This is absolutely true! I believe that the current structure and cost of healthcare in the US is one of the largest detriments to entrepreneurship. This is never brought up in political debates and is rarely talked about in media. Before the ACA, providers would deny people applying for individual coverage for the silliest pre-existing conditions and once you were denied, you wen't getting healthcare anywhere (black list).<p>This was a huge struggle for me early on in my career--and it wasn't until our company had a group (3+ people) that would could affordable plans. Even then, we were paying over $1000/mo to insure 3 healthy 26-year-olds.<p>You can read more about my story here: <a href="http://thecreativecareer.com/2009/03/30/us-healthcare-system-undermines-innovation/" rel="nofollow">http://thecreativecareer.com/2009/03/30/us-healthcare-system...</a><p>EDIT (In case the above is TL;DR):<p>"This means that many entrepreneurs and innovators—those of us paving the way on our own—are left with costly insurance or no insurance at all. Because of the limited choices for affordable healthcare, the decision to become an entrepreneur looks increasingly less attractive. Even if an individual is to secure an individual policy, the rates will be higher, and the coverage will be less than policies available through an employer."
Not to make this too political, but this is the big issue no one talks about when discussing healthcare. For many small businesses, providing health insurance is a major cost, and a major distraction from their core business.<p>Whenever I talk to my conservative friends I try and point this out. Many entrepeneurs with kids who might be out there 'creating jobs' can't because the healthcare industry owns our politicians.
Health insurance coverage, primarily for my wife, is one of the biggest reasons I have a full time job right now instead of expanding the contracting I was doing previously or trying to start a business. For various reasons, she is nigh-uninsurable, and she's working two part time jobs, which of course offer no health insurance whatsoever. When I was contracting, we had two separate private insurance policies, with a combined deductible of something like $6,000.<p>The bolded point at the top of the article is absolutely true: If you cannot afford health insurance, you can't afford to freelance. I often wonder if being shackled to a job by the specter of being uninsured isn't built into the system on purpose.
I'm a UK resident and I've never thought about any of those things, ever. I just take so much for granted.<p>I just do what I want and know I am covered for everything. We really do live in completely different worlds.
It's not health insurance, but for day to day health <i>care</i>, anyone in Seattle paying their own way should consider <a href="http://www.qliance.com" rel="nofollow">http://www.qliance.com</a> . Together with a (very) high deductible plan, I was able to get insurance and primary care for myself at around $100/mo.<p>The main selling point is the excellent access to care, though. When your time is money, you don't want to be bouncing around between three doctors for a month to treat an allergy that prevents you from sleeping. When I was on Awesome Traditional Insurance when I worked at BigCo, it sometimes took over a week to diagnose and treat a simple problem that was preventing me from working. With Qliance, I've gone from call-with-problem to prescription-and-plan-in-hand in under 3 hours. That's a big deal for a freelancer.<p>I understand there are other organizations around the country functioning on a similar model. You can google Direct Primary Care to find them.
<a href="http://freelancersunion.org/" rel="nofollow">http://freelancersunion.org/</a> ?<p>That's what everyone in NYC uses, at least. I've been on and off of it for years without any issues, definitely the cheapest option here.
The reality is that its not as easy as that.<p>Its not like "oh well, I can't be a freelancer because it doesn't provide healthcare, so I guess I am forced to just take that $90,000 a year job with full benefits."<p>The reality is, and I know I'm not the only one, that it can be much easier to find "freelance" or "contract" work than full-time employment with full benefits. And the alternative can often be zero income, because unemployment insurance doesn't cover a lot of circumstances, and it really doesn't apply (or shouldn't) when you can easily pick up a "freelance" or "contract" job.<p>The closest thing to 'full-time with benefits' that I have had (recently) has been 'contracting' jobs through staffing agencies, and there were no useful health benefits. Actually they had sort of a token health insurance, but it wasn't good for anything.<p>My health condition makes it harder for me to pick up and stick with one of these supposed full-time with benefits jobs that would probably be huge a waste of time anyway. I have a startupy idea and sort of a businessish that I am working on, and they are just much more useful ideas than most jobs I could pick up. And almost all of the most joblike jobs I have ever had have involved bosses who didn't know what they were doing wasting my time, office politics, and usually a few completely useless coworkers who I couldn't stand.<p>So I have been doing the "freelancing" thing, and even though the budget for this latest project basically has been on fumes for many months and I have to work for peanuts and can't afford healthcare, if I did manage to find a regular "job" after we get our new version into production, I don't think that would really be a win. It would suck all of my energy and time out just to support some asshole's lavish lifestyle on the basis of what would (odds on) just be a business based on some spammy bullshit marketing hacks or some other way to suck money out of the economy without providing any real benefit or innovation. Literally the only reason I would do that would be to take advantage of the healthcare after X months, assuming it somehow covered pre-existing conditions.<p>My hope is that the next day gig will have a better budget, and also that I can finish the startupish thing and that will provide money for me in a way that is not a waste of my time and allow me to eventually get rejected for health insurance and then reapply to the other California program and then get the insurance and then finally get my Nissen fundoplication.
