In my business I talk to a lot of small business owners, almost half of whom do not currently have health insurance.  The majority of these uninsured people tell me they're looking forward to the upcoming healthcare reform, exuberant about the fact that everyone will be guaranteed health coverage.  When I point out that guaranteed health insurance is something they already have available to them---be it group health insurance or a guaranteed coverage individual plan---the quick retort is invariably a variation of a standard "yeabut."  Yeah, but that costs too much.

How much is too much?  These are people who life in nice houses, make close to $100,000 per year, drive nice cars and enjoy dining our several times each month.  For them health insurance isn't really a matter of affordability, it's a matter of prioritizing.   Simply put, their annual vacation---which costs about as much as a year's health insurance---carries a higher priority.

Health care reform, identified as one of the current administration's highest priorities, is certain to take center stage in the coming months to the battle cry of providing coverage for millions of uninsured Americans.  I strongly urge those putting the plans in place to have a heart-to-heart chat with the abovementioned folks---let's call them the "voluntary uninsured"---first.  They are in need of some significant education.

President Obama has made it clear he isn't advocating a single (government) provider national health program, but that ace-in-the-hole is surely significant enough leverage to encourage the private health insurance system to reform itself.  Eliminating pre-existing condition exclusions and differential pricing based on health status is what the president wants, and private industry is apparently quite willing to give it to him.  All they ask is that the playing field be leveled:  make health insurance mandatory.  If everyone is in the pool, then it will be possible to come up with actuarially sound pricing and everyone of a certain age and gender would pay the same premium.  Certainly, there will be regional differences---costs in some states are higher than in others---but this is really a simple, effective solution that meets the president's criteria:  coverage for every American while premitting existing insurance companies to remain in business.  Lower income people would presumably receive a government subsidy to help offset the cost of the required coverage, paid for by taxing those with higher incomes.  I suspect, however, that many small business owners may earn too much to qualify for a subsidy and that several of them may, in addition to now being forced to pay for coverage for themselves, also see an increase in their taxes to help pay for the subsidies.  Clearly this is not what they were thinking when they first heard the words 'health care reform."  They were thinking free health insurance, which is not very likely at all.  So, to the millions of Americans who are currently voluntarily uninsured, I heartily suggest you become involved in the dialogue and make sure you realize just what the guaranteed health insurance you are cheering on might really mean to you.