Is expanding Medicare, the federal health insurance program for people age 65 and some younger folks with disabilities, bad or good for entrepreneurs and business startups? Under a Medicare for All (M4A) system, Uncle Sam would replace the private insurance industry.

We turn to Laura Good. She is a co-founder of StartupSac, a nonprofit organization that she and Jeff Bennett launched in 2015 to educate and connect startup founders and innovators.

“Most of the startups we work with don't have enough employees yet to have to provide medical insurance so it's a bit of a moot point,” Good told MultiBriefs in an email. “It's long after they start the business — usually at least a couple of years — before this becomes an issue. However, it might make it easier for them to quit their day job to start a business if they didn't have to worry about providing healthcare to themselves or their family.”

A recent peer-reviewed study published in The Lancet looks in part at the cost and benefits of M4A. Professor Alison P. Galvani, Ph.D., is the study’s lead author.

“Taking into account both the costs of coverage expansion and the savings that would be achieved through the Medicare for All Act; we calculate that a single-payer, universal health-care system is likely to lead to a 13 percent savings in national health-care expenditure, equivalent to more than U.S. $450 billion.” To put that figure in context, the National Institutes of Health, which in part finances medical research, got $41.46 billion of funding for fiscal year 2020 that President Trump signed in late December.

We turn to Wendell Potter, a former healthcare insurance industry executive turned whistleblower and president of Business for Medicare for All. The advocacy, based in Philadelphia, boasts 3,000 members.

“The impact of Medicare for All will be significant and lead to an acceleration in new business startups,” he told MultiBriefs via email. “The current system in the United States, in which a majority of working-age adults get coverage through an employer, is a major impediment to business startups.

“Our employer-based system favors large employers that have the resources to self-insure. Small businesses cannot do that. Consequently, they have to pay insurance companies more than larger employers to cover their workers.”

Advantage goes to big business in attracting new hires seeking employer-based health insurance versus smaller firms that are unable to do so. “Small businesses are also at a disadvantage when it comes to recruiting and retaining employees because they typically cannot afford to provide the same level of benefits as large employers,” said Potter.

According to him, the U.S. has 7.4 million employers, with 82% having less than 200 workers, while 62 percent have fewer than 10. “Because of the high cost of health insurance, 46 percent of employers with fewer than 200 workers do not offer coverage; 56 percent of employers with fewer than 10 employees don't offer it,” Potter said.

The U.S. is the only industrialized nation that lacks a cradle-to-grave healthcare system such as Medicare for its citizens. Vermont Independent Sen. Bernie Sanders, the front-runner among Democratic Party presidential candidates, won the Nevada caucuses partly due to his support of M4A. The Vermont senator’s plan would end private insurance deductibles and premiums, replacing that with taxation.

“When everyone is enrolled in an improved Medicare program,” according to Potter, “health insurance will no longer be tethered to employment. That will unleash a new and exciting era of entrepreneurship in this country.”

The National Federation of Independent Business declined to comment.