Health care reform -- that word "reform" tests well among focus groups, much like "new and improved" -- is moving along with a little GOP support, but it's still generally a Democratic initiative.

Our health care system is broken. We spend more on health care per capita than any other country and have shorter lifespans to show for it. We have a "crisis" -- another overused word. But how we deal with the problem is as important as recognizing that we have one.

A big government solution to the problem is not the right direction in Clark's mind.

As a nation, we either get health care from a large employer; by working for government; or through Medicare/Medicaid based on age or income. It's an ad hoc system that doesn't recognize that we don't stay loyal to one employer for a lifetime anymore. So the very presumptions made by our health care system are based on a prior era.

What we need is more affordability and availability to purchase health coverage. Of course, Clark is painting a simplified picture. But there's too much emphasis on how complicated everything is, with hundreds of pages in bills floating around Congress that nobody understands because we're adding onto a broken system instead of doing a fresh start.

This is not a red vs. blue issue. Both parties have failed to lead and serve the American people on the health care issue. What we need is an individual market, with vouchers for those of lower income. And yet the free market is obviously not the answer to everything; just witness the bank-led financial meltdown. So you need a cop on the beat. Clark believes that cop for health care should be a public/private commission that would draw up standard health policies.

Most importantly, we have to remove health care from the grip of big business, big government and big insurance.

In recent weeks, Clark has been talking a lot about the $8,000 first-time homebuyer tax credit. You don't actually have to be a first-time homebuyer to qualify; you simply must not have owned a principal residence during the three-year period prior to purchase.

There's still hope, however, for those who don't meet that loose criteria. Clark anticipates that December and January will be an extraordinary time to buy.

The reason behind his prediction is that the first-time homebuyer credit only provided artificial support for home purchasing. Much like people stopped buying cars when Cash for Clunkers ended, very few people will be purchasing houses when the $8,000 tax credit runs out on Nov. 30.

And, of course, autumn's procession of holidays and the arrival of winter always slow housing activity.

In other tax credit news, the consumer champ wants to get the word out about the federal subsidy of COBRA set to expire on Dec. 31.

The feds will pay for roughly two-thirds of your health premium once you get laid off. It's just there for the asking. That can be a great help when you consider that typically COBRA costs to an individual are your employer's premium plus two percent.

Whole Foods CEO John Mackey has created controversy with an op-ed piece he penned for The Wall Street Journal.

Before we go any further, it's important to note that Mackey and Clark are not the same person. Yet so many of the positions Mackey takes in his piece mirror Clark's stances. Like Clark, the CEO recognizes that our problem is not having a true free-market driven solution to the healthcare quandary.

Right now, health insurance is very confusing. It's not easy to make an individual decision based on cost. Mackey would clean-sheet the whole model and go to a system of individual purchase decisions. You would get your healthcare from the free market, not necessarily from your employer as so many of us do.

For this idea and others, Mackey has set off a firestorm. There is now a Facebook page with 30,000 members (at last check) who are part of the Boycott Whole Foods movement. And in the Northeast, people are picketing the CEO outside of stores.

Clark would not normally shop at "Whole Paycheck," as he derisively calls it because of the chain's high prices. But the idea of boycotting Whole Foods because you don't like the position of the CEO is silly.

Normally, CEOs hide behind layers of corporate lingo and bureaucracy to disguise their feelings. Clark thinks it's refreshing to hear one actually take a stand for something he believes in passionately.

When all is said and done, the idea of adding additional obligations on taxpayers to foot the healthcare reform bill -- especially when we can't pay our existing bills -- is reckless, dangerous and not possible.

Do you need to buy an individual health insurance policy because of a layoff, or because you're self-employed or work as an independent contractor? Clark knows it can be a daunting experience.

So often, the consumer champ gets calls from people who tell him what they paid for a policy and then ask him if it's a good price. There is no one answer. It depends on what's covered under the plan, the amount of the deductible and the limits therein.

We don't have what economists would call a "transparent market place." That means it's very difficult to shop apples-to-apples across the market.

The consumer champ has long advocated that coverage be standardized. In Clark's ideal world, there would be just 12 health plans offered to everyone: 3 HMOs, 3 PPOs, 3 HSAs and 3 of the traditional 80/20 splits. Every insurer would have to sell identical plans. That way you could switch to another insurer's HMO plan No. 2, for example, if your insurer's HMO plan No. 2 is too costly.

