Health Care Opinions Requested...

[Milo_Bloom]

A company I am 1/3 owner of is currently in the process of bringing on employees and when we receive our Angel Funding next month, we plan to provide full health care coverage to all employees. (We will have 7 employees at the time).

I want to make sure that the employees get the absolute best health care possible, but after watching Sicko, I wonder if it is even possible to get a health care plan that will give them proper coverage.

I currently have a Blue Cross/Blue Shield PPO plan, but after seeing Sicko, I think I want to avoid them.

HMO's are completely out of the question.

My fiance has a Great Western PPO, which so far seems okay, as they are paying 100% of her pregnancy expenses, but I remember when she first got the plan, I looked through it and thought (damn, we gotta get you off this plan as soon as possible).

So, the big question...

Is there a company I can go to in order to get employees PROPER health care or does it really not exist in the US?

[sailor65]

1. In all my years of working,

BCBS programs have been the best performers in terms of getting care for my family, and in terms of prescription costs. When everybody started this "3-tier" drug system, our BCBS still gave us the lowest copays even on the tier 3 stuff (Not great, just better than everyone else).

I didn't watch "Sicko," as I'm not a MM fan, but empirically BCBS has been the best for us (As the least of evils anyway).

[Yael]

2. Find one that is Not-for-profit for sure.

The Blues may be a bohemouth, but I believe many of them are NFP.

Stay the hell away from Aetna and Cigna.

Congrats on the baby!!

[elehhhhna]

3. Correction; BCBS USED to be great, however, in th last decade

MOST of the states non-profit BCBS companies converted to "for profit" status.

A not-for-profit company is probably your best bet...and kudos to you for doing the right thing by your (lucky) employees.

[Milo_Bloom]

5. How do I find a good Not-For-Profit?

I did a basic search for it and found that the only company claiming to be not for profit was ... Kaiser. Unfortunately, there is a game you can play with "non-profit". To be non-profit the company can't make a profit... however, if you pay your executives idiotic salaries and spend enough money on advertising, you can be "not for profit" while still making tons of money... you just have to spend it.

The other part of my research found that most of the time, if you find a non-profit system, you are limited to THAT system (you must go to their hospitals/doctors.)


Here's what I really want.

Everyone has the ability to go to any doctor they choose.

The doctor chooses what is best. There is no "approval" process for treatment.

The words "pre-existing condition" don't exist.


Does anyone know of such a thing at any price? I honestly don't care if we have to pay $700 per month per employee. Luckily, I have a ton of pull and have demanded that health care be an absolute top priority at any cost.

I guess part of this is selfish, because my family will be on this health care plan as well. (One thing I demanded in this company is that ALL employees are on the exact same plan.. we will not have an executive/worker set up like a lot of places).

[Yael]

8. I am not sure. The CEO of my NFP BCBS plan through work

made $3.2 million in 2006. One is just as rotten as the other, I guess.

Kaiser is the one who kicked this entire mess off.

Best of luck -- I hope you can find something reasonable. Maybe call over to the local Chamber and ask?

[Viva_La_Revolution]

12. I had an idea while reading your criteria...

If you had $700 per mo. for each employee, that's almost $5grand a month. If they are generally younger and healthy (ie- don't visit the doctor very often) maybe you could put the bulk of that in a draw account (for prescriptions and office visits) then use the rest for a catastrophic policy.

This is just an idea, I have no idea how the numbers would work out. Of course, when you throw in families, older or sick workers... then my idea falls apart :(

[Viva_La_Revolution]

4. Angel Funding...

Is this your first experience with it? I'm very curious about how it works.

[Milo_Bloom]

6. Angel funding..

This is my first experience with it in this form, but I have been involved in similar things in the past, with a slightly different twist.

Angel funding is basically a first or second round of funding for a company.

In our case the first round was funded by money from the 4 main partners, where we each put up our own money to get the company started. We got things rolling and now need to raise money to keep things going. We could go to VCs (venture capitalists) but at our current stage they would take a HUGE % of the company, so instead you go to "Angels".

