One thing that bothers me about taxes is that they are around 20-30% of profits. If you take on a business partner and give him/her 20%, you expect something in return.
What do we get for our taxes? Wars and social programs that will be bankrupt long before we can benefit from them. (roads, etc., are < 1%).
I would be OK with paying the taxes for social programs if I thought those programs would be sustainable into my old age, but they aren't and nobody seems to care, even though this is widely known.
So when you write the IRS a big check, you are paying for old people, and when you are old you will not receive the same treatment.
By the way, most of the cost of healthcare is in areas where the money has very little yield, such as end of life care for the elderly, bypass operations, stents, and statins. If people actually had the opportunity to consider the value of healthcare, reform would be nothing like what it is now.
Next time you see an old person eating bacon and eggs in a restaurant, picture that person's bypass operation, years of statins, and excessive end of life care that you are paying for... and think to yourself how perverse "reform" is.
Meanwhile, there are millions of so-called "illegal immigrants" who can't even call the police if they are assaulted or abused (for fear of deportation) being left out of the reform.
Most of your income taxes go to wars and medicare, and most of the healthcare reform goes to the practitioners who practice useless surgeries and interventions on a vulnerable population of elderly.
The "reform" bills don't change anything, they just transfer even more of the wealth of young people to the elderly and their exploiters.
I like driving too, but don't focus too narrowly on roads. I think you're getting benefit from more than < 1% of taxation. Public education helps everyone. Research helps everyone. Having a criminal justice system helps everyone (well, the non-violent drug offenders would disagree). Having a strong civil legal system helps everyone. Meat inspectors help everyone. Financial regulators help everyone.
You could even say that knowing that we don't have senior citizens starving and dying in the streets as helping everyone. I like knowing that I live in a society that takes care of many of the less fortunate.
I'm not saying that government is good at solving every problem, but focusing on just roads, wars, and old people is very narrow.
My one-sentence view of what is going to happen in America is that "repudiation is coming" - on multiple levels, people, organizations, maybe even states will say "sorry, we can't fulfill obligation X any longer, we are done paying" .
The idea behind a big piece of the reform is to reward doctors who push preventative care over pills, surgeries, and continued treatment. Therefore (ideally) we will see less and less of these preventable surgeries since doctors and hospitals are striving to reduce their preventable and recurring care for patients (i.e., they get cash if they reduce it).
My favorite proposed solution is "defined contribution instead of defined benefit", which would address most of the incentive problems and inequities you mention.
In Washington, they call it "privatizing" and run you out of town.
I think you see things very clearly. Such is the quagmire of a declining democracy where most people are intent on shifting the costs of their decisions to everybody else.
"most of the healthcare reform goes to the practitioners who practice useless surgeries and interventions on a vulnerable population of elderly"
A lot of doctors don't want anything to do with medicare patients because they are often breakeven at best and in many cases a net loss. They are many times required to care for these patients in order to maintain hospital accreditation programs that allow them to look attractive to patients with insurance (where the hospital actually makes some profit).
It is good to pay attention to healthcare availability, but no sustainable solution can ignore the cost side. Excess litigation has played a significant role in the massive overinflation of healthcare costs. Flooding hospitals with patients with government insurance - likely to be net-negative income for hospitals - is going to destroy the healthcare system faster than it fixes it.
I find myself very sympathetic to your view - especially the part about not wanting to pay for wars. I have also frequently heard people claim that entitlement programs to support the elderly are "unsustainable" - but I honestly don't understand what this means. Do you mean that the costs of providing for our elders would grow without bound? Also, if you know of a nice explanation that presents the evidence that entitlement programs like social security are doomed I would be very grateful if you could provide some links. I would really like to know.
"Next time you see an old person eating bacon and eggs in a restaurant, picture that person's bypass operation, years of statins, and excessive end of life care that you are paying for..."
Cardiovascular disease is mostly caused by carbohydrate consumption and inactivity. The Feds subsidize these, and health care "reform" will make the problem worse.
For all of the talk about the impact of higher cap gains taxes on startups, the far more important impact is likely to be that potential founders will have a (slightly) easier time leaving their jobs and purchasing insurance on a less-broken individual market.
Plus it'll be easier for us to poach employees with families from big companies. I couldn't imagine what it would take to get someone with a preexisting condition at a startup.
Indeed. One of the smartest things in the bill -- and yet one which has received little to no fanfare -- is the mandate for insurance exchanges.