But until the day when that becomes a reality, here are 2 websites that can walk you through the process of buying an individual policy:

• HealthCareCoach.com
• HealthInsuranceInfo.net (contains state-specific info)

Doctors are being squeezed between what they're paid from insurers and what they're paid from Medicare/Medicaid. The reality is that doctors often make no money or even lose money when they see you. So they're shifting their practices to reflect the free market.

For example, take the field of dermatology. If you have a suspicious mole, you may wait months for an appointment if you're an insurance customer. But if you're willing to pay cash for cosmetic dermatology, you can usually be seen in 24-48 hours.

The New York Times reports that dermatologists and laser-eye surgeons are even building separate waiting rooms for cash customers. They're rolling out the red carpet with fancy furniture, free lattes and more. Contrast that with the ratty furniture and long-expired magazines that fill traditional waiting rooms for insured customers.

The doctors are not bad guys; they're simply business people. You can't blame them for wanting to put food on the table. It's the current health insurance system that deserves your ire.

The Washington Post reports that health "credit reports" have been compiled on 200 million Americans. Ingenix and Milliman are 2 companies that make billions of dollars developing profiles based on your prescriptions. A "pharmacy risk score" tells insurers the risk level you pose to them as a potential customer.

Pharmacy benefits managers (PBMs) actually sell your information regarding prescriptions. PBMs are a popular option at companies because they offer cheaper prices when you get your drugs online or through the mail -- instead of at a retail pharmacy.

The info in your health "credit report" can be used by an insurer to charge you more or decline you coverage altogether.

Another wrinkle in the story comes with "off-label" prescriptions. Off-label refers to using a prescription for an unintended use. For example, your doctor may be using a depression medication to treat your stomachache. But that off-label usage could redline you with insurers who don't want to see a history of depression medication -- even though you're not depressed.

Under new federal rules, you are allowed to see your health "credit report" from Ingenix and Milliman.

However, the real problem is not the lack of privacy, but rather the way that insurers are allowed to redline you. We need insurance coverage based on community-rating standards -- that is to say, age and sex.

The latest stats from the Center for Disease Control show emergency rooms visits are up. Some 120 million of us visited the ER in 2006 -- the last year for which records are available.

Historically, the ER has been for uninsured people. But today, a very large numbers of insured individuals are making the trek -- even for non-emergency conditions in the middle of the day.

What's going on? Well, many people no longer have primary care doctors. So they just go to the hospital. Not a good idea. The wait is very long and you have to be assessed in triage; there's no "first come, first serve" service. The visits are also massively expensive even with insurance.

If you do have insurance, you'd be better off taking the time to pick a primary care doctor. This also allows for continuity of care and easy follow-up visits.

But most people won't get around to selecting a primary care doc. That's why there are alternatives like "nurse-in-a-boxes," which can be found at supermarkets, drug stores, Wal-Marts, etc. Nurse-in-a-boxes usually have a price list so you know how much you'll pay to be seen by a nurse practitioner.

Another alternative comes in the form of Doctor of Nursing Practice programs being offered at some 200 schools. These doctoral-level programs require nurses to take the same qualifying exam as a doctor. Clark loves that the marketplace is developing an answer to the primary care crunch.

This time of year, people choose whether to contribute to their 401k plans and pick what kind of health plan in which to enroll. With all those choices, how do you know which plan to pick? One annual report known as The Health Competence Survey found that more than half of people are in shell shock over the cost of coverage next year. People are seeing such large increases in health care costs that they are going to reduce the amount they contribute to their 401k plans. That is unfortunate, but it’s a sign of the times. So, when looking at jobs these days, consider health care, bonuses and other benefits. Typically, an employee only thinks of salary. But health care is huge these days. One alternative is a high-deductible health plans. Clark thinks these are great for people who own their own businesses and for contract workers. HSA plans are another option that Clark supports. Many people don’t have money saved, so paying the big out of pocket costs is not realistic. But for others it could be a great idea. For more on HSAs, click here.