Angels are usually friends/aquaintences of the parties involved. 2 of the partners in this business are very well connected and are able to bring some pretty high level "investors" to the table (1 is a multi-billionaire). We had to prepare a "pitch" to the angel investors describing the company, what we intend to do, how we intend to do it... put together a 3 year projection on the industry and our projected growth within the industry.

Then we had to execute on a minor level (show the viability of the company and the idea) and then they invest in the company.

We are raising enough money from the angels to keep the company alive for about 1 year... after which we will probably be forced to go to VCs OR seek investment from other companies who wish to be involved. (I believe we will probably do the latter, because of the industry and the flux in it...) I am not going to name the industry or the company because I can be a little controversial on this message board and I want to keep the "company" completely seperate from my politics, opinions, etc, especially at this time.

[lumberjack_jeff]

7. I'm sorry to be cynical...

... but your VC's are going to tell you how you're going to treat your employees.

The answer: badly.

[Milo_Bloom]

9. Ain't gonna happen.

I have made it very clear that I will walk away before allowing that to happen and for various reasons I cannot explain, without me, they will fail and they know it.


We have 2 VC's sniffing around already and they have already tried to issue orders and gotten shot down hard (They wanted me to look into selling collected information from clients and I told em the same thing I would say to less than perfect health care... Ain't gonna happen.).


BTW, I am one stubborn SOB and I can honestly say I would let the entire company die, including the 75K I have put into it before I let someone go through dealing with poor health care.

[lumberjack_jeff]

14. Good luck with that.

Experience tells me that the slippery slope is harder to resist than you might think.

a) an investor is going to want more if the business is worth nothing without you.
b) you might be willing to walk away now, but what about later? If you have a dozen employees whose families depend on you, would you still walk away? What if you need a mezzanine round of financing to take the next step? Those VC's now own a bigger share of the company. What if they insist that whatever intellectual property you have that the company relies on be given to the company?

The company I have familiarity with was founded on exactly the principles you describe. It still exists today, run by the VC's and none of the founders are involved, the working conditions for the domestic workers are poor and the company largely resells the services of call centers in India.

I have concluded that principled management and venture capitalists are mutually exclusive.

[Milo_Bloom]

16. Resistance is futile, eh?

At the end of the day, there is nothing I can do about it once I am gone. However, as long as I am here, I have the power to not work with any VC and reject anything I wish. In 5-7 years when I leave the company, I will not have the ability to influence them retroactively, but I am also guessing that most of the employees will have left as well (as that is what usually happens when the VC's take over and the early employees get to cash out.)

So, I have little doubt that down the road, the company will change and not be what I set up; however, I can only control that which I can control and that is the employees who are directly under me right now and in the near future and I can promise them and you that there is no offer a VC can make that will make me abandon my prinicples.

But, I am not here to argue whether I will stick to my principles or not... If you knew my personal history you would know that I have walked away from huge profits before based solely on principles.. but you don't... so all I am looking for right now is some way to find the best possible health care coverage that we can get for the employees we have an will be hiring in the next 2-5 years.

I could not live with myself if I made this choice wrong and someone who worked for me developed a serious condition and was not properly covered.

[lumberjack_jeff]

18. More like "no free lunch".

The VC's will want to maximize their return.

[Milo_Bloom]

21. I already told 2 VC's money doesn't matter to me.

So if all they are interested in "maximizing their return" they should find another company. I have laid out a plan that will provide them an excellent return on investment, but they will not be gorging at the troth on the backs of my customers or employees.

And, yes, I used those exact words.

One of the advantages I have in this is that one of our major investors ran a company under very similar principles and every single person in the company (ALL OF THEM) ended up becomming millionaires. The company was ultimately bought out and all employees of the original company is gone, but everyone who worked for her is now set for life.

The VC money for us is ultimately a convenience. We can run a slightly smaller operation and make money. The VCs allow us to grow faster, but I am just as satisfied growing slowly and taking bank loans for capital at the end of a year if the VCs won't play according to my rules.

[burythehatchet]

10. Doesn't matter which company it is. Its the plan you purchase

Insured employeed are treated according to how much you pay. Many large insurers now call them "buy-up" options, where higher premiums mean lower deductibles.

The system is not set up to work the way you want it to for your employees. There is very little "insurance" in the equation. You pay your own way, especially with a small group.

