The White House wants to know: What are the most important issues for small businesses when it comes to health care?
CEA Report: The Economic Effects of Health Care Reform on Small Businesses and Their Employees
The Council of Economic Advisers in the White House has just released a new report on the impact health insurance reform would have on small businesses. Download and look through the report, then give the White House your feedback, comments, questions, or objections. CEA Chair Christina Romer will answer some of the most penetrating responses, as chosen by LinkedIn, in a live video online discussion at WhiteHouse.gov on Wednesday, July 29th, at 3:00 PM EDT.
I want to know: “What are your experiences with health care as somebody involved in small business, and what are your thoughts and questions on the new CEA report in light of those experiences?”
Clarification added 1 month ago:
The report can be downloaded at the link below:
http://learn.linkedin.com/CEA-smallbusiness-july24.pdf
Answers (1,596)
Small businesses should be able to hire the workers they need, without thought to benefits and perks that larger companies can afford. Eventually, as companies grow, to attract higher caliber talent, they will have to offer higher caliber benefits and coverage. But to hold small businesses to the same standard as well-capitalized, public corporations is ludicrous. The backbone of our economy is small and medium-sized enterprises that are privately owned and run. This is where people make their living, as owners and employees. Unfairly and unnecessarily burdening this sector of the economy with regulations meant for firms much larger and more capable is nothing but poor policy. If a coverage scheme is needed, it is precisely because small business can't (and shouldn't) afford it. Our health and bodies are OUR OWN responsibility, and so long as quality (not the adjective) healthcare is available and affordable, the employee should seek appropriate coverage on his/her own. If they are fortunate enough to work for a public company with benefit features that can be taken advantage of, all the better, but it comes down to choice, and those who work for small business know that excessive demand with respect to pay, benefits and taxes is going to cost them their jobs eventually. You can only squeeze the private business owner so much until he/she is wrung dry.
Clarification added 1 month ago:
(typo- NOTE the adjective)
Jim H
Small Business Coach & Consultant at Foursight Small business Consulting
Best Answers in: Small Business (1)
Number one issue . . . Being able to afford it! Most businesses under 20 people in size do not offer any insurance beyond workers comp. When a business has 5 or less people, this is even a bigger challenge. In fact simply buying insurance for themselves seems like a very tall order.
That said, if a business cannot afford to offer health insurance to their people, how can they be competitive when it comes to hiring good people, let alone trying to get the best employees. Being competitive with products, pricing, marketing, borrowing, etc. is difficult enough as a small business, add to that the difficulty created by not being able to offer insurance to attract good people . . . well you can see where this is going. And, who do they often end up hiring? They get the less skilled, the less motivated, and/or the less motivated.
It has been my experience that of great concern to small business owners when it comes to health care is affording it and not having it. Seems too simple, but figuring out how to have what you cannot afford is quite a dilemma.
Now should they be forced to pay for what they already can't afford to offer? Well I just hate thinking about what that would do to innovation, entrepreneurship and one of the American dreams of starting, buying, having your own business.
Until recently, I was a corporate America employee enjoying health insurance benefits for my family and me. That is no longer the case as I was laid off June 17 from Microsoft.
So my question is: Why does it cost $12,000 a year to get insured for 2 people? What did we do? Our company intends to make money
I wholeheartedly agree with the previous answers (Raffy & Jim) relating to the burden of supplying my own healthcare as a business owner let alone having to supply it to employees in the future should I hire anyone on staff. As a 2 person husband/wife team we have gone back and forth on the issue of hiring anyone on because of the burden of providing benefits to those employees.
If small businesses were forced to shoulder the burden aimed at larger businesses it would be the equivalent of shooting America in the head at point blank range. Entrepreneurship would cease to exist in this country because it would be too large of a hurdle for small businesses to even start because the financial burden would be too high. I don't mean to sound like chicken little ("The sky is falling") because I am not that type of purpose, but forcing small businesses to shoulder the financial burden instead of allowing us to decide whether or not to pursue personal healthcare would severely cripple our economy because many small businesses would have to close their doors.
