So I don't see how you can make the statement "the government doesn't understand that affordable health care is the main priority for startups" - health care was clearly their highest priority to an unprecedented degree, whether or not you agree on the approach they took.

The government placed access to affordable health care at the top of its priority list from day one of the administration. The notion that a $75 a month plan ten years ago might now be $1000 a month is specifically targeted as a primary issue. Again, you can say the legislation is awful and won't work at all (I've no idea myself and I'm in the "something is better than nothing" camp), but they certainly understand the problem.

Edit: And I APOLOGIZE for quoting a paraphrase, I am no longer able to edit the comment else I would remove the quotes and fully explain what appears to be what you are saying. I sincerely hope that I am correctly understanding your assertion, which again appears to say, "the government doesn't understand that health care is a huge problem for startups", and if I am not, then I withdraw my comment fully.

Yes, I do believe that the government probably understands that health care is a huge problem for startups. What I don't believe (and this is the point of the Steve Blank blog post) is that the government can effectively prioritize what the biggest problems for startups are.

Now, lets talk about Startup America specifically. Going off the information available online ( e.g. http://www.whitehouse.gov/issues/startup-america ), this program is more focused on things like access to capital, mentorship and education, partnerships with big business, federally funded grants and research.

I think these are all really great things to work on, but health care, #1 on my list, is not even mentioned on their list at all. Again, I believe they know it's a huge issue, but they may be shying away from it now because "we did that already and it's done" or "we'll lose elections in 2012 if we keep talking about it".

I would prefer it all come in to effect immediately, but I understand there are business and regulatory systems that need to be developed in advance of implementation.

Scroll quickly and you can see context bouncing around in waves.

Haha, I didn't make that statement.. But you put quotes around it anyway? I was just speaking about my own situation and why I agree that Startup America is DOA.

Edit: Ok, forget about the quotes -- they're irrelevant. I do feel that you are misparaphrasing me, but I don't care. If you want to know what I really believe:

* Of course the current government has made health care reform a priority for everyone, not just startups. Nobody would say otherwise.

* I agree with the goals of the recent health care reform law. I think health insurance reform would have been a better way to approach the problem.

* It's a shame that the democrats lost the PR battle and as a result half the country wants the law repealed. Overall I think the law could be a good thing.

* I agree with the goals of Startup America, to use government influence to remove barriers to entrepreneurship

* Affordable health care for small business owners is a huge barrier. You can't hire most people unless you can afford to pay for their health care or a group plan.

* I predict that this won't be addressed at all by Startup America, because health care reform has become such a heated issue. People are losing elections because of it.

* By addressed I mean, where is it mentioned on their website? What experts do they have advising them? What insurers are they partnering with to provide breaks for small business owners?

I do welcome discussion about this stuff, but let's try not to misrepresent each other..

But I don't get it. Your initial comment (which I totally agree with) is right there. It is plainly obvious what you wrote and plainly obvious that the response is a paraphrase. You clearly disagree with that paraphrase, but that to me seems like an essential issue in the discussion, not a pointless tangent: "do I correctly understand you to be saying...", "no!", "oh, then...".

In fact just yesterday I got sucked into another thread that went the same way. I've come to the conclusion that that some people take counter points and play Devil's Advocate just because the enjoy argument and debate. Personally it's not my thing. I'd rather dash off a quick comment and get back to work.

This thread has gone crazy, hasn't it?

Unfortunately, attacking the form rather than the content of a position can also be an effective tactic for undermining an opposing view without having to risk justifying oneself. It consumes energy without contributing anything constructive. If there's a genuine ambiguity and a desire to work together to learn something, there are usually ways to clarify your opponent's position that help both people reach understanding.

But stop for a minute and think - we are seriously talking about commuting 2 hours to save a few hundred dollars a month on health care. Why?? Why do we even need to have that conversation? That's how broken things are.

I'm a non-smoking 34 year old marathon runner.. I go to the doctor once a year, if that. Companies should be fighting over the opportunity to insure me. It shouldn't be the #1 reason I can't grow a business.

It's great that you're healthy but business growth is going to involve taking other people on and I for one am not taking a job without health care while I have two other people depending on me. A single major health issue could bankrupt me!

