When you look back our nation's growth, the thing that has made us unique is our free market and entrepreneurial spirit. People come to America to start companies because we've been a beacon of opportunity. Our free enterprise system is unique in the Western world because half of all employment is with small firms.

Clark was recently speaking to a woman who used to be a burned-out corporate lawyer. She always loved making draperies and eventually quit her day job to do it fulltime. Now she has 6 employees in her basement -- probably against zoning laws -- and she makes more money than she did as a corporate lawyer.

The healthcare question has become the single greatest impediment to our nation's legacy of entrepreneurship. Would be entrepreneurs can not leave the firms they work for without fear of losing their employer-provided healthcare.

Simply put, our healthcare system is broken. The University of Minnesota finds that what we pay for healthcare is up 30% in 4 years! Meanwhile, the average family premium is $11K/year. It's gotten so bad that the University of Texas nonprofit medical system has actually turned dying people away because they're afraid they won't be paid.

Clark doesn't do politics on his show, but he believes that John McCain has come out with a common sense proposal to address the healthcare question. McCain is seeking to eliminate the corporate healthcare deduction. The 2 Democratic candidates, meanwhile, seek more government intervention in healthcare. McCain's plan would be similar to giving out vouchers for families to buy healthcare in the free market.

He's on the right track, Clark believes, though his proposal is like Swiss cheese and needs to be filled in. Standardized policies are necessary so that we can buy identical coverage from state to state and insurer to insurer. So far, the McCain plan is the only one that Clark sees helping out the small business entrepreneur. And that's crucial for the future success of our economy.

Should you list your Social Security number on a medical form? Clark does not. Medical record numbers have replaced Social Security number on insurance cards in an effort to stop ID theft. Why would you open yourself up to it again?

A Wall Street Journal reporter recently found that some hospitals now require Social Security numbers at registration. The facilities then quietly run your credit using an outside source that gives a proprietary rating to gauge your likelihood to pay for service. Some hospitals are even turning away urgent but non-emergency patients deemed to be credit risks. Unfortunately, many hospitals doing this are non-profit facilities that have a duty and mission to provide care to those who can't pay. So they get non-profit status, but they ignore their core values.

Your credit can help or hurt you in so many ways. Think about this: Clark recently froze his credit. Does that mean he might be temporarily denied service until his records can be thawed?

Economics have forced medical students to abandon primary care. The costs of medical school and the current health insurance system mean that everyone wants to be a specialist. Clark believes that nurse practitioners and physician assistants are the answer to the shortage of primary care doctors -- and the looming shortage of pediatricians. Clark recently read in the Personal Journal about a new program called Doctor of Nursing Practice that's being offered at 200 schools. This doctoral-level program requires nurses to take the same qualifying exam as a doctor. Clark loves that the marketplace is developing an answer to the primary care crunch.

Conventional wisdom holds that it's almost impossible for baby boomers who are in the 50-64 age group to buy individual health policies. But increasingly insurers are trying to woo more individuals as customers. That's because big employers are discontinuing health insurance and switching over to reimbursement plans. Such plans may still be managed by the insurers, who act as paper-pushers. But the actual business of insuring is increasingly done by the employers themselves.

Aetna, Humana and Wellpoint all offer products to uninsured baby boomers, according to The Dallas Morning News. They may even take you on if you have some pre-existing conditions. That's good news for the almost 7 million boomers who no longer get health insurance through work and aren't yet old enough for Medicare. Meanwhile, try looking to the warehouse clubs if you're an entrepreneur seeking an individual health plan. Sam's Club leads the field in offering volume-based pricing, but Costco also offers plans in select states.

There's often a gatekeeper at your doctor's office that won't let you talk to the doctor. They'll make an appointment for you, but they won't let you speak directly to him or her over the phone. After all, doctors don't get paid to just talk, right? Well, now Aetna and Cigna are reimbursing doctors for online virtual visits. You can chat directly with your doctor over the Internet. This creates a market incentive and saves the insurers a ton of money. The fees they disburse for online appointments are less than they'd pay out for an actual visit. Meanwhile, the CDC reports that visits to the doctor are up 20% over the last 5 years. With fewer general practitioners than ever, that's a train-wreck waiting to happen. Clark has long advocated for nurse-in-a-box practices to alleviate the crunch.

