Comment by timr | Hacker News Reader

Comment by timr | Hacker News Reader

Oh, come on. Saying that a job is created by "growing existing businesses" or "creating new businesses" isn't insightful or useful; it's a tautology. It's like saying that winning a war is simply a matter of killing more people than the other side. Easy as pie.

I know that we all like to get huffy and pretend that our favorite ideology is the one that has all the right answers for making jobs, or eliminating poverty, or creating world peace, but ultimately, adults have to acknowledge that there are going to be problems in the world that politicians can't solve.

Obama can't make your startup succeed. Congress can't make someone want your product. But they can do more basic things, like making sure that you won't starve to death when you fail, or ensuring that falling ill while starting your company won't bankrupt you (or kill you). They can make sure that the lights turn on, that clean water comes out of your faucet, and that you're reasonably safe at home and work. You've got to take it from there.

Absolutely. Creating a better safety net WOULD really help innovation -- being terrified of not having health insurance is a huge barrier to joining startups for many people. And the current government has so far done nothing to help that, and the republicans even less.

What a strange fear -- being afraid of not having health insurance. I haven't had a "real job" or health insurance for about a year now, and I don't care at all. If something bad happens to me, I'll put the bill on my credit cards. I doubt anything will happen though. I'm young, healthy, and don't get into car accidents by being stupid. Statistics are on my side here, and I feel completely comfortable living without health insurance for awhile.

Unless you have some kind of condition, is there any situation in which the fear of not having health insurance is actually justifiable? I mean, if you want to avoid paying off a huge hospital bill over time, then ok... but come on, if you're starting a startup, gambling a 0.001% chance (or whatever) that you might have to pay 4-5k off over a few years seems like an insanely good bet.

Also, I heard from a friend (who is very probably wrong about this) that you don't actually have to pay off a hospital bill. It won't count against your credit score. Is this true? I would never do something like that, but... if not paying the bill doesn't count against your credit score, then I can see why people might not pay it.

>> Unless you have some kind of condition

Apparently, a lot of people do... otherwise the nation wouldn't spend such a large percentage of the GDP on medical care.

Be thankful you're not old, yet.

Yeah, some kind of condition? I'm made out of meat, doesn't that count?

"Also, I heard from a friend (who is very probably wrong about this) that you don't actually have to pay off a hospital bill. It won't count against your credit score. Is this true? I would never do something like that, but... if not paying the bill doesn't count against your credit score, then I can see why people might not pay it."

Your friend is wrong. Google "medical bankruptcy".

I'm 23, healthy, and took a bad spill a few weeks ago. Nothing too serious, but it did require some stitching.

Total bill? $1553.

This is a very significant sum for people with regular, consistent income. For someone subsisting on ramen to launch their next great idea, this is crippling.

Also, I highly doubt the credit score thing is true.

I'm older, have children, and have been in two car accidents (one very serious) because someone else was being stupid (and uninsured).

Having treatment refused to my children because they are not insured (or not insured enough) is quite frankly terrifying. The system standing between me and medical machines and professionals is damn near random and I find it terrifying. Enough that I've had serious pause when striking out on my own.

Not everyone who starts startups (or other business) is 23 and single.

If you don't even have major medical, you're gambling with an almost unlimited downside. And it's not just you who will pick up the tab if you lose. If you have a serious enough accident, you'll become one of the people who are causing healthcare costs to rise for everyone else.

It does affect your credit, in some cases, even IF an insurance company steps in (or fails to).

I got in a car accident in 2000, other driver at fault. Their insurance company agreed to pay the medical bill. I didn't realize until 3 years later, when the collection agency tracked me down, that they never did. That crap finally fell off just a few years ago, but cost me who knows how much in added interest rates over the years.

Not having health insurance is pretty stupid, even if you're healthy, young, broke, and in college. If you're starting a company, it's just completely irresponsible.

I don't think your conclusion follows from your story.

I take exception to most of this statement. My story: At 25 years old, I took every penny I had in savings (about $300k) and started a company. I "created" 7 well-paying jobs. I put every single penny I had into my company. I had "major medical" insurance, which I paid about $600 a month for.

