Health insurance for companies is sold on a group basis and it's often much more difficult (and expensive) to negotiate a smaller group. If you do get a policy, good luck if anyone in your small group has a serious claim...

Right, US heath insurance is a form of collective bargaining. The more people you have the more you can negotiate. If you have a small group you cost are exponentially higher and the conditions covered significantly less.

I once bought a policy for myself, we had just exited one of our startups and I was on my own and working freelance. So I had no insurance. I was a 25 year old male and the only health problem I had was high blood pressure. It is/was controlled by medication.

Anyway, given that I was essentially a group of 1, the policies available to me where pretty expensive. If I recall correctly they where around $1000 a month for me. I did not have family at the time so it was just me.

Further I had a $500 annual deductible (I had to spend $500 before they started paying anything) then the per visit co-pays where pretty steep too. They ruled almost every possible male related problem a preexisting condition, so if I had a major medical issue related to any of them, they would not cover it and probably the wost of all, self purchased insurance plans don't cover perscriptions, these are a huge medical expense.

So not only where the policies expensive but they where essential useless for 2 years while you run down the clock on the preexisting conditions clauses. Given that many people are insured through a company policy or medicare many never deal directly with the reality of trying to get a decent policy on their own. I have to say, when I had that experience I realized how broke the insurance system is, it is totally stacked in the favor of the insurance company and the only way to claw some of that favor back is through collective bargaining.

> The more people you have the more you can negotiate. If you have a small group you cost are exponentially higher and the conditions covered significantly less.

I have not found this to be true. I run a small company in Florida. We have BlueCross BlueShield. Comparing notes with other employers, big and small, the size of the group does not appear to make a difference. What seems to matter more is the makeup of the group in terms of age, gender, and preexisting conditions.

There is a huge difference between buying individual insurance and qualifying as an employer group of two or more.

Yes, individuals cannot buy health insurance for the same rates that employers pay. Some individuals cannot buy health insurance at all if they have preexisting conditions.

> Some individuals cannot buy health insurance at all if they have preexisting conditions.

That's true only if they let their insurance lapse. As long as they don't do that, they can stay with their current, switch, etc, all without waiting periods or a significant premium relative to "well people". (It's been that way for years.)

That's why I wouldn't let insurance lapse if I had a pre-existing condition, so why do folks with pre-existing conditions let their insurance lapse? Or, are we assuming that they do without cause or that they don't know the rules?

Or, are "we" ranting about the system without knowing rules that don't apply to us?

I have employees who were laid off from their previous jobs. They could not afford to pay the COBRA payment and let their insurance lapse. They are now disqualified from private insurance and have pre-existing conditions that are not covered under our group plan.

It is easy to tell people not to let their insurance lapse. If they have no income, this is not feasible.

The point of the article is that the current system inhibits entrepreneurship. Plenty of employees in the current system stay with their employer out of fear of losing their coverage instead of pursuing other opportunities.

> It is easy to tell people not to let their insurance lapse. If they have no income, this is not feasible.

If they have no income, health insurance isn't their only problem. There's housing and food as well.

> Plenty of employees in the current system stay with their employer out of fear of losing their coverage instead of pursuing other opportunities.

Lots of things have that effect, including having kids, buying a house, and so on. Many of them have far greater effect than pre-existing conditions, yet ....

There are also people who can't take the leap because taxes keep them from saving enough. Increasing their taxes to pay for other people's healthcare is going to make that worse.

None of the proposals address cost. (No, preventative care doesn't actually reduce costs. It "merely" makes life more enjoyable.) They just cost shift differently.

>That's true only if they let their insurance lapse. As long as they don't do that, they can stay with their current, switch, etc, all without waiting periods or a significant premium relative to "well people". (It's been that way for years.)

On individual and even small group (or medium size groups) they up your premiums, often by a lot of you have something big done, possibly beyond the point of payment. So yes, "if you lapse it goes" is true, often the COST of insurance goes up 10x if something happens to you and you don't happen to be able to be kicked out on another technicality.

> Or, are "we" ranting about the system without knowing rules that don't apply to us?

I don't know about you. I am ranting about the system that I pay into every month for my employees that doesn't cover their pre-existing conditions.