The Los Angeles Times recently published a list of the 10 top issues that doctors are most asked about during Internet visits. Not as much fun as a Letterman list, but here goes: No. 1 medications; No.2 sinus problems; No. 3 back problems; No. 4 colds and flu; No. 5 test results; No. 6 coughs; No. 7 follow-up on surgery or another procedure; No. 8 headaches; No. 9 fevers; and No. 10 asthma.

The state of California has found that some insurers have been rewarding employees for digging through your initial application and finding omissions that allow them to yank your coverage. Meanwhile, New York is suing United Health Group for cheating people by making up bogus reasonable and customary charges. For example, say the average price of a procedure is $100. UHG will come back and say the local price is actually $30, and that they'll pay their customary 80% of that $30. Then they'll leave you with the entire remaining balance. But who can fight the big bad wolf of health insurance?

On a related note, here's a scoop on how insurers rip off small businesses. The math shows that the first 2 years of coverage are very profitable for insurers because few claims are filed. By year 3, however, that trend reverses. So some insurers offer teaser rates for the first 2 years and hike them up the following year. The hope is that you'll leave and go somewhere else for coverage at that point. Clark wants transparency in health coverage and thinks this could be achieved if there were only 8 plans offered to small businesses: 2 HMOs, 2 PPOs, 2 HSAs and 2 of the traditional 80/20 splits. The difference between plans would be that, for example, one PPO might pay for experimental treatments and the other might not. Every insurer would have to sell identical plans, and they could charge what they wanted for them. That way you could switch to HMO plan NO. 2 if your insurer's HMO plan 2 is too costly. As always, Clark says the real risk to insurers will come from socialized medicine if they don't shape up.

We're at a point in our country where 1 in 5 people don't have health insurance. It's not always the same 47 or so million who do without it at any one moment. It's constantly changing as people lose jobs and get hired. The oddball thing is that insured patients get quoted a rate that is as little as one-tenth the "retail" price of a medical service or procedure. But if you're uninsured, you pay full price and it seems like the hospital wanted the money from you yesterday. Now California has become one of two states (the other being New York) where hospitals must publish their price lists on a website. This helps the uninsured comparison shop in non-emergency situations.

Clark recently had some lab work sent to a facility that didn't have a deal with his insurer. So he was billed at the phony full "retail" price. He had to meet a big deductible before the insurer picked anything up. It's as if he was beaten up twice. There's such a shocking disparity between the billing for the insured and the uninsured. The healthcare issue has been a big one on the campaign trail. While the Dems treat it as a primary issue, it's been more of a sleeper one for the GOP. But ultimately to solve this, Clark thinks all health coverage should be individually purchased -- not gotten through your employer. Healthcare costs would be dramatically lower under that scenario. You don't go to your employer for car insurance and you don't lose your home insurance because you lost your job, do you?

Small business owners and individuals are becoming more and more frustrated trying to get health insurance. Clark knows a man who is a health insurance broker with some medical issues. His ailments prevent even him from getting and keeping health insurance -- and this is his line of work! Insurance originally operated under a risk-pooling model: Everyone was in one huge pot and the healthy paid for the sick; the sick convalesced and paid for the next sick ones; and so on. Today insurers use a completely different method where they evaluate each individual or small biz. Past illnesses will "redline" you and you'll usually get the heave-ho. Insurers have been so rotten about this that that millions have given up trying to get coverage.

The irony is that now insurers are looking for individual and small business customers, according to Business Week. But their premiums are still so outrageous that they're not affordable to many small businesses. Another interesting fact: Most big companies offer health-reimbursement plans, not real "insurance plans." You may have a branded insurance card and a list of in-network doctors, but the "insurance company" is just serving as a claims processor for your employer. Big employers gave up on insurers providing affordable coverage and now assume the risk themselves. It now may be possible for small businesses, individuals and families to potentially find more affordable coverage. Take a look around because this is a new scenario in the marketplace. But pre-existing conditions or poor medical history may still redline you.