If you own your own business and are self-employed, you probably know about the problems getting health care for yourself and your workers. Well, Clark has a solution for you. In response to Costco Wholesale offering health coverage in several states, Sam’s Club is now launching its own program in nearly all 50 states. The coverage is much less than other locations, including Costco, and there are several plans available. The Sam’s Club offering is designed to get people to buy the most expensive membership level, the “Plus” membership, in exchange for a large discount on health coverage. The information on Sam’s Web site is confusing, and you may have to go through medical underwriting. But the savings is worth it. Sam’s expects the most popular plan to be the one that has a $10,000 deductible. Yes, that’s a lot. But most people in small business want only catastrophic coverage and very low premiums, so the plan is perfect. Most employers will cap your coverage if you have a complicated procedure or long-term illness, regardless of whether your medical bills are paid. You can also take the HSA or Health Savings Account route. You put your money into a tax-free savings account, which pays for your premiums each month. There are a variety of offerings, so it’s great for business owners. For more, go to samsclub.com and click on “Member Services” in the left rail. From there you want to click on “Employee/Healthcare Services.”

Clark is a big advocate of Health Savings Accounts or HSAs, a new form of health coverage for which more than one million people have signed up. The most interested are the self employed and small business owners, but more corporations are starting to offer HSAs to employees, as well. Basically, members pay a $1,000 deductible up front and, in return, their premiums go down over time. At the same time, members can put money into a tax- free HSA, which earns interest and can be used down the road to pay for healthcare. It changes things because the member becomes the customer, not the company supplying the insurance. The problem is that some companies charge a significant amount to open an account. The Web site hsafinder.com lists the 10 worst companies out there today, and the worst one charges a $235 fee annual fee. So, if you open an account with $1,000, you immediately have only $765. Other companies charge no fee at all and those are the companies you want to join. When setting up your HSA, be aware of what charges are involved. There shouldn’t be any!

Health care in the United States is outrageously expensive, as you well know. Problems started in the '60s when companies offered to provide health coverage in lieu of pay raises and other benefits. The problem was people began not caring how much it cost because they weren’t paying. The whole thing has been upside down and backwards ever since. Well, fast forward to today when there is help on the way. Health Savings Accounts (HSAs) will provide us with that alternative. These are tax-advantaged accounts that allow individuals to shop around and keep track of how much health care costs them. You can end up with a big pile of cash if you remain fairly healthy. Information is slowly trickling out about these accounts and now there is a site that lists opportunities by state. It is hsadecisions.org.

You may have heard of Health Savings Accounts or HSAs but you’re not really sure what they are. It’s the Bush administration’s main initiative in the health care area and Clark really likes the idea. Right now, the health insurer and your employer are the customer, and you’re in third position. No one cares about you and you have no say in what you pay. But with an HSA, you get a trade-off. You get much lower premiums for health coverage, but you have to pay the first minimum $1,000 for coverage. The money you don’t spend, goes into a tax-free savings account known as an HAS. It earns money tax-free and is used tax free to pay for medical expenses. Now, if you see the doctor frequently, an HSA is not a good idea. But for many, it’s a huge improvement because you will be more conscious about how much you’re spending. Kaiser Permanente, one of the largest health care companies, is getting in on the HSA game early. The company is concerned about losing customers to individual HSA plans. So, as an experiment, the company is going to allow customers to buy an HSA plan through Kaiser. About one in four Kaiser members will be eligible. The premiums will be much lower, but the doctor visits will cost much more. It won’t be the typical $10 or $15 co-payment. It’s not the traditional Kaiser business model, but Clark congratulates them for trying something new. The market place will decide if it’s a good idea or not and we’ll keep you posted.

Clark has been getting a lot of calls from listeners about Health Savings Accounts or HSAs since Congress passed the law recently. These accounts are going to become a household name in the next few years, but right now they are very confusing. HSAs look at health care very differently. The idea is to make health care more of a patient-oriented system. Right now, you fill out medical forms and you might pay a co-payment or a percentage of the bill. And you have to check if your doctor or specialist is in your “network.” With HSAs, people are now “customers.” The first certain number of dollars come out of your pocket. After that, all the bills are paid by your health care plan. The idea is that you’ll try to think of a less expensive way to get care if you’re paying for it. If we’re spending someone else’s money, we don’t really care about it. With HSAs, your deductible could be as high as $2,600 or as low as $1,000. But the great thing is it’s up to you, and it’s tax free. And if you buy a policy that has a $1,500 deductible, you’re free to put $1,500 into it and it’s never taxed. HSAs will be available from large employers, small employers and the self-employed. It’s still very early in the HSA game, but we’ll keep you posted. There are some people who don’t like HSAs, of course. They think all of the money is being funneled to the rich. But, it’s better than our current system. Of all the economic output in the United States, 15 cents on every dollar goes to health care. That’s about 50 percent higher than any developed country. So, we are basically sapping our nation’s economic growth with the enormous amount of money going to health care.