In case you haven't followed that, the idea is basically to match up people who are looking for private insurance with companies offering policies, but to build in the ability to lump the customers together into ad-hoc risk pools. For the insurer this is the same as taking on, say, a medium-sized company with X employees, which means the terms offered can be far better than traditional individual policies.
It's not just founders, it's a big deal with startup staffing in general. I took an effective pay cut when I went to work for a startup because they weren't big enough to buy health insurance in bulk the way my previous employer could.
I promise +1 Karma to the first person that puts together an infographic actually explaining where, exactly, $100 billion a year of tax payer money is going to go, and what we are going to get in exchange.
I am all for affordable healthcare for everybody, just desperately afraid of how the gov't typically overspends.
It seems worrying that the best solution to a more efficient and cost effective system they come up with involves spending a lot more money now.
Looking at American policies from an outside perspective, it seems the government is unwilling to be the one that will actually suggest that maybe the answer to many current budget problems is to spend less.
"I am all for affordable healthcare for everybody, just desperately afraid of how the gov't typically overspends."
Medicare currently operates on a 3% margin. That is, 97% of funds in the medicare program go toward reimbursing patient care. The vast majority of private health insurers operate on a 20-30% margin. The rest of the money goes towards marketing, sales, and towards profit.
Like it or not, every body is shouldering the cost of uninsured patients. One in 6 Americans don't have health insurance, yet they still consume health care. Who pays for that? Everybody does. Hospitals are under a federal mandate to care for everyone regardless of ability to pay. So, to compensate for their losses on uninsured patients. They artificially inflate the rates they charge everyone else to compensate. So, every time you use the health care system, you are paying for uninsured people's care.
Hospitals that have a disproportionately large share of uninsured and minimally insured patients (e.g. a county hospital, non-profit hospitals in the ghetto, small rural hospitals in farming country) routinely need and receive government subsidies to function. Those hospitals are largely subsidized by special funding bills.
Universal coverage, just means that we are now going to be explicit in determining how we are going to pay for people's health care.
If you want to see how successful government health care will be, look at Medicare. Its a great example of how the true costs of things, low quality and large amount of fraud can be overlooked for decades.
The main objective is punishing those that wish to pay for their own care and retain control over it by shifting everyone else's costs to them.
Then once people give up fighting the current and get their care covered by the government, they lose control of what happens and accept lower quality because at least it is free.
Then whatever entity is providing care performs whatever possible procedure and drugs they can get away with, while starving the hell out of any preventive measure may make sense. The money spent follows the lobbying.
but don't worry, it will be years before you fall into this sink hole and your family come and visit you as you go down, so it won't be all bad
So I opposed this bill, but now I have an honest question: Rationally speaking, shouldn't I cancel my health insurance? I'll pay the fine, which is way less than my current premiums, and I'll just wait until something goes wrong to buy insurance, since I can't be turned down.
If you have a serious health problem ( heart attack, stroke, accident ),
you will not have time to fill out all of the paperwork and buy insurance because you will need help immediately.
Also insurance companies will probably have processing times of weeks when onboarding new customers, so you won't be able to just get the flu and then decide to have insurance that month.
The ban on pre-existing condition screening doesn't kick in until ¿2014?
There's a temporary public option for the people who would otherwise still be fucked until then. I'm not sure if you'll be able to get that on short notice.
Another way this bill affects readers of HN: Parents can keep children up to 26 years old on their health insurance. Previously, the age limit was determined by individual insurance companies or individual states.
[I posted this on the other thread, which seems to have been deleted as a dupe. Sorry if it's against protocol to re-post. But I tried to find both sides, good-and-bad wrt startups.]
While it didn't discuss all of these, it seems to me that the things that will directly impact startuppers:
Pros
- Community rating, no recision, etc will make it easier for people with pre-existing conditions to get coverage. For people who have pre-existing conditions (or who have kids who have pre-existing conditions) and don't have a spouse at a bigco and want to do startups, it makes it possible.
- Might also make it easier for bootstrappers to get coverage.
Cons:
- The new taxes are concentrated on capital gains, so will tax startups and angel investors most of all. [This bill proposes a 3.8% increase on cap gains. The administration is also planning to change the regular cap gains from 15 to 20%, so if everything passes the rate will go from 15% to 23.8%, or a 58.6% increase.]
- Shifts costs from the older to the younger, so most startups here will pay more.