The health insurance issue has been a hot one on the campaign trail. John Edwards and other Democrats have been pummeling insurers over the way they've been treating people. Insurers and their GOP supporters in Congress must offer reasonable plans to individuals and small businesses that don't redline. The alternative is too frightening; every time another free-enterpriser can't get insurance because of past history, that's another person who starts to think that socialized medicine may be the answer.

Since the late 1980s, Clark has thought it's crazy that medications can only be dispensed when a doctor writes a prescription. Many other countries have their pharmacists write scripts and dispense the medication. The FDA is now considering adopting a similar policy. We're not talking highly addictive things like Vicodin or Oxycontin here; we're talking about two-week cycles of antibiotics and other relatively benign medications. Clark loves this idea. Doctors are already overworked and in short supply. Because pharmacists are very well-trained and knowledgeable about medications, it's almost a no-brainer to allow them to pick up some of the slack. The Los Angeles Times reports that Kaiser Permanente pharmacists already have the authority to write and fill their own scripts.

Pharmacists are a vastly underutilized resource. To treat them like clericals who just fill prescriptions isn't Clark Smart. The numbers of primary care doctors are down 50 percent, so empowering pharmacists to write prescriptions is one possible solution to the shortage. Clark knows doctors will be up in arms about his feelings on this issue, so he's ready for the fallout on the Clark Stinks forum! On a related noted, Minnesota has banned pharmaceutical sales reps from giving free gifts and meals to doctors. These kinds of sales practices subtly influence the brand choices doctors make when they write prescriptions. Now The New York Times reports that the pharmaceutical companies have come up with yet another tactic to influence the selection of scripts; they're wooing nurses and office managers since they can't get to the doctors anymore!

Navigating the healthcare maze can be an exhausting process if you or your family members are sick. Employers are starting to understand this and make healthcare advocates available to their employees as a free benefit. Healthcare advocates are usually former medical professionals who help people get what they need from the medical system. Right now about 3,000 employers offer healthcare advocate access. But very few workers even know they're entitled to such a benefit. Clark thinks of the healthcare advocacy phenomenon like he does expeditors. When you live in a city, sometimes you can hire an expeditor who knows the right people to contact to expedite any request. In the same way, healthcare advocates can assist you in getting to doctors and certain facilities that you might not be able to get into on your own. Of course, it goes without saying that healthcare should not be this difficult. Yet that's the reality. Healthcare spending accounts for 1 in every 6 dollars in our economy and it's not slowing down anytime soon.

Health benefits are becoming more and more expensive for employers to provide. The Dallas Morning News estimates that the average employee will cost their company $9,312 next year. In classic cost-shifting mode, your share is going to steadily rise too. Employer costs are up about 50 percent over the last five years, but employee portions are up around 60 percent! Healthcare accounts for 1 in every 6 dollars spent in our country. So this hot potato issue is only going to keep getting hotter. Clark advises people to pay close attention during open enrollment periods. You need to make the smartest choice you can. If you choose unwisely, you may have limited and expensive access to certain services should you become ill. The latest stats show that the average employee will pay $165 out-of-pocket every month in 2008. But Joel -- one of Clark's producers -- is 23 and can buy an individual policy for about $65 per month because of his young age. That's without any employer subsidy. Meanwhile, Clark at 52 years of age would be charged big bucks for the same policy. The cost rises as you get older. Yet older workers rarely call out sick unless they're truly ill -- unlike younger folks who take mental health days. But it all balances out because older workers tend to be out for longer when they actually do get sick.

