Said entrepreneur can also buy a plan from an exchange
My grandmothers neighbor is in her 70’s and not great health. She needs a hip transplant and the doctor is basically like “nope, you don’t have many years left, better to prioritize a 50 year old”. Which makes perfect sense from a population perspective but sucks balls at an individual level.
Ehhh. Insurance will pay for what they want to pay. That means some treatments will be completely covered, and other treatments that your doctor really think should happen, won't be approved. Sometimes its because the doctor's out of wack and the insurance is calling bullshit on them (that's good!), sometimes insurance are just cheap (that's bad).
The biggest issue to me is getting far enough to even diagnose the cancer. In the US, they tend to just want to go through as many patients as possible. Maybe toss you some pills, but that's it. It's hard to get doctors to go through the more advanced diagnostics.
I had gallbladder stones for a while and it took FOUR YEARS of every doctor I talked to dismissing it as GERD (wtf) and countless ER visits before one lost patience and did the ultra sound here and there. "Oh, look at that, its not just plain stomach pain".
But who cares about finding the root cause when you can just keep billing patients after patients for GR visits where all you do is take their vitals and prescribe PPIs. If I had cancer, I'd be dead.
But yes, on the other end of the spectrum, my grandmother in Canada almost died because of critical and time sensitive heart surgery she needed that got cancelled and rescheduled over and over and over...
Of course this means they'll also push incredibly expensive but dubious interventions for all patients (even those that are clearly terminal).
I have no idea whether Canada etc are better in this regard, but all the incentives line up to treat all patients in the most expensive way possible to the "bitter end." I've seen this personally with terminal patients, resulting in them squandering their final months on brutal and ineffective treatment as they follow that "false hope" to gain some "extra time," but it also means expensive (and high risk) surgery is encouraged way more often than e.g. physical therapy for minor issues.
I guess if you're a very savvy consumer this system could work for the better, because you would only opt for the truly necessary and likely to be effective expensive procedures, but it's incredibly difficult to make clear-eyed decisions in moments of health crises.
I'm Canadian, now living in the US, and I'll be honest: for the first couple of years, where I had some medium sized health issues, the US system felt so much better. The hospital I was treated at was leagues better than anything I saw in Canada. The amount I had to pay on my paychecks was lower than the complementary insurance I had in Canada. I had dental insurance everywhere I worked! My teeth are a trainwreck from the years I didn't have access to good dental insurance).
So if someone was to dig in my old social media posts, they'd see my old stance of "I would prefer universal healthcare because its more fair, but if I was only thinking about myself, the US system is better".
Then, as anyone who knows better could have predicted, it went downhill and I was proven wrong. If you have something that's hard to diagnose, the insurance starts fighting against you/your provider to get lesser care (eg: getting a full sleep study is super hard because insurance companies will just want you to take a cheap at home sleep apnea test. If you have a sleep disorder that's not sleep apnea, good fucking luck).
Some providers will not talk to you if they're not in contract with your insurance. Good luck getting behavioral health care. Lots of clinics are in bed with very specific insurance, and will not even take self pay. So you have to call 15 of them because even the ones on your insurer's website may not want to speak with you.
The paperwork. Holy shit the paperwork. I had surgery once, and I was still getting bills for it 6 months later. SO MANY BILLS. Some of them were absolute bullshit, but who has time to call insurance and hospitals over and over and over to fight every single one when there's douzens for a single procedure. So I just paid the co-insurance fees and suck it up. I never had a way to tell when I was getting "the last bill".
In the end, I'm reasonably well off, and I have pretty much the best insurance one can have (no deductible, no employee contribution on paycheck, covers virtually everything), and it's STILL a pain in the ass. A pain enough that I've offered some providers to just pay cash to avoid the bullshit. THEY SAID NO and sent me on my way.
Oh, and if I want to start a business, work for a pre-seed startup, or just want to take some time between jobs, I need to coordinate with my significant other to make sure they are not planning on quitting any time soon so we don't have to deal with COBRA or worse.
Yeah, give me the Canadian system any day now.