- In realistic scenarios, will probably increase the deficit, affecting interest rates. But that's long-termand not clear.
Pro or con, depending on what you think:
- Mandatory coverage will require that you have coverage during a bootstrapping phase.
A mix of good and bad for startups, depending on where you are in the process.
I've heard this a number of times but not heard it detailed: in what way are the CBO estimates unrealistic? What more realistic assumptions would you make, and what is their effect on the deficit?
Also how is it shifting costs from the older to the younger? It seems more that it is shifting costs from the near-bankrupt uninsured to those who make significant portions of their income from capital gains, i.e. the wealthy.
Why should the average 20-30+ year old even carry insurance? The penalty is only $250 a year, rising to $750 in a few years. They can't deny you insurance based on pre-exiting issues. So why not just pay the penalty, which can be substantially less than the policy, until you have an issue?
An interesting aside - house dems tacked onto this bill an overhaul of student lending which eliminated $60b of private lending in exchange for a wholly gov't controlled program:
You've got some incredibly complex proposals being thrown into an incredibly complicated system (and by that I mean the entirety of the social, political and economic realm - not just health-care).
The law of unintended consequences is going to play out here massively. Not only is it an intractable problem to predict the outcome from our perspective but it will be near-impossible for historians in decades hence to look back and separate which of their present society's ills were caused by this bill or by the million other factors that occurred in the intervening years.
It's going to be interesting to see if the Supreme Court finds that the Constitution allows the Federal government to force people to buy health insurance. With a 4 liberal, 4 conservative, and 1 swing vote split, they could go either way.
One thing's for sure, this bill will be challenged.
The whole thing is about regulating a commercial transaction (buying health insurance) and taxes (aka fees). Both are areas that there is a lot of precedent saying that Congress is within its rights.
Missing in this thread so far is a discussion of whether or not this bill is even remotely constitutional.
Not only does it seemingly institute a poll tax, it stretches the "commerce clause" of the constitution beyond all reasonable limits, it violates the 10th amendment, and article 2 section 8.
But I suppose all of that will become irrelevant in our glorious new future where the life of every citizen of the US is dependent on the efficiency, fiscal discipline, and humane kindness of federal and state bureaucracies. Indeed, this is a future I think we all look forward to, as all of these glorious institutions have provided a hearteningly robust history exemplifying all of those qualities to the fullest. Haven't they?
In order to bring down the cost of health care, the government would have to operate the system more efficiently than the market does. I can't think of anything the government operates more efficiently than the market does.
It's more interesting that there's a 60% Democratic majority in both houses and yet this bill just barely passed with only 1 vote more than the minimum necessary.
As an outsider (Irish) I find it interesting that this occurred. Usually at least one backbencher in Ireland would support the opposing view based on their own such morales. Was this down to pressure from their own party, their constituency or just pure spite to derail something that was not their own idea in the first place?
I'm not pro/against the issue; I have no stake in US healthcare.
I sometimes wonder if these stories belong here, due to the incendiary properties and tangential relationship to start-ups. Not that I don't think Hacker News could handle the discussion more or less maturely.
I have been biting my tongue on other venues regarding this bill, which is a good sign it's probably not a good idea to discuss here.
Having said that, I'll put on my business hat and begin adapting. What's this mean for my startup?
1) Those of you who say the country is waiting for affordable insurance until startups take off are smoking crack. It's a great benefit, sure, but young folks don't need health insurance and startups are lucky to keep the lights on, much less pay fines to have everybody insured. The process of getting new employees may greatly be enhanced, but we need a thousand pre-employee startups for every one looking for employees, so that's where to look for impact, not with insurance. Not sure there is any impact at all for dirt-poor young startups. It should be interesting how the income requirements work -- can you get 15K in investments and keep that for operating? Or does that make you rich enough to start having to pay fines? Having said all of that (which you might hate), it's a great thing to keep your insurance.
2) Those of you saying that it's the end of Western free civilization are completely overstating the case as well. It's going to add 16 thousand new IRS agents, sure, and there will undoubtedly be new regulatory burdens associated with hiring employees and growing. The key metric to watch here is public debt. We're in a debt explosion and, to some, this just pours gasoline on the fire. If that assumption is true, and I believe it is, then watching the national debt rating could be an early indicator that different business configurations might be better than locating and operating in the states. (That doesn't mean you can't start out here, just once in growth mode getting the hell out of Dodge might be worth it) If the country is going broke, sooner or later somebody is going to come looking for any profits you might be making. I'm not saying it is or it isn't. I'm saying that it looks like a legit concern to me -- you can do the math.