Two years later, we were doing about 2 million a year. Still, I poured every penny I had into the company "creating" additional good-paying jobs. Then I had a stroke. Yes, at 27. Because the doctors could not find a "reason" for my stroke, the insurance company paid a grand total of $2700, mostly for the ambulance and the care I received in said ambulance.

I was left with a bill of $67,000. Yes 3 zeros. Because of how long I was in the hospital and recovering, and because my business was based on relationships with my clients, the business faltered, and I eventually shut it down. I am now paying off every cent of what I owed on the business, as well as that $67k in medical bills.

Moral of the story: don't think you're invincible because you're young, or because you don't have a pre-existing condition. Also, I can absolutely assure you that medical debt DOES affect your credit.

Here's the crazy part. I'd do it all again in a heartbeat, and I will.

I'm assuming you did not have group insurance at some point so it was deemed preexisting? Otherwise, how did they get out of paying for it?

At 21, I had a 'spontaneous pneumothorax', or collapsed lung, which was not due to any sort of accident or trauma, but 'just happened'. I was in good shape, going for regular bike rides, didn't (don't) smoke or do drugs, and was generally very fit and healthy. Luckily insurance covered it, but I think the total bill for the week in the hospital and operation was something like $20,000, and it took me a few months to really get back into the swing of things.

Last summer, my aunt was crossing the street in NYC and was hit by a cyclist. She landed on her head and ended up spending days in a coma, weeks in a hospital ward, months in physical therapy, and a six-figure medical bill. Fortunately, she had insurance. (If she didn’t, would she have received all that physical therapy, or would she have been discharged as soon as she was capable of walking out of the hospital under her own power, even if she was incapable of getting a job or caring for her children?)

Creating a better safety net WOULD really help innovation

This seems remarkably unsupported. I don't think of Europe as being very innovative, despite their impressive social safety net. And I think of Asia as being very innovative and entrepreneurial, despite their lack of much of a safety net. Hmmm...

The reality of a great safety net is that someone has to pay for it. Who is that?

As much as we spend on medical care that doesn't make us healthier, we spend more on wars that don't make us safer.

I'm a bit of a die-hard let-the-bozos-starve sort of wack-job libertarian. So, what's a bigger infringement of rights? Take hundreds of billions of dollars from US citizens, and spend it enforcing arbitrary rules on a populace that doesn't have representation or a vote? Or take billions from US citizens and spend it patching up said citizens when they fall down or get sick?

I hate taxes. Really, I do, as much as anyone you'll ever meet. And I hope that the market could someday solve this problem more efficiently. But I also think that killing people is a lot more evil than healing people. I voted for Ron Paul largely because he was the only candidate who said outright that he would shut down all unwanted military bases in his first year.

Dismantle the military empire, and you've got money for medical care. Additionally, adding a base level of safety net could be a disruptive force that allows smaller and more agile companies (ie, in the 1-10 employee range) to get more done with less overhead, which is exactly the sort of thing that needs to happen if stuff like this is going to be solved cleverly.

Come on, we're hackers, right? Think about it. This is a complex problem with a ton of moving parts, and that's kind of what we do, isn't it? So, apply the same maxims that serve you so well in dealing with software:

Measure before you optimize. Solve the big problems first. Patch the in-production product, and THEN design its replacement. The perfect is the enemy of the good.

As much as we spend on medical care that doesn't make us healthier, we spend more on wars that don't make us safer.

A bit of a false dichotomy, don't you think? I agree with most of the rest of your post, though I think that the primary effect of increasing the safety net will be moral hazard issues, not people jumping to do a startup now that they have a safety net. People who do startups are incredibly rare, and somehow I doubt that's because of any safety net issues.

The source of the huge costs in medical care are the way medicare/medicaid completely dominate the market with their hair-brained payment schemes. The way that insurance is tied to employment for tax reasons, the cartel that controls the supply of doctors (AMA), and hosts of other barriers and redtape that may improve the quality of healthcare, but make it unaffordable to a large portion of the population.

