally blunted what might be assumed to be its point in order to wallow in context-free criticism of any alternatives.

    Wandering down the text a bit there is the comment, "Big businesses can take care of their people, small ones can???t, and if you make them they???ll never get big... This argument has the benefit of truth behind it."

    Letting this stand for a moment (though I think it is a gross oversimplification, as not all small businesses are under equal constraints just because they are all small). What then is the proposed solution here? This article does not deign to make one. The article it criticizes offers a suggestion in the idea of health savings accounts. That article also clearly states (which this article takes no care to reference) that, "The consumer-directed plan isn't always the best way to go, especially for companies with an older employee base, or with a high turnover rate, which can make offering high-deductible plans more difficult." So it says, more or less, "Here is an idea, but it isn't for everybody." To which Mr. Blankenhorn replies with vigor, "Look at this unbelievably idiotic idea: it isn't for everybody!" Or more closely, he seems to say it isn't for anybody.

    Of course, a health savings account is one of the most flexible of programs for health coverage, as one can choose to a large degree exactly how much to contribute, to spend it on health items not covered by many common forms of insurance such as eyeglasses, or to take it out (with commiserate tax penalty) to spend on some other necessity. It also offers high-deductible insurance in the case of a major, unexpected illness.

    Given the complete dismissal of any possible usefulness to such a plan, all I can reckon is that Mr. Blankenhorn does not care for the concept of people having this level of freedom, which includes the freedom to do little, in regards to their own healthcare. I assume to him it appears to be insufficient, and people should be forced to have something better, as defined by his sensibilities and requirements.

    Since this is insufficient (as deemed by Mr. Blankenhorn) and many small businesses can do no better (as stipulated), I think it is simple enough to come to the conclusion that the only possible solution is for the state to offer healthcare directly, and relieve businesses of this unequal burden. Presuming, of course, it meets Mr. Blankenhorn's standards.

    But, can one possibly believe that if that were the case that the taxes on these small businesses would remain steady, thus relieving them of the burden of current payments and matching funds for their existing health programs?

    Can anyone believe that the taxes paid would be more efficiently spent, and therefore offer a lighter burden, than can currently be done with private insurance? (Not to be construed as praise of the efficiency of private insurance, only criticism of the inefficiency of the government in such matters.)

    Or, in short, does one think $200 in tax dollars is significantly more powerful than $200 in insurance payments? That it goes farther and accomplishes more? Or, as a greater argument, if we are in fact getting something that, for lack of funds, cannot now be provided, that $0 when paid in taxes is more than a match for some non-zero amount when paid in insurance?

    The only way to allow some $0 paid by company A to be turned into a product (healthcare) is to have some $X paid by company B or person C.

    Ultimately, you will either pass on the charge to the customer, which is where the analogy of the healthcare surcharge at restaurants in SF is perfectly appropriate, though dismissed out of hand in this article, or to another taxpayer, in which case you have just said, in so many words, that Jim's Large Insurance Co. is liable to pay the healthcare costs at Inga's Small Bakery. To Mr. Blankenhorn's mindset, that might appear just and equitable, buy I'd ask him to reflect for a moment if it is really fair for any business to pay the healthcare costs for the employees of another, and in some cases by the natural distribution of tax dollars, for that of their competitors'.

    More likely, however, we need not worry that large businesses will be unfairly burdened by paying for the healthcare of their smaller business cousins. I am quite certain the ideal of zero cost implications to the existing crop of small businesses will remain as idyllic and inviolate a dream as it is now, where it no doubt (though I make an assumption) rests comfortably in Mr. Blankenhorn's mind.
    • Great Post!

      This is obviously clearly thought out, but there's one problem with it.

      It's ideological, and absolutist.

      I reject ideological solutions. They don't work in the real world.

      What Kepcher is offering (and what you are supporting) is an ideological answer.

      Such answers only work in salons.

      Life ain't no salon.
  • Let's play hot potato with the premium...

    instead of looking at the real problem.

    It doesn't matter who pays for the premium, health care is too much. Why is medicine so expensive to begin with? Because they have you over a barrel. Some wheelchairs cost as much as a medium size Lexas. If Hillarycare went thru it would get more expensive because the gov't couldn't run a lemonade stand. Look at how those b*stard socialists ran Walter Reed. I say break up the AMA for it is a cartel to keep medical costs up and doctor's options down. This will allow more doctors on the market to compete and drive costs down. Also insurance companies should not make medical decisions like not paying for some procedure they believe is not necessary. All of these solutions they come up with for more affordable health care is nothing but a gimmick. It doesn't lower the costs. It either transfers it to someone else or masks it so it isn't that visible.
    • Who won the FA Cup in 1949?

      The workers control the means of production. The struggle of the urban proleteriat.

      No it was Wolverhampton Wanderers who beat Leicester 3-1.

      What am I saying? That ideology absolutism is absolute rubbish. Doesn't matter whether it's sold by Karl Marx or Ayn Rand.

      Medical care costs. Is it worthwhile? Life spans are longer than ever.
      • Actually, lifespans are longer due to sanitation

        and other clean living practices. My relatives lived to 70 and beyond all the way back to the 1600s. They had good genes and didn't crap in their water supply. The unlucky ones died of cancer in their 50s and 60s and that was a small percentage. So far there is no cure for cancer.

        As for is it worth it. Only if you want to hand over your life's savings to buy 6-18 months of miserable existence after the treatment if you got bad genes.

        There is a lot more to longevity than medical care. If care gets too expensive then we know for sure who takes care of themselves. By the way, there was no absolutism to my proposal unless you believe in state industries.