UPDATE: Tom Cooper has pointed me to this TED TALK by Eric Dishman. One of the most innovative ideas in health care that I’ve heard about. Spend 17 minutes and watch it.

If you run an American business, check out this guide to the new Health Care Bill. Thanks to Andrew Tobias for pointing it out.

If you have fewer than 50 employees, you may be able to get a tax credit to help pay your health insurance.

Now that the bill has passed, the furor seems to have ended, but the problem is far from solved. I believe the new bill is a step in the right direction, but we must continue to think about this problem and work toward a better solution, so here are some thoughts.

The last though is one I’ve not seen anyone else talk about. Ever. But I hope you’ll really click through on #8.

1. Insurance is a way to spread the financial burden. Don’t be mislead by advertising hype that insurance “protects” you from anything other than financial consequences. Auto insurance does not protect your car or your safety. It just spreads the financial burden of a crash among those who pay for insurance and never have a claim. So the more who pay, the more fairly the burden is spread.
2. Insurance, like any free and fair economic transaction, requires that neither side be privy to what economists call “informational asymmetry.” That’s why, if you sell your house in most states, you’re required to disclose if there’s been mold, or the basement floods.
3. If either side is able to adjust the deal after the fact – like insurance companies reducing coverage after you get sick – then it’s not really spreading the financial burden, it’s taking unfair advantage of the other side.
4. From an economic point of view, one of the most ridiculous aspects of health care in the US is that it is tied to employment. I understand the history of why this happened, but that doesn’t make it good policy. It basically keeps people in jobs (or out of jobs) for reasons that have nothing to do with them or their job. And that makes it harder to run a business.
5. It also keeps people from leaving their job to start companies and that’s bad for the economy.
6. It puts small companies at a disadvantage to big ones because any administrative function or cost that must be amortized over 15 employees is more burdensome than one that can be amortized over 1,500 or 15,000.
7. It puts American companies at a disadvantage to firms in other countries where health care is not a line item on a company budget.
8. Americans are getting ripped off by the system. Check out this post. And click on the graphic. It blew my mind. This makes me believe that we could solve the problem entirely at an over all cost savings – system wide. Many others are doing it with better outcomes for cheaper. So it’s obviously possible. The problem is that the savings would not be universal. Some would pay more than they are now even though on average, all would pay less. Unfortunately, our legislative system is organized so that those that would pay more have much stronger clout than those that would pay less.
9. Sick people are bad for business. If your customers have to choose between paying for pills and paying for groceries, they won’t have a lot of money to spend with you. If your employees are in a similar situation, they won’t be their most productive. I know most people’s situations are not that extreme but I think the point still holds.

One of the biggest challenges I deal with in helping people improve their companies, is changing beliefs. All of my clients are successful and what they’ve done (based on their beliefs) has gotten them where they are. But many times what got us here, won’t get us there – wherever we want “there” to be. And facing up to that reality often requires real courage. I think health care is one of those situations.