A small company can use a PEO like Rippling (a YC company) where employees are “co employed” with the actual company and for taxes/HR/benefits with for Rippling. It’s not like contracting. Everyone from the CEO down is “co employed”
I’m never going to defend the American health care system as I sit in a country now for six weeks where I fully plan to become a resident of post retirement mainly because of the healthcare even if I don’t live here full time.