Italy, while being beautiful and full of amazing places, is a country that is not particularly well-run, in many ways.  Despite having many very smart, talented, hard working people, it’s not very friendly to entrepreneurs (it ranks 50th on the Doing Business list here: http://www.doingbusiness.org/rankings ), but during my years there, I was always struck by the fact that for startups, there is zero hassle in terms of dealing with the selection of a health insurance plan, or worrying about employees or founders not being covered.

For instance, at the company I worked for , which was up to around 40 people by the time I left, the number of person-hours dedicate to health insurance/health care issues was 0.  In the US, in a company that size, there would be at least one person whose job would involve sorting through different, equally crappy and confusing health care plans and then dealing with their ongoing administration.

This is all kind of difficult for a small company: the bigger the company, the more they can bargain with health insurance companies, giving them something of an advantage compared to small companies and startups.

And of course, for those with pre-existing conditions, striking out on their own to found a company in the US is something that might not just be a huge financial risk, as it is anywhere, but if the circumstances are wrong, could put your health at risk.

Single payer health care is, of course not ‘free’: you pay for it via taxes if you are earning money.  However, the vast amount of time saved in terms of paperwork and bureaucracy is truly liberating even if you’re not dealing with all the complexities of starting a company.  The overall costs to society are actually lower too, if you look at what percentage of GDP goes to health care: http://data.worldbank.org/indicator/SH.XPD.TOTL.ZS?year_high_desc=true .  This is easy to see if you think about the layer upon layer upon layer of bureaucracy in the US: first the company has a person who deals with it, then you yourself have to deal with paperwork and various hassles, and of course the doctor has one or more people whose job it is to deal with patients’ payments and health insurance, and then deal with the health insurance company itself, which has an army of people.  Single payer systems are not without their bureaucrats, but there’s one layer of them, rather than several.  When you visit your family doctor, there’s no one there to deal with paperwork, because there isn’t any!

And while you can find horror stories about health care in any country, people mostly seem to live long, healthy, productive lives in Italy.  The quality of care is good, although sometimes the ‘surroundings’ are a bit more drab: doctors offices are often converted apartments, for instance, that don’t look quite so new or modern or with fancy decor like many in the US.  But ultimately, it’s you who is paying for that, so if you care about health care, rather than fancy offices, it’s good to see money being saved.