The relevance of health care in this negotiation is contextual. For young, healthy, child-less people, their usage of health care is going to be minimal at best - and really amounts of catastrophic insurance against accidents or major illnesses.

This changes dramatically if the individual has children, chronic illnesses, or other persistent conditions that will require regular use of the medical system.

And also, ouch, $780 monthly premiums - is the company any of your premiums?!

Yeah, they're fronting the other $1400 of the premium. We're a very small company and getting completely dicked by Blue Cross / Blue Shield. Doesn't help that most of the principals are senior people with families. I also chose the PPO over the HMO and FSA plans. I've btdt with those two and will never go back.

Which brings me back to your first point. Yes, the healthcare aspect (especially in the US) is contextual. Which means startups can favor younger/inexperienced/childless early employees over older experienced/family people.

And remember, anyone's situation can change on a dime. Doesn't matter where or when you work.

$2180 a month, $3000 deductible. Did your founders meet at a cancer remission support group? Or is it just that hard to negotiate for a small group policy where you are?

He's quoting what sounds like a market small-group PPO normal-deductible rate for family coverage in the US.

You can get the rates down by opting for an HSA-qualified HDHP plan (the deductibles for those plans in IL are in the range of $5k/$10k-family). I'm not sure how much lower the rate is, but normal-deductible insurance is not a good deal for most people.

If his founders met at a cancer remission support group --- or, for that matter, the support group for any of a list of hundreds of self-evidently nonfatal medical conditions, most of them affecting women --- he would not be able to get insurance at any price. At any price. He would not get "dicked over with worse rates"; he simply would be unable to set up small-group health insurance for that group at all, under any circumstances, unless he excluded members of his group (or fired them). People with those conditions, which (it should not surprise you) are very common, and which very rarely implicate expensive treatment demands down the road†, can obtain insurance only by accepting jobs at companies with large group health plans.

It is sad for me to have to call this comment out for being naive, because is naive in the face of a terrible injustice that also happens to be a thorn in the corneas of many startup founders, but it's naive.

I know several very smart startup founders that have families who are opposed to guaranteed-issue health insurance, but I cannot personally for the life of me fathom how they arrived at that opinion, having myself had to go through the shitshow that is securing family health insurance coverage on the private market.

† But actuarially incur high costs enough to fuck over multiple percentage point-sized swaths of the whole US population

Thanks for the backup. Tom is totally on the mark.

Every time I encounter a conversation about healthcare in the US, all I do now is ask if the other party has ever tried to purchase private coverage for their family on the open market. You have no standing to discuss the true situation in this country until you have.

I did it 7 years ago and it was hell. Absolute hell. I can only imagine it's gotten worse since then.

To add a data point, I dug out the medical rate information from my offer package three years ago. The Family PPO premium was $17,000 annually, of which I paid $9600. The Family PPO with $5K HSA was $12,500 to my employer, $5000 of which I would have had to pay. At the time I was easily consuming $5K+ of services for my children, and I had awful experiences with a previous HSA, so the normal PPO was my choice. The rates have jumped 30% since then, and my employer has absorbed most of the jump.

Pretty much the latter. A few in our group also had kids over the last few years. That's a guaranteed premium hike right there.

This is actually lower that what it cost me as a one-person company. Fortunately, my C-corp enables me to deduct health care costs (so long as the benefit is given to all employees). It is rather outrageous.

Agree - this could be a huge difference in total package value and it's glossed over.

At my company we have what I call dental "insurance". As in, it covers about 0-10% of any given procedure.

Maybe better pronounced "insure-ish"

I authored the post and you're absolutely right. It was a lazy approximation. My healthcare in the startup isn't quite as good now, but I'm also very fortunate in that I don't have any healthcare-related expenses.

Thank you for bringing it up here, it could be a significant differentiator for some folks.