From my discussions with Americans, one of the most underreported problems with the current US system is the treatment of people who are sole traders or work for small companies.

If you work for a large company you get healthcare with your employment. Your company has reasonable bargaining power with the insurance companies and can get a relatively good deal (the US portion of the company I work for gets health care cover for employees at a very reasonable rate – and it is top notch cover).

If you work for a small company or are a sole trader, or otherwise don’t have bargaining power, it is really hard to get a decent health policy at anything approaching this rate.

Logically in this situation you would band together with some other similar companies and get a good deal in bulk – you would be able to arbitrage the market to drive down the cost for small purchasers as well.

The anomaly is that this is expressly forbidden by the law.

You heard me right, the health industry have managed to get law written that prevents small groups of people having any bargaining power. And they use that law to absolutely screw anyone who wants a decent policy and isn’t part of a large organisation.

It is amazing what this does to their economy – it makes it unattractive or impossible to be an indepedent contractor (so they have almost no independent contractors), it is very risky to set up a small business (hard to get cover) etc etc.

Not to mention the general shamefulness of this as a law.

Yes, you are quite right. If Obama really just wanted a tussle with the insurance companies that he could win, repealing this law would have been the way to go.

Yep. I really shouldn’t max my mitterfors…