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Comment by sitkack | Hacker News Reader

If we had strong single-payer, we would see a 100 fold increase in startups. And these startups would self funded and creatively bootstrapped. Without the burden and complexity of securing private health insurance, anyone with a couple months rent saved up could try starting a business. We'd probably even see old people do it.

Speaking of which, I'd love to see the temporal evolution of a histogram of ages of founders of all the IPOs in a given year. In a good economy, I bet it would be a fixed density across the spectrum, in an ok economy it might be bimodal and in a poor economy it would be a single peak.

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> If we had strong single-payer, we would see a 100 fold increase in startups. And these startups would self funded and creatively bootstrapped. Without the burden and complexity of securing private health insurance, anyone with a couple months rent saved up could try starting a business. We'd probably even see old people do it.

This is a good thought! You've identified a factor holding people back and thought about what might happen if it was removed.

Yet, is it perhaps possible that there could be more complexity to this? Several countried with strong single-payer health care systems spring to mind. France and Germany and the UK are not generally regarded as having 100x the startups as the US. Self-funding and creative bootstrapping has not replaced VCs.

It could be worth considering the possibility that access to health care might not be the thing preventing endless fields of startups. Perhaps there could be some other factors at work?

Single-payer is a policy whose time has come in the US. But it might not be a silver bullet for conjuring startups ex nihilo.

> Several countried with strong single-payer health care systems spring to mind. France and Germany and the UK are not generally regarded as having 100x the startups as the US.

The consensus is that it's too hard to fire in those countries. (Look at the lawsuit that bankrupted Mandriva for an especially pointed example). I'm not aware of any country that combines socialized healthcare with US-style at-will employment, but perhaps that's the ideal combination - you can lose your job at any time, but losing your job does not mean losing access to medicine.

> Self-funding and creative bootstrapping has not replaced VCs.

It sort of has. VCs have shown very poor returns and a lot of companies have bypassed them.

> Single-payer is a policy whose time has come in the US. But it might not be a silver bullet for conjuring startups ex nihilo.

There's a noticeable spike in people starting businesses once they reach medicaid eligibility age (50 I think?) So while it won't fix everything it should make a significant difference.

> The consensus is that it's too hard to fire in those countries.

I've heard the same. I know it's true that it's very hard to fire in many places. At the same time, it might be worth considering that this could be more silver bullet thinking.

It is perhaps more likely that instead of there being one thing holding back an endless wave of startups in each country, there is instead a series of interacting forces producing the same effect.

It's possible. Still, if the expert consensus is that x is the biggest issue, it seems worth fixing x and seeing what happens.

With reasonable expectations, sure!

Doing so with the expectation that one change will permanently 100x something might be considered by some to be slightly less than maximally reasonable.

It's not really very difficult to fire people in the UK.

https://www.irwinmitchell.com/about-us/newsletters/employmen...

> The consensus is that it's too hard to fire in those countries.

At least in the UK this is hard to agree with. It's fairly easy fire people, I've done it myself. No problem at all.

France and Germany have different cultures as well. Single payer isn’t the difference. We waste a lot of time and money in America on a broken system. That time and money could go elsewhere while encouraging more risk-taking.

I also wonder about non-medical insurance costs and how much that is propped up by high medical costs. Would my business’s general liability or workers comp be half the price if we had single payer? A lot less? After all, most injury claims are for cost recovery.

> Without the burden and complexity of securing private health insurance, anyone with a couple months rent saved up could try starting a business.

How expensive is private health insurance in the US? I've seen numbers as low as $6k a year, but from your post it sounds more like $20k a year.

I doubt that it would massively increase the amount of startups. We have all that (and more) in Germany, and you don't see companies popping up everywhere, and the ones that are founded are mostly copy cats.

At a minimum, for the healthiest young males, health insurance premiums are at least $300 per month with a $3.5k deductible. Older people are in the $600 or more range per month.

I would budget $500 per person per month with a $7.5k deductible for a family.

Thanks, that's about the same as private health insurance in Germany, with slightly lower premiums and higher deductibles (1000€ is common here).

Are those regionally different? I understand that rent is much more expensive than this in sought after areas.

> Are those regionally different?

Perhaps, but I think most of the difference is between healthcare provider plans. In other words, depends on who employs you.

That’s two separate factors. Different insurance plans have different contracted providers, and different employers subsidize different portions of their employee’s health insurance premiums. Some employers might subsidize 50%, some 80%, some $100, etc.

I was referring to the cost of insuring someone, regardless of who is paying. I’ve compared costs on healthcare.gov to employer based options in a few states, and they’re not far off from each other unless the employer has many younger employees and few old employees.

I’m a startup founder, and the current Obamacare system is sufficient. You should check it out.

I’m a serial entrepreneur that’s hired hundreds of people. I’m well aware of Obamacare. In fact, my wife is an insurance and benefits broker for large groups.

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