Today concludes our series with Bob Graboyes, the senior health care advisor to the National Federation of Independent Business on the organization's evolving stance on health care reform. We wrap up with a discussion of how individuals who are ill or poor will afford health insurance in NFIB's ideal health economy. Note that Bob's comment about "government-issued price controls" could be directed toward Sen. Hillary Clinton, the only candidate to come out in favor of a cap on health insurance premiums.

To read the NFIB's principles, click here. To read previous installments of this Q&A, including the the tale of how it all began, click here.

INC.COM: For those who can't afford health insurance now, what specifically would NFIB propose to make it available to them?

GRABOYES: There's no single, simple cure to the problem, but the best tool will be to restrain and even diminish the cost of care. And as for that goal, government-issued price controls won't do the job. Automobiles and computers didn't sweep the American economy because of complex tax schemes and government programs. The market expanded because the products became cheap, understandable, and clearly useful. In health care, the opposite is true.

Subsidies for the poor and sick will be a part of any expansion in coverage, and better pooling arrangements are vital. The current system is tilted toward large-group employer-based policies: small businesses pay around 18% more for their employees' coverage than do larger employers. And a big reason is that small employers and individuals are denied access to the efficient pooling arrangements that large employers enjoy.

INC.COM: You wrote that the current system's inability to accommodate people with pre-existing conditions is one of the motives behind NFIB's principles. In NFIB's estimation, how should a reformed system ensure that sick people do find insurance that is "affordable and obtainable"?

GRABOYES: There are many possible mechanisms for enabling sick people to obtain insurance. We could begin quickly by developing better pooling arrangements for individuals and small businesses. Perhaps the biggest cause of our system's dysfunction is the inability to forge long-term contracts between insurers and consumers. Your insurer has little motive to keep you healthy because he's nearly certain that you'll switch insurers before too many years pass. Why should your insurer help you to get your blood pressure or weight under control when some other insurer will be the financial beneficiary of your good health?

INC.COM: In NFIB's view, what is a "realistic" target date for fully implementing health care reform?

GRABOYES: This depends entirely upon what kinds of reforms are eventually enacted. Too much discussion today revolves around arguments over which off-the-rack health care system ought to be plopped down on the country to cure all our ills. What we need is a carefully tailored, uniquely American system that draws good ideas from different states, countries, ideologies, and theories.

NFIB's take on health care is, "When it's fixed for small business, it's fixed for America." We sincerely believe that, which is why we place such importance on the needs and wishes of small business. At this very early stage, we're laying the groundwork for future discussions by engaging organizations across the political spectrum in open, honest dialogue. Notably, NFIB joined AARP, the Business Roundtable, and the Service Employees International Union in the Divided We Fail coalition. NFIB is engaged in friendly discussions with health care experts from across the partisan/ideological spectrum. We believe that finding real solutions requires the cooperation of diverse, bipartisan groups willing to work together for change. And that is what NFIB and our members intend to do.


I want to thank Bob for participating in this lengthy and thought-provoking endeavor. We've covered a lot of ground over the last several weeks -- although there's plenty more to say. Hopefully, he and I will return to the discussion as the general election approaches. In the meantime, feel free, Entrepreneurial Agenda readers, to continue the conversation.