Jeff M also suggests this expert on this topic:
Clarification added 1 month ago:
I meant to say "not that type of person" not "not that type of purpose"
Ryan B
bio-business Strategist
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This Question wouldn't come into discussion if we would have National health care plan that guarantees Health for all citizen. I do not see it is a rocket science. We live in a entropically "CLOSED SYSTEM". We all are connected and we share the AIR - thus one or more sick person(s) would contaminate the environment. It is the interest of the Nation to have a National-Health Care plan. It is much cheaper in a long run.
What matters most to small business in regards to health care:
1.) Cost to the Employer
2.) cost to the Employee
3.) quality of medical services offered
4.) Insurance should be linked to the individual, not to the company, so that the insurance goes whereever the person works.
5.) STOP the lawsuits, and you will decrease insurance rates dramaticaly
I have traveled abroad, to Russia, Canada, Germany etc... and I have experienced "socialized" medicine, and from personal experience, it is way better than what we have in America.
ie: when an ambulance comes out to you, it comes with an actual DOCTOR on board, and it is usually a wise old doctor that knows a few things that the youngsters don't know. I have even been able to go to the doctors home, to get help late at night. In Europe, Doctors become Doctors to SERVE and HELP ALL people, regardless of socio-economic status; where as here in the USA, Doctors become doctors to become rich, so only want to serve the wealthy. The biggest problems that we have personally had with the medical system in the USA has not been with the doctors, but with the INSURANCE companies, that charge you according to your CREDIT history, and based on where you live in the country. DOCTORS are expensive, ONLY BECAUSE of the cost for their MALPRACTICE insurance. I love OBAMA, my wife also loves him, so dont take this the wrong way, but tell Obama to wake up, and go after the INSURANCE companies, NOT the Doctors. Also, the Pharmaceutical companies sell the same drugs in Europe and Asia, but for about one percent of what they charge us here in America. Go after them for this as well. There needs to be a reckoning. I just wish I could be the one to do it with a baseball bat against the heads of the mafia run drug lords (Pharmaceutical Companies) and protection racketeers (Insurance Companies). These two companies are NO DIFFERENT than the RUSSIAN mafia that I have personally had dealings with in Russia. They have been paying off our government officials for years, and have been getting away with it for years. It needs to stop, no matter what. I truly pray OBAMA, is not on their payroll, I hope he is the one to finally level the playing field.
I don't want free healthcare! There is not one place in the world that has a successful universal healthcare system! Work on fixing Medicare and the other government run programs; eliminate the high cost of malpractice insurance for doctors, and, help hospitals and health information exchanges with necessary technology investments.
Disclosure: I haven't read the report.
Perhaps the K.I.S.S. method would be beneficial to provide healthcare and to manage costs. When organizations (public or private) get too large, by their very nature, they will become inefficient and wasteful.We need to keep competition in play, which forces good ideas and new methods into the marketplace. Only one provider (US Govt) is not ideal, nor is having so many provider options available that confusion, fraud, fracturing, etc. occurs. A balance of public/private may just be the ticket. The gov't creates the framework, measurements and satisfaction ratings, while the day-to-day providers are the professionals in the field. Then process improvement can be realized, and the recipient (the patient) realizes they have a voice in the matter (customer sat rankings, etc.)
Obvious issues for small business:
1. cost to provide healthcare to its employees; it can't break the bank but can be a shared expense
2. what is the opportunity cost if not available (do I lose, or not get, good talent)
3. "I hired these people for a reason", and I want them to thrive within my organization because it helps both of us; how do we stay healthy and productive
Having worked for both 'large' and small companies the fees I have paid for health care have varied greatly - however, I believe it is my responsisbility to provide my insurance - so if I am able to gain better coverage through the company I work for and have them pay some or all, I thank them and accept, if I cannot gain the level of coverage I wish to maintain I supplement or purchase my own. I do not want the government telling me what health care options I have or don't have. Fix the insurance companies from their side (reduce lawsuits, liability insurance costs, etc) and the rest will fall into place.
Douglas H
Functional Medicine doctor, Certified Clinical Nutritionist, Chiropractor, Anti-Aging Health. Public Speaker & Writer.
Small businesses should be able to offer various types and choices of health plans without government intervention or direction. In opposition to the proposed health plan as it is written on page 16:
"Except as provided in this paragraph, the individual health insurance issuer offering such coverage does not enroll any individual in such coverage if the first effective date of coverage is on or after the first day" of the year the legislation becomes law.
