When Clark talks about improvements in the economy while you or a loved one remains unemployed, he knows his words can ring hollow or even hurt. It's like, "What about me?" It's one of those cruel facts of life that jobs are generally a lagging indicator of economic recovery.

The length of time of unemployment in the Great Recession has been the longest in memory. You'd have to go back to the 1930s to find comparable stretches of joblessness.

With that in mind, there is a new extension of jobless benefits for 99 weeks in select states.

These states include Alabama, Arizona, California, Florida, Georgia, Idaho, Illinois, Indiana, Kentucky, Massachusetts, Maine, Michigan, Mississippi, Missouri, Nevada, New Jersey, North Carolina, New York, Ohio, Oregon, Pennsylvania, Rhode Island, South Carolina, Tennessee, Washington, Wisconsin and West Virginia.

In related news, the federal subsidy of COBRA has a special one-month extension through the end of March 2010. Good news for those who have been laid off and need to continue their health coverage at a discounted rate.

COBRA allows you to extend health coverage after you leave an employer. Traditionally, you had to pay 100 percent of your insurance costs (minus any employer subsidy) plus a two percent administrative fee. That high cost made it prohibitive for many.

As part of the economic stimulus package, the federal government began paying about two-thirds of the cost for individuals who lost their jobs. That program ran out at the end of February and has now been extended through March 31, 2010.

Contact the Department of Labor or call 1.866.444.3272 to see if you qualify.

Finally, remember that our nation's joblessness is not a permanent situation. We're just waiting out the economic cycle; the jobs will come back.

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)

Since the late '80s/early '90s, Clark has been receiving calls from people in dispute with their health insurers about "reasonable and customary" charges. This is a tactic used by insurers to shift costs away from themselves and onto consumers.

Say, for example, your doctor bills your insurer $100 for a procedure. Typically, the insurer might cover 80% and you would pay 20% after meeting a deductible. But using the guise of "reasonable and customary" charges, the insurer goes back to the doctor and says it's only reasonable for him or her to have charged $50 for the procedure. Suddenly, the insurer is only paying $40 (80% of $50) and you get stuck picking up the remaining $60 tab.

In a massive conflict of interest, insurers were actually using an internal database to calculate what level of reimbursement they would give out-of-network providers for reasonable and customary charges. A new settlement between UnitedHealth and the state of New York, however, will change all that.

Under the settlement, UnitedHealth will pay $50 million to build a more transparent database. In a predictable move, the company admitted no wrongdoing whatsoever.

If you're locked in an ongoing dispute with your insurer, Clark advises the following: Go to other doctors in your area and ask them what they would charge for the procedure in question. That will build a consensus to show that the charge should be closer to what your doctor says instead of what your insurer says -- and that gives you leverage to negotiate.

Hospitals across America are doing covert "wallet biopsies" to deny life-saving treatment for patients, according to BusinessWeek. This is even happening to those patients who have insurance!

In a wallet biopsy, the hospital takes a separately purchased health credit report and then factors in your income, insurance and level of debt. The goal is to gain a profitability index score on you so they can determine how to handle your individual case.

If your index score is too low -- meaning that your insurer is unlikely to pay and you're unlikely to meet your out-of-pocket expenses -- they won't treat you, according to BusinessWeek.

But there is a way to fight back. Many hospitals have non-profit status, which means that they receive massive subsidies from taxpayers in return for the promise to provide charitable care. Have a family member go directly to the hospital's administrator and threaten to challenge their tax-exempt status if they're not providing care to you.

Meanwhile, new figures show that the instance of cancer has had its first recorded drop ever. Let's hope this is a turning point and not just a statistical aberration.

After his initial misgivings, Clark now reports that the Massachusetts healthcare experiment -- where they've required all citizens to have coverage -- is working better than expected. Mitt Romney was viewed as pandering to the Democrats when he agreed to implement this experiment. But really he just found a good compromise.

Clark believes the Democrats are too fervent for socialized medicine, and the GOP is too dead-set on a free-market solution. Both parties are leaving the American people behind as they get into partisan battles over the healthcare issue.

In Massachusetts, the number of people with coverage is up -- and almost all of it is not the welfare-state stuff you might expect. Romney's plan effectively eliminated redlining and allowed people with pre-existing conditions to buy health coverage for the first time ever.

The Democrats were upset that the Massachusetts law made individuals responsible for buying their own health coverage. But Clark loves it. The GOP was upset that the state had to subsidize coverage for the poor. But Clark loves that too. After all, it frees up the emergency rooms and saves money because hospitals no longer have to write off the cost of treating uninsured people.

Of course, Massachusetts didn't get everything right. But the state put aside partisanship and blazed the trail into new territory. Their experiment provides a marker for other states to try to improve upon.

