Absolutely. I'm planning to move into full-time freelancing work next year, and health care is the most unsettling part of this move. It's the most unpredictable aspect of moving into a full-time freelancing role.
1. Coverage is more expensive for lesser benefits.
2. Year-over-year changes to costs and benefits are less predictable.
2b. Continuity of coverage may itself be at risk with pre-existing conditions returning to the political debate.
If you have basic, predictable medical costs — and believe that you will stay in that bucket — these concerns may not be very relevant to you.
But a lot of people don’t fall in that bucket or aren’t confident that they’ll stay there. For these people, this adds a big risk to venturing out as an entrepreneur or freelancer.
A wholly privatized, largely deregulated health care market is toxic to entrepreneurialism because of these risks.
> A wholly privatized, largely deregulated health care market is toxic to entrepreneurialism because of these risks.
Except that the American health insurance market is both regulated in the extreme and, in the case of the extremely poor and the elderly, heavily subsidized by taxpayers as Medicaid/Medicare. I really don't know what the effects of a private, deregulated health insurance market would be because we're so far from that.
I think there may be good arguments for either free market health care or nationalized health care. But whatever this thing that we've got is, it should be burned to the ground.
> 2b. Continuity of coverage may itself be at risk with pre-existing conditions returning to the political debate.
This reminds me, when I was in college I had a pretty bad accident, but I had some college provided health care plan my parents paid for that covered it.
Even after being employed and having employer health care, I kept renewing it incase I had a longer term issue related to the accident that my new insurance wouldn't cover due to it being pre-existing.
In particular, I had to get a rod inserted into my leg, and thought if I had a problem with it down the line, it might get denied by my new insurer.
If you or your dependents have any medical complications or are something other than young and healthy, the costs can increase drastically. Also employers often provide a lot of resources via HR and FAQ websites for navigating health care related topics. And I think there is safety in numbers so to speak. Insurance companies don't care at all if they loose one customer. They care a lot if they loose a big contract with a big company. Maybe they'll decide you provided false information in one of their 1,000 forms and thus will deny coverage when you desperately need it. They're less likely to pull that sort of crap if you can complain to your employer and have them apply pressure.
Put simply: there's little incentive for health insurance companies to provide good service to individuals; there's lot of incentive to provide good coverage to company employees.
If that really is the problem then you, as a freelancer, can hire a company to navigate and negotiate the health care plans for you and other freelancers as a pool and get the same quality and discounts as you would in a large corporation.
But even so, they'll be a middle-man and they'll try to take as much profit from the group discounts they get instead of passing those savings on. An employer doesn't have an incentive to make profit there.
I don't know, do they? If they do, then your premise is correct and there's enough benefit in negotiating in groups that it's worthwhile. If there aren't, then it's either a) the "economist sees a 20 on the ground and immediately assumes it's fake because someone else would have picked it up otherwise" or b) your premise is wrong and having a large HR department doesn't make a difference in your plan costs and pricing.
The real answer is that they do exist. I used Oscar for a year and their plans were actually by either United Healthcare or Aetna (I don't remember anymore) and the premiums were less and the quality was identical to what I had through a company provided insurance later. There's also Justworks that does something similar, though they're more of a full HR service provider.
There are so many fewer options when you're not a larger company with group healthcare buying power. A middle class family of 4, to get the worst healthcare available on the marketplace (i.e. 7k deductible/max per person, very limited doctors) may pay 1300/mo from what I've seen (more than doubled from a couple years ago). Large employer subsidized healthcare from places like Aetna give better rates but don't offer individual plans ([0] "we don't offer individual health plans at this time").
Not OP, but have had to buy insurance as a freelancer before.
Do you have a family? Health insurance prices are far, far higher if you have a family.
The type of coverage you can by as an individual is also inferior to those you get access to at large companies, so it can be harder to get in-network coverage.
I agree. I have been independent for almost two decades and paid for my family’s health insurance all that time. If you factor in the cost in your planning, there isn’t any reason for it to be a big deal. At least no more than housing, or car insurance or any of the basic, predictable expenses.
One issue is you have to pay a monthly. In most other countries you wouldn't have to do this, so you dont have to worry if you have a slow month, or no work at all.