This would prohibit enrollment in a private health plan once someone has left the private plan after the Obama socialized medicine plan is initiated if it does in fact come into fruition. This would eventually eliminate all health insurance plans as we know it. This is only one disastrous result of socialized medicine.
According to the Small Business Administration's Office of Advocacy, the statistics from 2006 show that 99.70% of all American businesses had fewer than 500 employees. Of those businesses with less than 500 employees, 98.2% had less than 100 employees, 89.3% had less than 20 employees, 78.56% had less than 10 employees, and 61% had less than 5 employees. America clearly runs on small businesses. If you increase the tax burden on the majority of small businesses, as Obama-care would, you will burden the majority of small businesses with a burden that would greatly impair the ability to keep businesses open, further undermining the economy, leading to further economic downturns. This socialized medicine bill, if passed will be the death of the backbone of American economy.
The U.S. government should not become involved in health care at all. All other countries which have done so have huge waits for necessary surgeries and very limited services. The U.S. should not follow a plan which has already shown not to work! Socialized medicine is NOT the answer to the imperfect system we presently have!
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Hi Christina,
I’m genuinely excited about the notion of health insurance reform and could discuss it for hours, but to answer your question concisely, I’ll keep it to this:
My experience: I co-founded a services firm two years ago with my wife that has grown to 9 employees. I don’t offer benefits currently because 1) I can’t afford to do so and 2) my wife and I are covered and were only able to afford starting our business since I am still in the Army Reserves and have healthcare since I’m an Iraq Veteran. I have found a team of incredible employees (mostly found using LinkedIn), who currently have insurance from another source. However, for most of them, I am in an ongoing conversation about the date when they will need benefits from my firm before they will need to seek alternate employment. Negotiating the quagmire of my benefits responsibilities as an employer with my accountant, attorney and a client who is conveniently in the benefits business and discussing this issue regularly with my employees to ensure they know I care about their health care interests are two activities that take up a tremendous amount of my time that I could otherwise spend reinforcing my business’ success.
My thoughts on the report: I listened to the President’s comments and read the report one time (14 pages on health care discussion is tough to get through more than once with competing time requirements, even though a truly adequate response would warrant multiple reviews with a highlighter). I believe (and hope) the proposed reform will allow me to, in the words I used as a Soldier, “take care of my troops” and “keep my head in the fight,” instead of spending so much time ensuring I’m fulfilling my legal and ethical obligations to those that make my company successful.
My questions:
1) Assuming this reform is a zero-sum game in the short run, it’s clear who the winners are, but can you provide a list of all those groups that “lose” and would bear the cost of this reform? (My concern is that if the latter category includes large businesses who have the time and resources to spend reading not only this report more than once, but the actual legislation behind this reform, they may be able to find loopholes to “pass the costs” they will bear either back to small businesses or another group that does not deserve to pay them.)
2) Is there any way to provide those who are bearing the cost of this reform long term incentives to support it?
3) The President alluded to those urging a delay in reform. What non-political justifications exist for such a delay?
4) As someone with a close contact in a healthcare risk management position, I’m concerned about “sue-happy” citizens that burden the system, looking to achieve excessive wealth from healthcare-associated accidents (or worse, faked accidents). Is there a provision in this reform to limit cash awards in such cases or, perhaps, to give judges the option of identifying lawsuits that appear to be illegitimate and fine the plaintiff to pay all or a percentage of the defendant's legal costs (which would ultimately deter such ill-intended lawsuits)?
5) Finally, as the leader of a “tiny start-up with a big idea,” and a military veteran, I’m not looking to get more than I give. What can we as small businesses tangibly do to not only help support the passing of this reform, but to facilitate its success once it passes? My next step is to contact my congressional representatives, but I trust there is more I can do.
Thanks,
Dave Gowel
President and CEO, Clearly Creative
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Analysts, commentators, and anyone trying to make a quick point always refer to “Small Businesses” as a homogenous group. The truth is that small businesses are as diverse as any other large group in this country. Please stop doing this… My comments, therefore, come from the perspective of a IT services startup, Safelight Security Advisors, with the following characteristics:
a) My firm, Safelight, competes for contracts and talent in the market for information security services.
b) Offering premium healthcare plans is a requirement in our field. All prospective talent will be attracted from well financed startups or from large corporations, so not offering a plan isn’t an option.
c) Safelight has fewer than 10 employees
d) Safelight is growing its workforce across multiple states
Here is what is important to our firm:
1) Give our firm, and our employees, more choice when it comes to healthcare. I would like to offer more plans with varying coverage levels and price points. At our size, we can only offer a single plan to our staff.
