I don't think you can actually separate discussion of health care (even though its a political hot button) from discussion of running a small business, given the challenges in getting insurance as an individual or for the employees of a small business. Honestly, in the U.S., one of the major things that turns me off from working on a small start-up is the health insurance situation. Even if you're ok now, then the chance of a double whammy (job loss plus development of a pre-existing condition that makes it hard to regain insurance) is non-negligible and you can end up in the bad situation where you have no job, health problems (maybe even precluding work), and no way to get back into the health insurance system.
If you're lucky enough to maintain continuous employer coverage, you're ok, or if you have enough free cash that you can maintain COBRA or individual coverage, then you're probably ok for some time, but that isn't always the case.
I can't quantify how much this biases people towards working for established companies with good health plans and job security versus risky companies, but it must be a pretty large effect - it certainly would make me think twice about taking a job at a startup, versus, say, Google.
Marco of Instapaper had most of one of his recent podcasts on this subject. As a non-US listener I was surprised at the cost. It is jaw droppingly expensive to get health insurance. Surely the inefficiency in the system alone is a strong argument for almost any other system? The years lived per dollar spent graphs usually get busted out about now.
According to the economist Dean Baker, if the US spent the same amount as other industrialized countries do on health care, it would have huge budget surpluses right now.
I don't think you can actually separate discussion of health care (even though its a political hot button) from discussion of running a small business, given the challenges in getting insurance as an individual or for the employees of a small business. Honestly, in the U.S., one of the major things that turns me off from working on a small start-up is the health insurance situation. Even if you're ok now, then the chance of a double whammy (job loss plus development of a pre-existing condition that makes it hard to regain insurance) is non-negligible and you can end up in the bad situation where you have no job, health problems (maybe even precluding work), and no way to get back into the health insurance system.
If you're lucky enough to maintain continuous employer coverage, you're ok, or if you have enough free cash that you can maintain COBRA or individual coverage, then you're probably ok for some time, but that isn't always the case.
I can't quantify how much this biases people towards working for established companies with good health plans and job security versus risky companies, but it must be a pretty large effect - it certainly would make me think twice about taking a job at a startup, versus, say, Google.