[Milo_Bloom]

11. That is what I was afraid of.

I was just saying to my fiance, I wish we had to money to just start a company health "insurance" policy (essentially put 30-50 million in the bank and use interest generated to pay medical expenses, while having the rest for backup in case of catastrophe and then divert a certain % of company profits each year into the "plan"). Unfortunately, we are going to be operating on 6-8 million total, not 50-75.

As I said before, I don't care if we are paying $700 per month per employee, but I want to make sure that the employees can go to the doctor whenever they want and don't have to worry about having some middleman in their health care decisions.

I just found out that CIGNA bought Great West (my fiances current plan), so that option is now out.


I guess I find it hard to believe that some well intentioned billionaire hasn't started a plan that works the way these plans SHOULD, based on the concept of getting people healthy INSTEAD of providing as little care as possible to maximize profits.

[Viva_La_Revolution]

13. I think the answer to that is ... there is no money in doing it right.

If you do give people the healthcare they need and deserve (especially at today's inflated prices) you will always end up in the red monetarily (short term). It would pay off hugely in the end, of course.

Most people in America just can't make the connections in their head, more concerned about having that $20 bucks in their own pocket, than helping lift up the people they live amongst. I know that that $20 will help the junkie on the corner get rehab, instead of spending the next few years mugging my neighbors for his fix, then costing me more money while he sits in jail being punished for having an illness. I know it will help that adorable little down-stair terror's Mom get the antidepressants she needs to take better care of him. I know it will help some old crotchety O'reilly watching ditto head get his liver fixed years of working in a factory that poisoned him.

They can have it, as far as I am concerned.

[sandnsea]

15. What state are you in?

Before you do anything, look to see what benefits your state might provide in getting health coverage. Oregon has several programs, some help the business owner, others help the worker, some do both I believe. Maybe that way, you could get premium coverage at a reasonable rate.

My sister works for Alltel and has had cancer treatment twice in the last couple years. She absolutely raves about her insurance. I have no idea what company or plan it is, but maybe that info is available through their annual reports. My uncle died and she is at his funeral, so I can't ask her anything right now.

[Milo_Bloom]

17. California.

I am very sorry to hear about your Uncle.

I don't need this information immediately. Anytime in the next month is fine, as nothing will start until approximately February 15th (it takes that long for all checks to be written and clear).

I have several feelers out to people, but I wanted to go to the place I know and ask, because I figured if anyone knew about proper health insurance that meets with my ideals, that person would be on DU.

[sandnsea]

20. Thank you, he was 83

My dad had 7 siblings, plus their spouses. There are 4 left. *sigh* They all lived good lives though, good St Louis Catholic Union Democrats. :)

Have you looked to see how this program might be useful to you and your employees.
http://www.healthyfamilies.ca.gov/hfhome.asp

I'm not finding anything to help small business yet. That's unfortunate.

I was looking for something like this, although I see this didn't prove useful either as the program is sunsetting.

http://www.oregon.gov/OPHP/index.shtml

[TygrBright]

19. Look for pooled management groups... Business assoc. in your state might be able to help.

I don't know of any insurance company that provides what you want at a reasonable rate for a group as small as yours. The smaller the group, the crummier your options are likely to be. So look around for a pool you can buy into. Nonprofits do this a lot, many states' nonprofit business associations have a management pool that small nonprofits can buy into.

Trade and business associations also sometimes manage pools for their members. The idea is that the shafting a shared pool of a few hundred (or thousand) members will get is less painful than the shafting a dozen or so members will get. A larger membership pool does have a microscopically greater leverage in negotiating plan benefits, provisions, etc.

At this point, I'd endorse a suggestion another poster made, and work out a deal whereby you manage contributions for routine medical expenses and pay employee's and family members' premiums in your state's catastrophic coverage pool. In an organization as small as yours, if you put the employees in charge of managing the contributions and setting policy for payouts you should be able to be fairly generous with coverage for ordinary purposes. Prescriptions are another matter, though.

Good luck. Sorry there is no really good option for you, and kudos to you for your commitment to doing the right thing by your workers.

diffidently,
Bright