3) Medical and insurance discussions will now become political ones. In other words, somebody has to say "no" in order for any kind of health service plan to work without going broke. It used to be those people were the insurance companies. It was a lot of fun hating the insurance companies. Now that we're regulating the insurance companies like utilities, however, that person is going to be some bureaucrat somewhere. Your best access to him, if you have an employee with a complaint or are looking for some kind of change, is probably through your Congressman, giving your local Congressional weasel even more power than he currently has. This means all startups, from dollar one, need to have some face time with their Congressperson if at all possible. Increasingly he/she is the guy who influences more and more details of operating -- bandwidth availability, insurance standards (now), investment criteria, etc.
I hope that sounded reasonably neutral. I certainly didn't feel angry while writing it. While the immediate impacts are very low, over time I think this is a major change in the country's direction. Small business guys need to pay attention.
[+] [-] grandalf|16 years ago|reply
What do we get for our taxes? Wars and social programs that will be bankrupt long before we can benefit from them. (roads, etc., are < 1%).
I would be OK with paying the taxes for social programs if I thought those programs would be sustainable into my old age, but they aren't and nobody seems to care, even though this is widely known.
So when you write the IRS a big check, you are paying for old people, and when you are old you will not receive the same treatment.
By the way, most of the cost of healthcare is in areas where the money has very little yield, such as end of life care for the elderly, bypass operations, stents, and statins. If people actually had the opportunity to consider the value of healthcare, reform would be nothing like what it is now.
Next time you see an old person eating bacon and eggs in a restaurant, picture that person's bypass operation, years of statins, and excessive end of life care that you are paying for... and think to yourself how perverse "reform" is.
Meanwhile, there are millions of so-called "illegal immigrants" who can't even call the police if they are assaulted or abused (for fear of deportation) being left out of the reform.
Most of your income taxes go to wars and medicare, and most of the healthcare reform goes to the practitioners who practice useless surgeries and interventions on a vulnerable population of elderly.
The "reform" bills don't change anything, they just transfer even more of the wealth of young people to the elderly and their exploiters.
[+] [-] MartinCron|16 years ago|reply
You could even say that knowing that we don't have senior citizens starving and dying in the streets as helping everyone. I like knowing that I live in a society that takes care of many of the less fortunate.
I'm not saying that government is good at solving every problem, but focusing on just roads, wars, and old people is very narrow.
[+] [-] patrickgzill|16 years ago|reply
[+] [-] jeremymcanally|16 years ago|reply
[+] [-] jacoblyles|16 years ago|reply
In Washington, they call it "privatizing" and run you out of town.
[+] [-] coryrc|16 years ago|reply
http://www.newsweek.com/id/224020
[+] [-] stretchwithme|16 years ago|reply
[+] [-] jamiequint|16 years ago|reply
A lot of doctors don't want anything to do with medicare patients because they are often breakeven at best and in many cases a net loss. They are many times required to care for these patients in order to maintain hospital accreditation programs that allow them to look attractive to patients with insurance (where the hospital actually makes some profit).
It is good to pay attention to healthcare availability, but no sustainable solution can ignore the cost side. Excess litigation has played a significant role in the massive overinflation of healthcare costs. Flooding hospitals with patients with government insurance - likely to be net-negative income for hospitals - is going to destroy the healthcare system faster than it fixes it.
[+] [-] kurtosis|16 years ago|reply
[+] [-] unknown|16 years ago|reply
[deleted]
[+] [-] Daniel_Newby|16 years ago|reply
Cardiovascular disease is mostly caused by carbohydrate consumption and inactivity. The Feds subsidize these, and health care "reform" will make the problem worse.
[+] [-] kgrin|16 years ago|reply
[+] [-] gte910h|16 years ago|reply
[+] [-] mmastrac|16 years ago|reply
[+] [-] ubernostrum|16 years ago|reply
In case you haven't followed that, the idea is basically to match up people who are looking for private insurance with companies offering policies, but to build in the ability to lump the customers together into ad-hoc risk pools. For the insurer this is the same as taking on, say, a medium-sized company with X employees, which means the terms offered can be far better than traditional individual policies.