In related news, The Dallas Morning News reports that Bennigan's and Steak & Ale employees/former employees are out of luck with insurance and COBRA now that both companies have gone bankrupt. One woman who is in a late stage of pregnancy is uninsured and uninsurable for her delivery -- even though she's been paying into the plan.

Clark has long believed that employer-provided healthcare is not the way to go -- and this is a perfect example why not.

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.

Single-issue insurance policies are considered a rip-off by some consumer advocates. Clark also agrees that you should avoid them. Examples of single-issue policies include mortgage life insurance, cancer insurance and accident insurance.

In the case of cancer insurance, insurers use the power of the C-word to sell the policy. Years ago, people wouldn't even utter the word "cancer." They would just say that you had a malignant tumor, because a diagnosis was often considered fatal. But today, many people survive cancer. Insurers, however, have learned that they can still capitalize on people's fear of the disease.

Accident policies are a tremendous rip-off. The reality is that general insurance -- of the life, disability and/or health variety -- represents a better choice.

Mortgage life insurance, meanwhile, is also garbage. The premiums are about 10 times what life insurance should cost. The worst part of it all is that you're insuring the mortgage company, not yourself; mortgage life insurance pays off the lender in the event of your death! But your survivors likely will have more pressing financial needs at that time. That's why plain vanilla term life insurance would suffice in such an instance.

Finally, extended warranties on electronics are another example of single-issue insurance policies that you should avoid. Consumer Reports says that 1 in 5 laptops will fail in the first 5 years. Yet, on the bright side, 80% will go for 5 years without a problem.

Another reason why extended warranties don't make sense is that the laptop or HDTV you buy today will be obsolete in 24 months. You shouldn't insure rapidly depreciating commodities.

When you have a medical procedure, a bill is generated, the insurer pays a negotiated amount and you have your co-pay. That should be the end of the story. But right now there's a fight in California about who gets stuck with the tab. Doctors and hospitals are furious that they bill one amount, yet the insurers come back saying they'll only pay a fraction of it.

In the push and pull, the weakest player here is the consumer. The doctors and hospitals are trying to pass unpaid costs off to the patient through a practice known as "balance billing." Clark has no idea how this fight will go in the Golden State, but he'll keep you updated.

The real solution here would be for customers to know the cost of medical care before a procedure and shop accordingly. But we're nowhere near this being the case.

The Society of Actuaries finds that paying for healthcare is the No. 1 concern of workers, cited by 70% of people. Right now there's a stalemate with employers, medical providers and consumers all hating the system. The only ones who like the system are the insurers.

The problem is we don't have a marketplace where insurers are required to practice normal capitalism. Clark has long been an advocate of vouchers for healthcare. Insurers would then have to compete for everyone's business and there wouldn't be exclusions for pre-existing conditions. This is not a justification for universal healthcare; it's just a call for healthcare vouchers.

Healthcare is a hot button issue for voters in '08. But both parties are stuck in a prior decade with their views. We need to move into the future and vouchers might be one way to get the job done.

We often hear about how people are uninsured, but we don't hear about how they're underinsured. A lot of people have coverage, but it may only be minimal for some procedures. Figuring out what's covered and what's not is like reading hieroglyphics.

Smart Money magazine reports that consumers can really benefit by negotiating upfront for non-emergency care. The classic example of this is an uninsured pregnancy. The list price can be as much as 900% above what an insurance company can negotiate. The key is to negotiate beforehand; after the fact, you'll have no recourse.

Consumers need to know that the price difference from hospital to hospital is all over the map. So Clark's advice is negotiate, negotiate, negotiate. About two-thirds of people who haggle do get a lower price.

Whenever Clark gives this advice, medical professionals get hot under the collar. They often allege that he's turning medicine into Wal-Mart. But they need to understand that medicine is the only thing we buy that we don't know the cost of until after consumption. Doctors also need to know that a customer with a cash payment represents more money in their pocket than a negotiated insurance claim.

Clark recalls that before the "dot bomb" era, there were a lot of websites offering Internet price shopping and bidding services for medical care. They all went bust in the tech crash, but their time is coming again as consumers take on a larger portion of health costs. Having the ability to shop based on price makes perfect sense to Clark.

There is a scandal that's broken in a very unlikely place -- the Journal of the American Medical Association. Some doctors have been selling their names to be fake front people on articles running in medical journals. Merck ran 72 different fake medical review articles touting Vioxx, with endorsements from respected physicians. The doctors got $2,500 to sell their souls. It was never disclosed that they were paid for the use of their names. This is a true scandal because Vioxx actually harmed people. It amazes Clark that doctors allowed their reputations to be sullied for a relative pittance. So when you see an ad on TV for a hot new drug, you have to realize that it's just propaganda. Many times a generic or over-the-counter drug would work just as well.

