First, approximately 47 million Americans are uninsured. Why?

• They have a condition that makes them uninsurable for individual health care.
• The condition drives up their premiums therefore making health care too expensive.
• They work for a small business where the group is rated unfavorably when this person is included on the plan, making it unaffordable to both the employer and employee.
• The person is eligible for public assistance, but cannot work through the system to obtain the coverage.
• The individual does not value health care and is not going to pay a dime toward coverage, even if their employer pays most of the cost.

Second, we have an industry that does not adhere to the rules of capitalism. Why?

• Employees do not pay for their health care and are therefore unaware of the cost of services.
• Employers in small groups are not able to obtain loss ratios, large claim reports, demographic changes, etc., to understand the reasoning behind the premiums they are being charged or the increases they may have; they have no recourse to these increases.
• Employees believe health care in the form of health insurance is the responsibility of the employer and is therefore part of their compensation. Thus, they use the system liberally.
• Employees in small groups have no incentive to participate in healthy lifestyles. In most cases, they are not fed information regularly that would educate them on the physical risks of their current lifestyle decisions (there is no HR department and the employer/employees are trying to work in the company; the agent generally is not going to provide this).
• We talk about transparency for health care providers, but do not talk about transparency for the actual insurance companies. If we are going to understand what a consumer is going to pay for a service, we also have to know what the insurance company is paying and what their discounts are.
• Small employers do not know what their agent is being paid and therefore cannot determine if they are getting a value.
• Health care providers do not know, and have no way of checking, if a person has insurance. When someone comes to the emergency room and has a high-deductible plan, they may not tell the hospital they have insurance, making the hospital file for indigent payment.
• Employees with high deductibles will try to negotiate with the health care providers to reduce their liability on the deductible. What these employees are missing is the fact that the price has already been discounted and this is their portion. Their savings came in the form of premium reduction.

Given this information, the solutions are easy. Take small steps and adjust the specific items addressed above.

1. Tax incentives for individuals purchasing health insurance outside of an employer, or who are self-employed or unemployed.
2. Create a viable opportunity for uninsurable individuals to obtain quality coverage at a reasonable price on the open market.
3. Provide a viable option for small businesses who have an employee with a medical condition that drives up the rates.
4. Double the tax savings to small businesses offering health insurance.
5. Any small business offering health insurance coverage to their employees is taking money directly from the bottom line. It prevents a company from reinvesting this money in growth or for the employer to pay back the risk incurred in creating the business.
6. Make public program eligibility known among the general public, employers and agents. Create the ability to easily register individuals online, whether covered by a group or seeking an individual policy.
7. Work with insurance companies to educate the population on the real cost of health care. Create transparency on all fronts of the equation, including the insurance companies and the agents.
8. Require insurance companies to provide detailed renewal information to the employers (insurance is not hard, claims paid versus premium collected).
9. Educate individuals and create rewards relative to healthy lifestyles.
10. Make health care accessible, including moving government-funded clinics into or close to hospitals so our ERs are not overrun with minor medical problems.

Victoria J. Braden is president and CEO of Braden Benefit Strategies, Inc.