[+] [-] MartinCron|16 years ago|reply
My CEO wrote about this last year: http://www.benhuh.com/2009/08/01/the-killer-fear-of-guarante...
[+] [-] anamax|16 years ago|reply
It's not startups. It's single people making more than $200k or married couples making over $250k.
The latter affects more people than the former.
[+] [-] unknown|16 years ago|reply
[deleted]
[+] [-] aresant|16 years ago|reply
I am all for affordable healthcare for everybody, just desperately afraid of how the gov't typically overspends.
[+] [-] robryan|16 years ago|reply
Looking at American policies from an outside perspective, it seems the government is unwilling to be the one that will actually suggest that maybe the answer to many current budget problems is to spend less.
[+] [-] iamelgringo|16 years ago|reply
Medicare currently operates on a 3% margin. That is, 97% of funds in the medicare program go toward reimbursing patient care. The vast majority of private health insurers operate on a 20-30% margin. The rest of the money goes towards marketing, sales, and towards profit.
Like it or not, every body is shouldering the cost of uninsured patients. One in 6 Americans don't have health insurance, yet they still consume health care. Who pays for that? Everybody does. Hospitals are under a federal mandate to care for everyone regardless of ability to pay. So, to compensate for their losses on uninsured patients. They artificially inflate the rates they charge everyone else to compensate. So, every time you use the health care system, you are paying for uninsured people's care.
Hospitals that have a disproportionately large share of uninsured and minimally insured patients (e.g. a county hospital, non-profit hospitals in the ghetto, small rural hospitals in farming country) routinely need and receive government subsidies to function. Those hospitals are largely subsidized by special funding bills.
Universal coverage, just means that we are now going to be explicit in determining how we are going to pay for people's health care.
edit: added 3rd paragraph.
[+] [-] stretchwithme|16 years ago|reply
The main objective is punishing those that wish to pay for their own care and retain control over it by shifting everyone else's costs to them.
Then once people give up fighting the current and get their care covered by the government, they lose control of what happens and accept lower quality because at least it is free.
Then whatever entity is providing care performs whatever possible procedure and drugs they can get away with, while starving the hell out of any preventive measure may make sense. The money spent follows the lobbying.
but don't worry, it will be years before you fall into this sink hole and your family come and visit you as you go down, so it won't be all bad
[+] [-] defen|16 years ago|reply
[+] [-] utnick|16 years ago|reply
If you have a serious health problem ( heart attack, stroke, accident ), you will not have time to fill out all of the paperwork and buy insurance because you will need help immediately.
Also insurance companies will probably have processing times of weeks when onboarding new customers, so you won't be able to just get the flu and then decide to have insurance that month.
[+] [-] blasdel|16 years ago|reply
There's a temporary public option for the people who would otherwise still be fucked until then. I'm not sure if you'll be able to get that on short notice.
[+] [-] tdoggette|16 years ago|reply
[+] [-] luigi|16 years ago|reply
[+] [-] hzlz|16 years ago|reply
Some discussion of the impact on startups in the thread at http://news.ycombinator.com/item?id=1208019
While it didn't discuss all of these, it seems to me that the things that will directly impact startuppers:
Pros
- Community rating, no recision, etc will make it easier for people with pre-existing conditions to get coverage. For people who have pre-existing conditions (or who have kids who have pre-existing conditions) and don't have a spouse at a bigco and want to do startups, it makes it possible.
- Might also make it easier for bootstrappers to get coverage.
Cons:
- The new taxes are concentrated on capital gains, so will tax startups and angel investors most of all. [This bill proposes a 3.8% increase on cap gains. The administration is also planning to change the regular cap gains from 15 to 20%, so if everything passes the rate will go from 15% to 23.8%, or a 58.6% increase.]
- Shifts costs from the older to the younger, so most startups here will pay more.
- In realistic scenarios, will probably increase the deficit, affecting interest rates. But that's long-termand not clear.
Pro or con, depending on what you think:
- Mandatory coverage will require that you have coverage during a bootstrapping phase.
A mix of good and bad for startups, depending on where you are in the process.
[+] [-] jbarciauskas|16 years ago|reply
Also how is it shifting costs from the older to the younger? It seems more that it is shifting costs from the near-bankrupt uninsured to those who make significant portions of their income from capital gains, i.e. the wealthy.
[+] [-] dryicerx|16 years ago|reply
Just trying to make the top story in HN at least a tiny bit relevant to HN...