Clark has to go to the doctor for a second opinion on a medical condition. When he made the appointment, he was told he'd have to bring a copy of his test results from his other doctor or have them faxed. Isn't it bonkers that in 2007 were still passing medical records around like it's the 19th century? We waste so much labor and time in the United States with how we process medical information. Clark previously talked about Revolution Health, a company that's been trying to update the process. Now Microsoft is spending a lot of money to bring medical record handling into the 21st century. Why is it that with all of our modern equipment we're still doing things by hand? There's no reason why Clark can't have a test and leave the doctor's office with an e-version of his results or password-protected results. The problem is that there's no financial incentive for doctors to modernize the way they process medical records. The insurance companies don't give them extra money for having e-files for all their patients. So Microsoft is also trying to come up with a system that would save doctors money. We'll keep you updated on their progress.

The recent GM strike highlights something important about healthcare benefits in our country. GM has historically been one of the most generous providers of healthcare to its employees. In fact, they've been so giving that employee and retiree healthcare has been something of an albatross around the company's neck. Now GM has worked out a deal to end the strike that's shocking: The company has agreed to put $35 billion into a union-run trust fund that will provide healthcare to retirees. By contrast, some small employers don't even provide healthcare and some entrepreneurs don't have it for themselves! On the other side is Wal-Mart, which is now offering better healthcare plans for its employees that start at about $100/year -- this from the company that's earned so much ire for its treatment of workers. Meanwhile, Wal-Mart has cut most of its generic drug prices down to $4. So when you go to the doctor, bring the Wal-Mart list of cheap prescriptions and ask your doctor if any discounted drugs would work for you before he or she writes the prescription. This will help you take control of your healthcare. Clark is a big believer in people taking control of this part of their lives. He doesn’t think that employers should offer healthcare to employees. He prefers that each individual or family should buy its own coverage. The future of healthcare in our country is going one of two ways: Either we'll have socialized medicine or people will have to provide it for themselves.

Clark recently read a story in The Wall Street Journal -- a paper he loves so much that his executive producer Christa calls it his "girlfriend" -- that reinforced a longstanding belief he's had about healthcare. About two years ago, the Netherlands privatized its healthcare system. The government has decreed that everyone has to buy health insurance themselves and that employers are not allowed to provide it. The insurance companies must offer it to everyone regardless of their medical history, and those who can't afford the premiums receive subsidies to help out. So now the Dutch -- who are some of the world's tallest and healthiest people -- have a flourishing private health market. So far the results have been very positive. Healthcare costs have declined significantly since the switch. When you put the consumer in charge, it changes the equation. Clark acknowledges that this experiment is still in its earliest days and that some problems may emerge down the road. But the insurers in our country are constantly alienating the consumer and pushing us closer to socialized medicine, which Clark thinks will be a terrible thing if we ever get there. Will the Dutch model ever gain traction here? Republican presidential hopeful/former Massachusetts governor Mitt Romney has already gotten heat over his adoption of some principles similar to what they're doing in the Netherlands. Only time will tell…

The healthcare question is a big one among presidential candidates. There's no one right answer to this question, but Clark knows that he doesn't like the idea of government-provided healthcare. If you ask the Europeans or Canadians who have government-sponsored health benefits they'll tell you they love it -- until they get sick and run into all the hassles associated with it. In our own way, we've moved closer to a parallel system. A recent report about the dermatology industry found that patients who want Botox -- which is not covered under insurance -- are seen much quicker than people who have a mole that may be cancerous. Why does this happen? Because the doctor's expenses to see the patient with the mole will barely be covered by an insurance company -- and the doctor's office will have to fight tooth and nail for whatever money the doc gets. But people coming in for Botox pay cash upfront. So the free market kicks in and the doctors treat those patients who will reward them the most financially. Now there's a trend among doctors who offer Botox, Lasik and other cash-only, uninsurable services to offer "no no no" plans: no payment, no interest and no down payment.

50 million Americans have no health insurance and are getting price-gouged by hospitals. One of the medical journals did a study that compares the prices for service paid by the insured vs. the uninsured. Those with coverage might get a bill that's $5,000 for a certain service. Typically they'll also have 20 percent co-pay, so that's an additional $1,000, for a combined $6,000 price tag. However, if you don't have coverage you will be billed $12,500 for the same procedure -- that's more than twice the price! What happens is that the big insurance companies cut deals with hospitals to reduce the amount they have to pay. Then they pass some of those saving on to their customers. But people without insurance don't have the same negotiating power and get stuck with the bill that's twice as large.