Important! Overall a good piece, but one glaring inaccuracy: if you are self-employed in the US, you <i>can</i> deduct your health and dental insurance premiums <i>without</i> needing to reach the 10% of gross income threshold. The 10% threshold [probably] does apply for health care costs other than premiums [1]. Assuming family premiums of $1k / month and a marginal tax rate of around 40% (which may be low after state is taken into account), being able to deduct your premiums is worth about $5k / year in tax savings, so this is not a minor detail.<p>Source: <a href="http://www.irs.gov/publications/p535/ch06.html#en_US_2011_publink1000208843" rel="nofollow">http://www.irs.gov/publications/p535/ch06.html#en_US_2011_pu...</a><p>1. Depending on whether you setup an entity through which you do freelance work (and what type), you may be able to setup a plan that allows you to pay for healthcare expenses with pre-tax dollars, even if you don't reach the 10% threshold. See your friendly CPA for details.
From the post: "If you cannot afford health insurance, you cannot afford to freelance."<p>I'd say that's true (in the US). Health insurance is just but one cost of working for yourself. Since freelancing, I've found that I've been bumping my deductible up over the years to keep up with the 15% YOY price increases, but it is what it is, "catastrophic" insurance. I'm definitely not covering acupuncture.<p>One thing I always wished there were was a pool for sole proprietors, which would allow you to negotiate better terms, just as if you were a large company.<p>It's starting to look like this might be part of ACA with the creation of state run exchanges, or at least I hope that's a possibility, so it will be interesting to see how that turns out.
Health insurance for healthy people without kids shouldn't be a deterrent to freelance. Self employed health insurance is generally relatively affordable and easy to get, provided you are in good health and don't have any dependents.<p>If you have kids or health problems it might give pause but there are options - you need to attempt to get on a group health plan of some sort. Here in NYC we have freelancer's union but a little known trick I learned recently is that in most cities you can actually use the health insurance plan associated with your local chamber of commerce, which they offer as an enticement to joining.
"I live in New Jersey, which is a fair coverage state, so I’ve never had to deal with being rejected from a plan because of pre-existing conditions."<p>This is a huge omission. If you don't live in a fair coverage state, you have a high chance of being ineligible for individual health coverage based on preexisting conditions. Preexisting conditions include migraines, depression, and benign conditions with scary-sounding names, like "subaortic stenosis." There was a Planet Money interview recently with an insurance broker who generally rejected 50% of applicants. Granted, this selects for people who think they need health insurance, so the actual number may be a bit lower, but it still stands to reason that a large number of people are getting denied coverage.<p>If you don't fit the platonic ideal of "healthy," you may have no choice but to work for "the man."
I'm leaving my job in 2 weeks. I'm planning to get insurance through ACM if it's cheaper than COBRA.<p><a href="http://www.acm.org/membership/insurance" rel="nofollow">http://www.acm.org/membership/insurance</a>
This probably applies to start-ups as well. I wonder how many would-be start-up founders changed their minds after realizing they would not be able to afford health insurance without a full-time job.<p>Reminds me of an article I read last year about how there are more start-ups in Norway because the country has a really wide and extensive social safety net, so people don't have to worry about hitting rock bottom if they quit their job to pursue their own endeavors.