2) Remove the complexities around offering plans to staff in multiple states.
3) Find a way to allow small businesses to pool their buying power so that there is not as much of a cost differential with large firms. In other words, large firms should not have such a significant cost advantage over small firms. I believe is free markets, so having the government facilitate pooling may be a way to do this competitively without any funding.
Healthcare isn’t broken from my perspective, however it is amazingly expensive to offer. We have a great plan to offer our staff, but it is over $12,000 per year. The premium is only 10% of a consultant’s compensation package, but could easily be 25% or more for administrative or junior staff – wow.
Mike Maziarz
COO, Safelight Security Advisors, Inc
Providence, RI
Help keep it affordable, and private. No govt intervention or plan.
As many have stated, cost is key. Requiring small businesses to insure employees with expensive plans will limit growth of the sector best positioned to boost the economy.
I think that an area of cost that is being overlooked is a focus on consumerism. I'm not an expert on this, but many conversations I have heard about the cause of health care costs is the use of health care. Two causes for this: one that many love to trumpet and the other is often overlooked. The overlooked cause is that there is a disconnect between the use of a medical service and the cost. If a doctor suggests an expensive test "just to be sure", one is more likely to consider it when there is no cost implication to the individual. Some of this is necessary and some is redundant. The consumer would be more involved if it impacted their pocket.
Some of the reason that doctors feel it is necessary is to avoid any future litigation. This is talked about a lot, but it is real. Doctors order extra tests and procedures to better defend against being wrong. It's a large component of rising costs that till only go away when we change the tort part of the system. But there is a lot written on this part - don't forget the consumerism piece, too.
Liz M
Experienced Transportation, Rail, Supply Chain, Accounting/Finance Exec
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First off, I've not read the report and only marginally been following the issue.
I am self employed and own my own business though. And I do have my own personal insurance.
Insurance is extremely expensive. One thing worse than expensive insurance is no insurance and then having an emergency procedure which puts you hundreds of thousands of dollars in the hole... and into bankruptcy!
I am against a government sponsored insurance plan. There is no such thing as "free insurance". No matter if it is yourself or someone else that has it, you all pay for it in the various taxes etc. So it never ends up being free.
Instead fix the parts that are having problems. Fix the issues with Medicare. Deal with the ever rising costs of malpractice insurance. Doing this latter will go far in lowering the cost of insurance. Largely because the Dr's offices can lower their costs and reduce the amount they charge for their services.
As a self-employed person, married, with two children, I think we all should be allowed choices as we do currently. Yes, medical expenses are high. But as a mother of a child that has spent thousands of dollars on his needs since birth, I enjoy the fact that we have the freedom to choose which clinic, health care professional, etc. I do not want that to go away or the fact that we have some excellent professionals in this country to give us exceptional care. We have had medical bills for 11 years and will continue to have. But that is okay because our son is alive, well and becoming a very fine young man. We have had to sacrifice in other areas, but it has all been worth it. It is frustrating that our health insurance continues to increase, but we are thankful for it, as without it, there would be an even greater expense.
The biggest issue for small business is the cost of coverage. If you have an employee with a serious precondition, the premiums are unaffordable. Secondly, we need more choice in insurance providers. There are not enough providers who cover small business that provide the array of coverage options that would help us compete on par with midsize employers. Finally, the sole proprietors are treated unfairly. The tax code seems to work against them and they can least afford not to be covered.
Affordability is the first and foremost that comes to my mind. Looking over the other answers it seems to be uppermost on others minds. I am not presently in a place for a need to hire other employees but if I were I would voice my concern along the lines regarding the ablity to hire employees without a burdensome requirement to offer costly benefits.
As a small business owner I want to be able to provide good health care coverage for my employees. The outright cost is getting more and more difficult to afford. Cost should be reduced if we could participate in a larger pool. Pre-existing exclusions is an important cost of switching plans. Again, participation in larger pools would seem to be a way to eliminate pre-existing exclusions.