It's nuts that our system is upside down and backwards, especially if the goal is to move toward consumer-driven healthcare based on quality of service and price. Clark thinks there's no excuse not to have price lists at your medical provider. Medicine suffers from lack of financial transparency -- you can't comparison shop because you don’t know the price of any of the services you're going to receive. One insurance company is tackling this problem by ranking hospitals and doctors with green, yellow and red colors to tell you how much out-of-pocket expense you'll have. But we really need to be able to shop for medical care by price. Medical care accounts for 15 percent of our total national wealth each year. Of course, people are getting better health care, but Clark still has the feeling that we're squandering that 15 percent. After all, we spend more on health costs per person than any other country, yet we have shorter life-spans and are not as healthy as citizens in other nations. We're spending so much, but getting so little back. The reason is because medicine is largely not run like a business; Dentistry and Lasik eye surgery are two areas of the medical profession that are run like a business. The experiences in those offices are great because the services are driven by modern technology and the marketplace sets the price. They're great with customer service too, providing prompt appointments because they have to compete in a real marketplace.

About two years ago, Clark first started talking about clinics where you can go to see a medical professional without an appointment. Big retail chains like Wal-Mart and Target sometimes have such places on premises. What you usually do is speak with a nurse practitioner, not an actual doctor. But they're affordable and a good choice if you have a very routine medical concern. The drugstores chains have also jumped on the idea of these in-store clinics because they help create an instant market for their own pharmacy counters. The latest development now is that Wal-Mart has announced plans to establish 2,000 of these "doc-in-a-box" practices in its stores.

Clark loves the idea of having a one-stop shop option in the medical field. Up until now, the medical profession has been very slow to embrace change in the marketplace. That's why the healthcare experience for the average American includes going to the doctor's office across town, getting a handwritten prescription and then running all the way back across town to the pharmacy just to wait to have it filled. That's a very inefficient process that's not customer friendly. This new wave of in-store clinics promises to help shake up the medical field. And because they take up very little real estate in a retail store, Clark believes they're the wave of the future. Whether it's a good or bad future remains to be seen; at the very least, the clinics will help alleviate the crunch in hospital emergency rooms.

Not very long ago, Clark mentioned that people from the United States are now going to Mexico for dental care. That discussion sparked some unfriendly response. Now London's Financial Times has done a report about the medical tourism trend. People are going overseas to Thailand and India to save money on surgeries. The number of Americans going overseas is rising 20 percent per year, according to the report. The savings can be extraordinary -- up to 75 percent. The big question is, "What kind of care will you get overseas?" While the quality does vary, many third-world countries have first-rate hospitals that cater to foreigners. The Financial Times reports that Singapore is the best place to go for overseas medical care that is roughly equal to American care. You'll still save substantial amounts there -- up to 50 percent off -- and have a private nurse for 24 hours a day. While Clark admits that he is a medical idiot, he does believe that if you are grappling with the cost issue alone you should consider this option. There are now medical tourism businesses that handle accommodations, finding doctors and all the other logistics of getting care abroad. Be sure to vote in our new poll when you visit our homepage and tell us what you think about this emerging trend!

If you’ve ever been sick, health insurance companies have no interest in having you as a customer. You’d think it would be the other way around since insurance is supposed to provide financial protection by pooling money. But health insurers only want to ensure the healthy and, therefore, are looking for ways to boot people with illnesses. Some insurers in California are even going back and reviewing people’s medical histories in an effort to kick them to the curb. For instance, they will review a person’s medical history and compare it to their application for insurance. If someone forgot to list a cold or left something out of the application, that company will claim the person committed fraud and kick them out. Kaiser Permanente is the only insurer in California that isn’t doing this, and the rest of the companies are furious at KP because of it. Clearly, the insurance industry wants to collect premiums but doesn’t want to ensure people. This could lead our country down a path to socialized medicine and that would be terrible for the country. Insurers will have to live with causing that decline unless they change their behavior.

