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If companies cannot afford the employer share of healthcare plans, they'll reduce or drop them. This is the reality that has been growing for the past couple of decades.

For example, IBM used to offer one of the best corporate employee benefit plans available. My DH was with them twice. The first time around, we enjoyed low co-pays, extensive coverage and great rates. The second time he joined them, we got a Health Spending Account that we were told moved with us should he leave the company (which he eventually did), but our health plan was pretty basic and at significantly higher costs. Age was not the significant factor.

To keep premiums down, you will most likely have to pay high deductibles. The rising cost of corporate plans is as affected by litigation and covering unhealthy participants as other healthcare programs.

The programs designed to provide group rates to small businesses within an association have seen premiums rise, as well. Private individual healthcare plans are becoming more available, but with many restrictions.

I've observed the emergence of new low-cost clinics, like Redi-Clinic, designed to fill the gap between private physician care and public clinics. Costs are reasonable, at least that I've seen, and routine preventive services, like flu shots and basic health screenings, are provided by Nurse Practitioners. These clinics can be the affordable care alternative to traditional corporate plans that an employer could offer.

The nation will not "shore up" the situation for self-employed or under-employed any time soon. Corporate America rules the roost because that's where the money is. The smaller neighborhood clinics and individual plans are trying to fill that gap for the self-employed, small business and under-employed.

We have a new service in our area, now, too - the return of the doctor who makes house calls!

Bottom line, national care will be a long, painful and costly proposition just to define, design and deploy - if ever. Corporate healthcare plans are crumbling. Creative healthcare plans are on the rise, it seems. But, until there are more medical professionals willing and able to make a difference in rural or economically disadvantaged America, we will, unfortunately, continue to experience a lack of good care in those areas and there will still be no answer to our growing healthcare dilemma.

October 3, 2008 - 4:44pm

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