There are three tiers to the health care issue. Tier one, the providers (doctors, hospitals). Tier two, insurance. Tier three, business. The primary problem is with Tier one. That is where the cost factors truly begin. Providers do not post prices. Their charges are not required to be competitive. (See the $20 Tylenol and $150 ice pack). Their costs are hidden by Tier two and three. Rarely does anyone change doctors because they are cheaper (even if they are better doctors). Doctors basically charge whatever they want. Tier two, insurance helps hide these costs and adds to the cost of health care by profiting from this process. (I understand they must make a profit, but regardless, it adds to the overall cost of healthcare.) Tier three, business, also must add to their revenue/profits in order to pay for the insurance. But insurance was never intended to be a necessary component of running a business. Insurance was a perk, that businesses provided to compete for better employees. How did we get from providing insurance as a benefit, to the "requirement" that businesses provide insurance? This process is bass-ackward and essentially hides the costs already built in by Tier one and Tier two, from the individual. The key here is to cut through this obfuscation of responsibility and hidden costs. The burden of insurance should not be shouldered by business, period. Indeed, it should be illegal to sell group policies to businesses. Individuals, with individual policies, is the only sane way to proceed. In this fashion, individuals would directly know the costs of the services provided, and can search for policies that handle specific health situations. Government and Private plans then compete for providing the best solutions. Our 33 year old business has not been able to provide insurance to our 30 to 50 employees for many, many years. If we are mandated to cover employees, we simply will have to let many of them go or close our doors. There will be no choice. There is no "wiggle room" left in our revenues, no matter how concerned we are and how much we care for our employees, many of whom have been with us for over 20 years.
I am self employed. I have to buy my own health insurance, which is expensive. My wife is uninsurable, which makes it even more difficult.
However, I do not want socialized medicine. I do not want the federal government to run the private insurance companies out of business with unfair competition paid for with tax money. I do not want the federal government to dictate and ration healthcare according to their perspective which is often poisoned with politically corrupt agendas and "correctness".
I don't want the government to tell me how to run my business or how to perform my work. I don't think they ought to be doing so with the healthcare industry either. I want individual freedom and liberty, even if it presents hardships and challenges. I have hope that I can overcome the challenges. Once a socialistic bureaucracy is in place, I have no hope, I cannot work my way out of that sort of nanny-state regime.
The models are there to look at. Other countries have tried the state-run healthcare. The results are unsatisfactory. Their systems have not solved the problems, they are not better than ours. They are not desirable. I have every confidence that the quality will go down and we will still pay one way or the other, namely taxes! More and more taxes! there's no such thing as a free lunch.
Part of what gives our system the problems that it has are the present government mandates and controls. Physicians are not free to negotiate fees with me if I am uninsured. They have to charge the same for every body. But they don't get paid the same for everybody. Insurance companies are allowed to broker reduced rates. Why shouldn't I get a reduced rate for cash on the barrel head, no paper work, no waiting?
Rates are high because about 40% of the consumers never pay anything, and the rest of us wind up subsidizing that care. If I didn't have to subsidize illegals who have been known to get better health care than I do (why not, they don't have to pay for it?), if I didn't have to subsidize low income people who exploit welfare programs etc, then I may not have to be charged so much for my needs.
Sean, Self-Employed artist.
I've owned and run my software development company for 15 years and I previously was a partner in another business for 12 years. So, I've run companies in the 10-25 employee range since the early 80s.
First, I'm glad to see the discussion is finally about truly small businesses. In the past, the government has defined "small" as much larger businesses (200 employees?) that do not have the same issues. My experience extends through the HMO industry and consolidation of many of them. I've gone through many types of plans and went through a period of time in the 90s that I changed providers nearly every year or two.
In the software industry, I have to offer healthcare. I resisted charging co-pays as long as I could, but had to start doing so about 5 years ago. My healthcare costs have gone from an small expense to about 10% of my costs. I can no longer afford to provide any additional coverages (dental, eyecare, etc.).
Some issues I have:
Costs continue to climb approximately 10-15% a year. I can absorb some, but I have to pass on a significant amount of that through increased copays (either directly or from plan modifications).
Many plans are isolated to my state. Switching to a plan that covers out of state employees costs more.