A new report out on health coverage shows that about 50 million Americans have no health coverage. That’s about one in six Americans. The percent covered through an employer plan is just about 50 percent. So, the number of people moving away from employer-provided plans is increasing at the same time. People no longer spend their working lifetime in one job, so employers are steadily reducing the amount of coverage they offer employees. The problem now is that we don’t have a health care market for individuals and families in America. People are reluctant to start businesses because they don’t know how they’re going to get health care. And that hurts the economy. Yes, health care is morphing into more of a personal responsibility, and we need to realize that. If Clark had his druthers, individuals could buy coverage based on their age and the area in which they live. It’s called community-based health care. It will help those people who have no coverage and save us from socialized medicine.

Clark talked recently about the new law in Massachusetts that requires everyone in the state to have health insurance. Well, the legislation has been made even stronger because the governor used the “line item veto” power to keep the system in the hands of individuals, not corporations. Yes, the government plays a role, but that is okay in Clark’s opinion. That’s because if everyone has to have insurance, people who pay don’t have to cover for the people who don’t. So, Massachusetts has offered insurers a giant health market to sell to and has made it more clear what must be covered. Who knows if it’s going to work, but it’s a great start in the right direction. Lower income people who normally wouldn’t be able to afford insurance are subsidized by the government so they can afford it. Still, the responsibility of payment and what coverage you want comes down to the individual. And that is what people in all states need to be doing.

Massachusetts sets an example of what we need as a country in terms of health care insurance. Hear what Clark has to say about it. Just remember to turn off your pop-up blocker.

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.”

Health care costs are eating up our country’s resources as we spend more each year, compared to other developed countries. Not to mention the fact that the level of care is mediocre. So, the Governor of Massachusetts has been working on a universal health care plan that could possibly change the course of health care. Governor Mitt Romney, a Republican who has presidential ambitions, is trying to make it mandatory for everyone in the state to have health coverage. It’s not socialized medicine, but Romney’s idea would require every resident to have a private health insurance policy just as every driver needs a license. People of lower incomes who can’t afford an entire policy would be subsidized by the state. It would be the end of employer-sponsored health care, which scares some people. But Clark says hallelujah! People stay in bad jobs because they are tied to their health plans, and those plans are often marked up significantly. People are focusing on solutions in Massachusetts, which is a great thing.

Clark has a warning for you about your health care plan at work this year. Many companies are switching to “active enrollment” this fall instead of automatic enrollment. In the past, if you weren’t making a change, you simply did nothing when you got your enrollment forms. But with active enrollment, you have to re-register or you may lose benefits, have higher premiums or be put in a reduced-choice plan. It saves the company a lot of money because people forget about registering. So, the spirit of the plans is becoming very unfriendly. You need to know the ropes and know how your plan works.

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The positive flip side of this is that more and more large employers are offering on-site medical clinics. It’s voluntary and usually free to use the clinics, and it saves the company money as well. This is great news for people with chronic illnesses like diabetes. They are more likely to see someone close by than to make an appointment and travel to a doctor’s office. It’s paternalistic, but the company is able to help you stay on the straight and narrow while keeping costs low.

What do you do if you’re an independent contractor with a company and you need health coverage? Well, a number of large companies have come up with the idea to create limited low-cost health benefits for part timers and contractors. The group is called the HR Policy Association, and there are 250 of the nation’s largest employers involved. The first companies have now started launching their programs and that speaks to the need to buy individual health coverage en masse. The idea is that your premium is based on your age and gender. And, people in the plan get to speak to an advice nurse before they actually go in to see a doctor. There are a number of price levels, depending on how much coverage you want. It will eventually be available in most states, and Clark hopes this kind of insurance becomes the standard way health care is distributed. Our health car system is in need of serious help right now, and we need to figure how to make it easier for people to get it. Kaiser Permanente has a system similar to this that puts people in five different tiers based on age and gender. Why are large employers doing this? It will ultimately lead to lower insurance costs for corporate America. So, it benefits you and them.