I would assume you'd also save hundreds of dollars a month on rent and other living expenses in PA (or MA, though I can't speak directly for Boston). I don't think moving 2 hours away to save $1k or more per month is a bad move for a startup.

It's only insane if you believe that health insurance is a major barrier for startups. The fact that startups didn't relocate to MA en masse after Romneycare took effect suggests that perhaps access to capital/talent is far more important.

Health care clearly is a factor...

I wasn't disputing that it is a factor. I was disputing the idea that it is a larger factor than access to capital or talent. Look, we hear about people moving to the valley all the time. People move to NY as well, though it's less common. Are all of these entrepreneurs "insane" (to borrow sachinag's language) for chasing capital/talent rather than Romneycare?

Second: yes. Most of the people who are moving to NYC and SFBA are irrational. Most of their companies fail. Everybody knows that going in. To the extent that they move entirely in support of their startups, they are crazy. (The fact is, most of the people moving aren't doing so entirely for their startup; they want to live there.)

Third, I doubt most entrepreneurs even know about "Romneycare". I'm only peripherally familiar with its specifics, and, as you can probably tell, health care is one of my issues.

The problem with MassCare (and ObamaCare) is that their mix of guaranteed issue, mandates, community rating, minimum creditable coverage guidelines, and subsidies still inflates the price of health insurance, and state subsidies can't keep up. This was evident in Massachusetts as early as 2007, right after MassCare began to be implemented (see this report for exmaple: http://www.ncpa.org/sub/dpd/index.php?Article_ID=14237)

I think the Startup America concept is admirable. Would that the federal government understood the real problem with starting a business in the United States right now isn't the lack of a couple billion in government programs, but the regulatory barriers and inflation in commodities and products like health insurance that prevent new firms from entering the market, inflation that the federal government has in many ways helped create.

I really wish the administration had tried to take some baby steps instead of going for something they are giving waivers to avoid and really not explaining how their thing would be different from the VA or IHS.

A "flood"-style insurance to protect against the catastrophic, and changing the Health savings accounts to be easier and inheritable probably would have been good first steps.

At least, that's the argument. I don't claim to be an expert in these things.

I'd recommend that startups in Mass/looking to move just have everyone pay their own health insurance through the Connector until you raise angel funding and scale up in people. (I set up the group health insurance when I led Operations at oneforty.)

I have survived just fine without health insurance. I know plenty of people who do so. Surviving without a paycheck is a lot harder.

Insurance is "take the bank". And the way insurance tends to work is that everything is fine until you need. Then you're screwed. That's the nature of it.

[edit] My point is: While health insurance may be a barrier, a paycheck should not be.

[edit2] I'll definitely explain; I apologize that it wasn't clear.

I'm not trying to argue that a paycheck couldn't be a barrier to launching a startup; I'm arguing that it shouldn't be one. Requiring a paycheck translates to requiring job security, and a startup is not necessarily the path to take if that's the case.

In contrast, health insurance cannot be helped as a barrier to launching as, paycheck or not, a lack of health insurance can completely ruin you in the event of an accident, which you cannot control.

People flock to the Valley where money is easier to come by not because they need a paycheck personally, but because it's easier to fund your startup. I'm not even saying that, at this point, you shouldn't cut yourself a small check to live off of. Being able to pay yourself is an awesome goal, and something that everyone should look forward to. However, if you require job security (which many do), then it would likely be to your benefit to get to a point in your life where that's not a barrier before launching.

And cosgroveb, if you're suggesting that I only believe those born into money can be successful founders, you're simply incorrect. Anyone from any socioeconomic background has the ultimate ability to launch a startup. No one is questioning that. The actual question, though, is when should you launch a startup?

[edit: my question is "why?" I.e., could you explain why health insurance is a barrier, but a paycheck is not?

Also useful would be explaining why startups flock to the valley and NYC, where access to capital/a paycheck is easier, rather than MA where access to health insurance is easier.]

I can have access to a paycheck by selling stuff.

I can have access to affordable health care through some combination of public policy, state and federal programs, laws that may or may not end up being repealed or enforced, regulations on the insurance industry, reforms on the legal industry, pressure from consumer advocacy groups, happening to live in the right place, hoping that my insurance company doesn't raise rates too much, or possibly marrying someone with good health insurance, or being the right age to be on my parents' plan, if they have an affordable plan to begin with. Also I can choose not to smoke or have kids if I want to keep my costs down.

