I've been thinking about this issue a lot recently. I'm getting ready to re-up with our health insurance carrier, and am looking at some other policies to see if I can cut costs while maintaining benefits. Last year we raised our deductibles to save an approximately equal amount in premiums. It ended up being a cost saving move, only because neither me nor my youngest son needed much in the line of medical services, so we only paid about one full deductible, and another at about half. But it's a major monthly expense. Yes, I'm able to pay it pre-tax through my business, but still...those premium expenses come directly out of what I can take home.

It's a major monthly expense for many people. A lot of families get health care coverage through their employers, an arrangement where the employer pays a large part of the premium, and where a relatively large pool of people to cover with insurance spreads out the risk, resulting in lower premiums. But when the business pays those escalating costs, it comes out of someone's bottom line, or gets passed on to the consumer in the form of increased costs for goods and services. Don't think it doesn't. Nothing is free.

Same with government programs. We all pay 2.9 percent in taxes on all of our income (1.45 comes out of our checks, and the other 1.45 comes from the employer) for the huge government entitlement called Medicare. The payoff is that when we turn 65, we get to be covered by a pretty decent (for the patient/consumer) insurance plan.

If you have to buy coverage on your own, you have a major decision to make. For some, the choice may be paying rent or putting food on the table and paying for health insurance. (I don't know how many people in that boat would qualify for Medicaid type programs through their state of residence...I suspect that a bunch would.) For others, it's a choice between maybe buying that coverage and taking a vacation, or buying that newer automobile they really need, or whatever else. For others, it's just that they don't see enough value in the insurance to justify spending the money every month.

I had an employee (ex-employee now) who came to me wanting me to provide her with health insurance. At this time I don't provide it for any of my employees. Before that I hadn't had a need to do so; everyone had coverage through their spouses, and appreciated that for me to provide health insurance I'd have to take some of it out of their wage base.

So this one employee now needed it. And I didn't want to set a precedent, so I sat down with her after having my insurance agent quote me prices for her (she was about 22 at the time). I worked out what it would cost her per month for a basic health insurance plan, figured out approximately how many hours she worked per month, and raised her wage enough to cover the cost of her buying insurance through my agent. If she could find a better deal, which was certainly possible, she was free to go for it.

So what do you suppose happened? Think she went out and bought that insurance? Obviously the answer is no. She continued to live without health benefits, but with another hundred and change in her pocket every month.

She was young, healthy and prepared to take the risk. If she had been diagnosed with a major health problem, I don't know what she would have done, but the odds were in her favor.

I never went without health insurance. Went off my parents' policy and onto a student policy through college and dental school. Then when I graduated, I may have had a one month period there where I didn't have insurance, but I bought an individual policy as soon as possible. I made around a hundred bucks clear my first month out practicing, but I bought health insurance. (I was living with my parents at that moment, rent free and sponging food off them too.) It wasn't terribly expensive; it's a lot more costly now if the prices given to my ex-employee are a good indication.

I once read that the average person in our country, whether insured or not, is one serious illness away from bankruptcy, and I believe it. That's a real shame, also.

But we need more than just an extremely expensive "universal" insurance plan. We need a paradigm shift in the medical field, a change in the very thinking processes of the individuals going into the field.

I'll try to get to that shift, and problems associated with it, later...