I think many entrepreneurs understand that it is somewhere between difficult and impossible to provide decent healthcare coverage for your employees and their families in the first 2-3 years of a start-up.
Then there's M&A activity. Since I worked at, or began, so many start-ups, I was often with the company being acquired. Even if you had good health care by that time, you've no idea what you'll have after that.
And strictly from an employer's point of view, it would be better if basic and catastrophic health care was not the responsibility of the employer. I've interviewed dozens of fantastic people with families that will not come to work for a start-up because their current health insurance is much better. This is particularly a problem when you've grown enough where you want to hire senior management away from much larger competitors.
Any universal system will also have to allow for private insurance for those who can afford "Cadillac" insurance. The Dalai Lama may have taken a vow of poverty but he still flies into the Mayo Clinic each year for his checkup. No one wants the best of the American medical system to go away. Most will not be able to afford it, like now, but everyone should have access to health care.
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