If you live without health care you throw dice with high stakes. Point is, when you get older the dice get loaded.

My remaining hair is gray specked, this is something I considered carefully when I accepted to be outsourced to East Europe (-: love it so far, the city is almost called Kludge! :-).

Edit: Made a little bit clearer.

Second, this comment offers a valuable non-tech perspective on Startup America and thought it was worth pointing out: http://steveblank.com/2011/02/08/startup-america-dead-on-arr...

That comment was absolutely golden, and an idea that I've advocated for a long time now.

We can't rely on web/high/bio/green technology to save us. As a heterogeneous society with differing skin tones and accents and places of origin, we also have differing education levels. You can't say "hey there, person from a mining town with 5 generations of mining-town subsistence living, come join us over in good ol' Silly-Con valley and pull up a cubicle, work on some Erlang". But, is Mining Jane somehow less deserving of a shot at entrepreneurship than Aspie Joe who was raised with a keyboard under his fingers? When it boils down to it, they're both a big risk, and as we've seen our fair share of pizzerias and beauty supply shops go out business in our lifetime, we've also seen tech flameouts of the scale that makes the pizzeria one look like a rounding error. And, that's the _vast majority_ of *-tech venture. Only a few come out on top.

I think a refocus of the SBA and Startup America and all those other things should be to empower entrepreneurship at _every_ skill, education, and economic level. Look for opportunities like Champs. Set up a 1-2 million dollar fund for them to continue educating, maybe give out grants. So what if there's a barber shop or bodega or gun shop on every block. I'd much rather they toil and struggle away on a business than slog it out at the french frier for the big Clown McMachine. And, when they fail, hey they fail. But, they fail with a much better feel for how real business is supposed to run, and they might get better at it (or go work for someone else in a much higher position than one that requires bell-bottom uniforms and a paper hat).

Well, you can see how this can spiral out of control until I end up blowing all my savings on health care bills and eventually have to declare bankruptcy. That's the kind of fear that keeps people in boring corporate jobs: the gnawing uncertainty that even if you're healthy now, you (and your family members) are one major medical crisis away from financial ruin and being forever locked out of the good insurance system.

Now, this doesn't apply in MA today and as the new health care law goes into effect over the next few years, it won't apply anywhere in the US. Sorry to write so much, but in my experience, people in the UK just have no reference for how screwed up American health care is and how much fear it can inspire.

The end result is that many developers aren't willing to take jobs where health insurance isn't included.

I've been paying ~$80/month for high-deductible (but 100% after the deductible) health care for a few years. My HSA account will now cover my deductible if I ever need it to.

That's one thing that will make it much easier for me to found.

Could you tell what a new single startup founder should do to get health insurance in nyc? Thanks

You should check out the Freelancers' Union, too (I wasn't eligible since they require that you haven't been employed full-time for the three months prior to joining.)

It's my understanding that part of why NY health insurance is so expensive is because we've had many of the regulations from the new health care bill (e.g., about discrimination based on preexisting conditions) here for many years and no individual mandate.

All I can suggest is to go to http://www.ehealthinsurance.com and shop around.

1. Small business tax credit (35% of healthcare premium is given as a tax credit) http://www.irs.gov/newsroom/article/0,,id=223666,00.html

2. Tax credit for individuals. http://www.healthcare.gov/foryou/healthy/index.html

I strongly suspect that neither of these will be available to any financially responsible adult, since my soundbite version of the healthcare bill was it was geared towards the poor (many other aid programs such as food stamps dont kick in until you deplete you assets to ridiculous levels like $2500 in TOTAL including your car).

That doesn't make sense. Many of the ACA's biggest provisions (establishing exchanges, banning pre-existing condition limitations, allowing 26 year olds to stay on their parents' healthcare) are not at all limited to poor folks. They're primarily useful to middle class and up folks.

Allowing 26-yr old "children" to stay on parents' healthcare only makes sense if the children are poor. Hence I counted it as geared towards poor. But I can see your point of view too.