The source of the huge costs in medical care are the way medicare/medicaid completely dominate the market with their hair-brained payment schemes.

Medicare and Medicaid appear to be similar to the systems that most other countries (e.g. Britain, Canada) have in place to pay for healthcare (except that in most other countries everyone is covered). How do you explain that, in those other countries, the per-capita costs of healthcare are lower than in the US?

Different wage levels is one major reason.

Most other countries are poorer than the US; the US has a GDP per capita 50% higher than the EU and (for example) 40% higher than France. Since a medical procedure takes the same amount of time in either place, the cost will be proportional to wages.

Additionally, the US is far more unequal than most other countries. At the top of the skill chain, the gap increases significantly [1]. The US costs more simply because doctor's salaries need to be competitive with banker and programmer salaries.

[1] I know a few FOB Indians who had multiple jobs/offers, they say the US can often pay double what the EU does.

The way doctors are reimbursed is based on a formula that ranks the amount of effort the doctor has put in and not on the actual value they are providing. This means that specialists, tests, and other advanced areas receive the bulk of the money regardless of the actual impact on the patient. This leads doctors ordering unnecessary tests and a lack of general practitioners and an abundance of specialists.

I don't recall exactly how Britain and Canada do it, but I'm pretty sure it's not the same way. Here's how it works:

The RBRVS Fee Schedule.[6]Medicare uses the resource-based relative value scale (RBRVS) to pay for physician services. Under this formula, Medicare officials compute the “objective value” of an estimated 7,000 procedures.[7] Each component of a medical service is assigned a weighted value that is calculated by using social science measurements of the time, energy, and effort required to perform a given procedure, including resource inputs such as medical equipment, malpractice insurance, and administrative costs. These weighted “values” are then converted into dollar amounts and used to determine the fees that Medicare pays to physicians for those services.[8] The diagnosis related group (DRG) system reimburses hospitals using a similar strategy.[9]

http://www.heritage.org/Research/HealthCare/bg1882.cfm

Dismantle the military empire, and you've got money for medical care.

You've also got, unfortunately, a ton of people that go out of work. Noone will get rid of military programs if it shuts down jobs in their district.

For the record, Japan has universal, socialized healthcare:

http://en.wikipedia.org/wiki/Health_care_system_in_Japan

So does Korea:

http://www.slideshare.net/manhattanresearch/south-koreas-hea...

And so does Taiwan:

http://en.wikipedia.org/wiki/Healthcare_in_Taiwan

Any other innovative Asian economies you'd like to compare?

While you have a point, Obama isn't going to make anyone's startup succeed, you are off base. Saying that a job is created by "growing existing businesses" or "creating new businesses" is insightful, as it gets back to the core of what is needed. As far as the private sector is concerned, jobs are created by growing and new businesses.

With the massive amounts of cash that has been thrown at shrinking big businesses in the recent past, it is important to recognize that over half of Americans work in small business, and it is the small businesses that are having the most difficult time accessing capital. Not just in the valley, but the mom and pop, brick and mortal business that should be considered the bread and butter of society.

Yes the author is focused on his own plight, in a slightly whiny and entitled sort of way, but that doesn't mean he doesn't have a point.

His point was a very simple argument, based on plain old common sense. It was intended to be simple.

It becomes insightful when you take his point and put it next to the jarring inconsistency in our reality. Fact is, nothing done by Washington has done anything remotely to help this in a meaningful way.

Jobs aren't created by legislating them, as is currently fashionable in believing. Jobs aren't created by shoveling truckloads of money to special interest. It is the people "in the trenches" who are trying to get stuff done that create jobs.

Sometimes it is worth repeating the common sense truths as we often tend to loose sight of them.

Jobs aren't created by legislating them, as is currently fashionable in believing.

I've never encountered anyone who believes this. Have you, really?

But they can do more basic things, like making sure that you won't starve to death when you fail, or ensuring that falling ill while starting your company won't bankrupt you (or kill you). They can make sure that the lights turn on, that clean water comes out of your faucet, and that you're reasonably safe at home and work.

All of these things are provided by your state, not congress.

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