My costs per person are adjusted depending on each employee's claim history. Essentially, I get pay more for more 'expensive patients".
I get charged more for older employees. I get charged more for employees with families.
So, I'm being penalized by insurance providers if I hire an older, experienced person, someone with a pre-existing condition, someone with a family, a woman, or someone outside my area.
The net result is that I'm being incented by insurance companies to hire young males without families and no pre-existing conditions or employees with spouses who have better coverage somewhere else.
One more point -- when I compete for a sale against a company from a foreign country, my competitor probably has a cost advantage on the project.
Clarification added 1 month ago:
Another point I forgot to make is that there are many pressures to move development off-shore, of which healthcare is a major factor. If we're going to increase jobs in the U.S., it only makes sense to reduce factors that work against it.
Christina:
If you are truly interested in helping small business vis a vis health care and not allow health care reform to stymie job & economic growth, then I suggest the following:
1) Decouple health care from business. It does not make sense to force businesses (especially small businesses) to shoulder the burden of health care. It helps to promote waste in overall health care spending and creates an uneven playing field for small businesses, their employees and displaced corporate employees.
2) Scrap the notion of a public option that will be hugely bureaucratic, prone to political tinkering/corruption and historically has done nothing to reduce health care inflation, rather just shift the burden of rising costs onto the private sector thus exacerbating the small business health care problem. Besides, name on government run organization the is either cost efficient or well run? Consumers are willing to pay a significant premium to Fedex or UPS for important packages then rely on the post office; it cost as much to take a 4 hour Amtrak train from Boston to NYC as it does for a 45 minute shuttle flight; private, parochial and Charter schools provide a vastly superior educational alternative to the union pandering public school system (non union, inner city charter schools in MA have proven that inner city children can score higher than public schools in wealthy suburbs); the level and quality of care is far superior at private, for profit hospitals then at community hospitals.
3) Legislate that insurance companies must treat all citizens/residents as a single class/group and no exclusion for pre-existing conditions. In addition legislate that all Americans must purchase insurance (or face a reasonably onerous penalty) and utilize tax credits to either the insurance industry or consumers to fund the payment of premiums for lower income Americans. This would be the most effective way to make health care more affordable for all!
4) Legislate a no-fault malpractice system similar to Workman's comp or Sweden's malpractice system. This will avoid the waste inherent in the practice of defensive medicine. (of course, you may lose some political contributions from the legal community, but we are trying to do the right thing here).
5) Most importantly, provide incentives to change the reimbursement guideline from a fees for service to a fees or performance/results model.
Let's take the inefficiencies out of the current system instead of gambling on a wholesale change that is already fraught with problems and will be difficult and costly to implement.
Small business would like run our own operations without interference from Washington. It's tough enough, without mandates and other costs. We shouldn't need to provide health care insurance to employees, we are barely paying for our own insurance at this point. There are jobs out there that will simply have to go away if any further increases are imposed. Let's get the economy going, first, with 94% of new job creation since 1989, then we'll look at health care! Let me again re-iterate, JOBS COME FROM SMALL BUSINESS.
Cost to employer and employee have always been a concern. However, the marketplace HAS risen to work these problems out without the need for legislation in the past. There ARE health insurance companies that have grouped many small businesses together to leverage lower rates. This has been successful without one extra penny in taxes levied on anyone.
I spent enough time in the military and at VA centers to know exactly what a full government health care program will look like.. I have a question for Congress, the President and all of you so-called "advisers" trying to help push this crap (yes, crap) through.. Will YOU be using the same health care system as what you're trying to push on the rest of us? Don't even bother answering.. I don't want to put you in the position of spewing any more lies than you've already told to get THIS far.. Why do you not reference the failing Massachusetts state-run health care experiment? Why are Canadians so dog gone happy to have finally passed legislation allowing them to HAVE private insurance if they want to? One reason is that they save money by not having to come across the border to receive QUALITY health care!!! Your system will attempt to tell some of us who's "expendable" with less reasoning than current insurance companies do! I just LOVE how you demonize the big bad corporations for screwing us -when you will end up screwing us even worse! At least with the current situation, we'd HAVE a CHOICE to drop them and find another carrier.. After a year or two of YOUR system, there would be no other choices.. Ahh.. Socialism at its finest!