[+] [-] jpwagner|16 years ago|reply
[+] [-] tptacek|16 years ago|reply
[+] [-] rajat|16 years ago|reply
[+] [-] aresant|16 years ago|reply
http://www.washingtonpost.com/wp-dyn/content/article/2010/03...
[+] [-] andybak|16 years ago|reply
The law of unintended consequences is going to play out here massively. Not only is it an intractable problem to predict the outcome from our perspective but it will be near-impossible for historians in decades hence to look back and separate which of their present society's ills were caused by this bill or by the million other factors that occurred in the intervening years.
[+] [-] jacoblyles|16 years ago|reply
One thing's for sure, this bill will be challenged.
[+] [-] btilly|16 years ago|reply
The whole thing is about regulating a commercial transaction (buying health insurance) and taxes (aka fees). Both are areas that there is a lot of precedent saying that Congress is within its rights.
[+] [-] grandalf|16 years ago|reply
[+] [-] InclinedPlane|16 years ago|reply
Not only does it seemingly institute a poll tax, it stretches the "commerce clause" of the constitution beyond all reasonable limits, it violates the 10th amendment, and article 2 section 8.
But I suppose all of that will become irrelevant in our glorious new future where the life of every citizen of the US is dependent on the efficiency, fiscal discipline, and humane kindness of federal and state bureaucracies. Indeed, this is a future I think we all look forward to, as all of these glorious institutions have provided a hearteningly robust history exemplifying all of those qualities to the fullest. Haven't they?
[+] [-] eserorg|16 years ago|reply
[+] [-] tbrooks|16 years ago|reply
[+] [-] unknown|16 years ago|reply
[deleted]
[+] [-] haupt|16 years ago|reply
This insane partisanship cannot last.
[+] [-] InclinedPlane|16 years ago|reply
[+] [-] beilabs|16 years ago|reply
I'm not pro/against the issue; I have no stake in US healthcare.
[+] [-] jcnnghm|16 years ago|reply
[+] [-] unknown|16 years ago|reply
[deleted]
[+] [-] SlyShy|16 years ago|reply
[+] [-] curtis|16 years ago|reply
[+] [-] DanielBMarkham|16 years ago|reply
Having said that, I'll put on my business hat and begin adapting. What's this mean for my startup?
1) Those of you who say the country is waiting for affordable insurance until startups take off are smoking crack. It's a great benefit, sure, but young folks don't need health insurance and startups are lucky to keep the lights on, much less pay fines to have everybody insured. The process of getting new employees may greatly be enhanced, but we need a thousand pre-employee startups for every one looking for employees, so that's where to look for impact, not with insurance. Not sure there is any impact at all for dirt-poor young startups. It should be interesting how the income requirements work -- can you get 15K in investments and keep that for operating? Or does that make you rich enough to start having to pay fines? Having said all of that (which you might hate), it's a great thing to keep your insurance.
2) Those of you saying that it's the end of Western free civilization are completely overstating the case as well. It's going to add 16 thousand new IRS agents, sure, and there will undoubtedly be new regulatory burdens associated with hiring employees and growing. The key metric to watch here is public debt. We're in a debt explosion and, to some, this just pours gasoline on the fire. If that assumption is true, and I believe it is, then watching the national debt rating could be an early indicator that different business configurations might be better than locating and operating in the states. (That doesn't mean you can't start out here, just once in growth mode getting the hell out of Dodge might be worth it) If the country is going broke, sooner or later somebody is going to come looking for any profits you might be making. I'm not saying it is or it isn't. I'm saying that it looks like a legit concern to me -- you can do the math.
3) Medical and insurance discussions will now become political ones. In other words, somebody has to say "no" in order for any kind of health service plan to work without going broke. It used to be those people were the insurance companies. It was a lot of fun hating the insurance companies. Now that we're regulating the insurance companies like utilities, however, that person is going to be some bureaucrat somewhere. Your best access to him, if you have an employee with a complaint or are looking for some kind of change, is probably through your Congressman, giving your local Congressional weasel even more power than he currently has. This means all startups, from dollar one, need to have some face time with their Congressperson if at all possible. Increasingly he/she is the guy who influences more and more details of operating -- bandwidth availability, insurance standards (now), investment criteria, etc.
I hope that sounded reasonably neutral. I certainly didn't feel angry while writing it. While the immediate impacts are very low, over time I think this is a major change in the country's direction. Small business guys need to pay attention.