The American Health Care system works well for people on Medicare (the highest number of satisfied people) and people in large group plans (white and blue collar workers in large industrial, financial, and consumer product companies). For people who work in small businesses and the services industry, our two fastest growing industries, the system does not work so well. Many (I beleive most, but have no reference, so I'll say many), service industry companies do not provide health insurance to employees. Small businesses try to provide insurance to attract the best employees, but they often cannot afford to, or they can't afford comprehensive policies. This means more and more people have to buy individual policies, or are part of small groups. These groups are vulnerable the way current health insurance works. It also means there are more people that cannot afford insurance, because individual plans are more costly to the insured than group plans. This is a problem because the number of uninsured and underinsured will keep growing with the continued shift in industries. More and more people will contribute to rising costs and fewer people will have adequate insurance to cover costs. Already, one of the biggest reasons for foreclosure in the recent housing crisis was the burden of health care costs which made it difficult to make house payments. This issue affects not only health care, but the whole economy. Also, our health indicators are dropping, even though we are paying more. We now have a higher infant mortality rate than Cuba -- a developing economy with socialized medicine.

If you have a pre-existing condition, you may be refused coverage. That may seem to make sense, but what happens in reality, is that when you become ill (we aren't talking one time things like appendicitis or a broken bone, but a longer term illness), the insurance companies raise rates, and raise rates and lower your cap, etc. You can't change insurance companies, because they won't accept you with preexisting conditions, even at higher rates. This puts you in a position where you cannot afford not to pay whatever rates, fees, and endure whatever caps your insurance company puts on you, because you can't switch, and as an individual, you have no power to stop them. The same kind of thing works for small group plans. In some ways, the companies are justified because with these groups, the risk is not spread over as healthy a group. (SInce individual plans are more expensive, some people who think they are healthy take the risk of having no insurance, so the overall pool is less healthy than in a large group plan where the cost is low enough that even healthy people buy in.) But, in many cases, the companies look for reasons to drop costly customers, and that leaves many sick people uninsured just when they need coverage most. In the meantime, the people who don't have insurance end up having problems too. They are likely to wait until their problems are acute, since they cannot afford to pay for tests and specialists early on. Or, they show up with catastrophic injuries. These people show up in the emergency room and can't pay. That raises the costs for the rest of us.

The way the proposed bill deals with all this is to let people who are happy where they are stay there. It creates an "exchange" that will allow small businesses to be part of large group plans, so that they can offere lower premiums to their employees and are part of a larger risk pool. This gives them more leverage over the insurer and the insurer a better profit on the group than it would have on many small groups. People would also be required to have insurance, which would make for a better risk pool for insurers so that they can keep premiums within reach. This would also stop them from landing in the emergency room and raising costs for everybody. Companies will no longer be allowed to refuse a person based on preexisting conditions, so they will still need to be competitive with their rates, even after people get sick.

That is the best I can figure out how to explain it. I hope it "meets the challenge."