Whatever brilliant solutions you come up with, it won't take long before the American people realize that it's no different than every other failed, governmental waste of (OUR) money..
I suppose I'll now be on some sort of black list now.. Well bring it on! This is STILL America.. And starting in 2010, everyone will begin to understand what that means.. Those who don't are more than welcome to hop the border to either the north or south.. I suggest you do so now.. Then you can see what we'd be headed for under this stupid plan!
Keeping government involvement to a minimum. Our system of healthcare delivers more services to more people than any other system. most families are coverd and have access to a very broad spectrum of care at a price strucytre that is working better than any other. The role of insurance providors may need tweeked, but the last thing we need is healthcare deliverd by controlled by or managed by a govenment agency.
Thank you for asking Ms. Romer.
What is important to us is cost of the health care obviously but additionally if someone leaves my employment then have extra admin cost of dealing with COBRA. I'm angered by the response of so many is nationalized health care by government. I do not need more government inefficiency I need less.
Small business associations can allow small businesses to ban together over state lines to utilize group power to buy health coverage IF the gov. would allow it. Pres. Obama's speech that we need public option for this is ignorance on his part and show's how the left is leading the country to more government control as that's the only option in their mind.
If government wants to be in control then use Medicare CMS at a guideline for reimbursement or 20% over, then make it law for all providers. Mandate everyone to purchase individual health insurance if not offered through their employer that they've gotten through a national exchange via independent brokers. No one who works for a company with 100 employees or more can get individual coverage as mandate those companies to provide that coverage. Facilitate technological advances to get providers integrated to eliminate duplicate treatments, testing and more effective treatment.
Government should if they are going to subsidize anything then make it where people have first dollar coverage for preventative checkups and immunizations. In addition, tax incentives to individuals and companies alike that participate in wellness programs as individuals and as a company such as weight watchers, gym membership & attendance (gym owners have form signed that active 3x a wk average for them to get tax break) and effective quit smoking programs. Also increase in provider pay based upon better outcomes and participation in technological integration.
Do this spread out over the next 4 years. That will lower cost of coverage NOT big inefficient government for pete's sake.
We can in no way as small business owners afford a mandate to cover the few employees we have. Our economy can not stand further taxation of individuals that provide 80% of the jobs in this country. Health care is a privilege not a right. If this administration continues the path they are on we will have another great depression and the lack of tax proceeds to the government will bankrupt the country and no one will lend us any.
Time to wake up people and unite to fight bigger government. We like the country the way it is and I'm tired of paying for those who will not work hard to change their place in society if unhappy. I'm tired of people telling me more of my hard earned dollars from me and my wife should get "spread around" to help those who choose to stay that way. Come on people that's like telling me I have to buy alcohol for the drunks as they can't afford it any longer because they're to drunk to work.
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Our largest issue, over the years, has been access. Many small businesses, depending on the state you are based in, do not qualify for affordable rates unless you have over a minimum number of employees. Just changing the rules could help a lot in allowing businesses who want to provide health care to afford to do so.
Align and integrate the incentives for hospitals and physicians.
Gregory R
► Principal & Chief Creative Officer, Ronin Associates
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Christina:
I believe that the debate that is being lost here is not on healthcare, but on issues of vision, language and meaning. I believe that we are seldom even talking about the same things at the same time, though think that we are -- or are managed to think that we are.
We do not need a debate on healthcare in this country. There is nothing to debate. Are we somehow not aligned on the salient points that there needs to be quality healthcare provided at manageable cost?
We need a manifesto.
Why is that small business is at the center of this?
Why not corporate America? Not all of corporate America, but certainly Coca-Cola (and the like), McDonald's (and the like) and tobacco companies? If some of the greatest healthcare costs facing America can be directly connected back to what we ingest into our bodies through our mouths, why not tax every soda and every french fry and every cigarette to cover contributions to healthcare coverage?
And when I suggest that corporate America pay for this, we all know what that means: a corporation passing along its costs to the consumers of its products/services to maintain profits and shareholder value. So, with this as context, the net result is that those individuals who will most likely be utilizing the greatest % of healthcare service now and/or in the future, are the ones who contribute the most to it.
In my opinion, one of the goals should be not to come up with ways for ever-mounting costs to be covered, but for the focus to be on reducing our need for healthcare and, in so doing, reduce overall costs.
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