In another disturbing trend, some medications are so expensive that they're being classified as Tier 4 drugs by the insurance companies. The new classification has priced low-income Medicare patients out of the market. The real tragedy is that T4 pricing has been applied to medications for chronic conditions like cancer. Clark wonders about the ethics behind the decision to reclassify a drug as T4. Be sure to let him know what you think by voting in the latest poll.

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.

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.

There are a lot of pseudo health insurance companies out there selling fake plans to employers and individuals. The Wall Street Journal reports that some 200,000 businesses have been taken in these kinds of rip-offs. Small businesses crushed by high premiums are very susceptible to the lure of cheaper health care. But when somebody gets sick, the insurance card comes back as a fake and all the bills go unpaid. This has been happening in state after state. Insurance is regulated by the states, not the feds, so the rip-off artists can just bounce around from state to state pulling their scams. What do you need to know to stay safe? First off, be wary if you get a pitch for a great deal with drastically lower premiums. But don't let your skepticism stop there. Contact your state insurance department and ask if a prospective company is licensed to do business in your state. Make sure the name matches exactly because sometimes the rip-off artists will use a name that's very similar to that of a legitimate business. Seniors also have to be especially careful of fake prescription plans. Once again, call your state insurance department to verify if a health insurance salesperson represents a legitimately licensed company. Preventative steps are the best medicine for your wallet.

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…

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.

One hospital system is now beginning to guarantee their work for 90 days. This is amazing that in medicine some are now beginning to stand behind what they do. Why hasn’t this been done until now you may ask? Well, medicine has always been considered different from other industries that must focus on customer satisfaction. Having warranties with a surgery is something we shouldn’t be surprised of, we should be surprised if they are not offering it. This kind of creative thinking in the medical industry could revolutionize it.

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.

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.

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.”

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.

There is a lot of confusion these days over what types of insurance you really need. There are only three. But first let’s discuss the kinds of insurance you don’t need. One kind of insurance you should never buy is credit life insurance, also known as “croak and choke.” Mortgage life insurance is the technical term. The salespeople pretend it’s a great idea, claiming that if you die your debts are paid off. But how important is it to pay off your debts when you’re gone? Basically, with this insurance, the bank gets paid off and gets your money instead of your heirs. In addition, the premiums are about 10 times as high as traditional types of life insurance. Mortgage life’s cousin is credit life insurance, and you are pushed to get this when you buy a car or other big purchase. These are sold as protection for you, but really they provide protection for the bank. So, it’s essentially like putting lipstick on a pig. Maybe it looks better, but it’s still a pig. Another popular item is the variable annuity. It’s almost never a good idea to buy one of these because there are monstrous commissions. What about cancer insurance? If you get cancer, you need health insurance and term life insurance, and that’s it. And, if you can’t work and need replacement of your income, you want disability insurance. Those are the only three you need. All the others you can chuck. What about your car? You don’t need rental insurance when renting a car, first of all. If you get in an accident, you’ll owe regardless of whether you have insurance. And usually your credit cards or auto insurance company has some type of temporary rental car coverage. PEC or “personal effects coverage,” which covers things stolen out of your rental car, is not necessary either.

Clark spoke with Rep. John Shadegg, of Arizona, today about his proposal for a new health care system that could end up making history. There are shocking disparities in the cost of health care from one state to another, and Clark doesn’t think that is fair or smart. Shadegg said the “old rules” of health care prevent people from getting health insurance. He would like insurance companies to get “qualified” in all states, instead of writing a different policy for every state as is required now. As a result, there only two or three insurance companies in each state and it drives insurance costs way up. For instance, insurance costs in New Jersey are about five times more than in neighboring Pennsylvania. So, New Jersey residents have had to apply for insurance in Pennsylvania under a family member’s address to get affordable insurance. Shadegg would like people to qualify for insurance wherever they go. It’s known as “50-state coverage” and it means that you’d continue to have insurance even if you move. And, in addition to being available in every state, companies that issue plans would still have to follow regulations in each state. If the company doesn’t honor claims in a particular state, that state could enforce the law. We’ll keep you up to date on what happens with the bill.

The Wall Street Journal has been doing a series of stories about a movement in the health insurance business that should be music to the ears of individuals. The industry has decided that its greatest profits will no longer come from giant corporations, but from individuals and small businesses. Many of the small companies are following Kaiser Permanente, one of the largest HMOs, into the individual health coverage market. The problem right now is that insurers are cherry picking people they want to cover. This move is a good one, but there should be a way to cover all people. The state of New York requires that everyone get insurance, but it doesn’t pinpoint plans for people depending on their health and age. Clark thinks that is too extreme. Kaiser, on the other hand, puts people into you’re in a certain category based on age. Every five years, people move into a higher risk category and the cost goes up. Clark thinks this is the way to go. It doesn’t solve the problem of lack of insurance for everyone out there. But it ensures that once people are in, they’re in.

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In other health news, Costco is now experimenting with providing insurance in Southern California. It’s a pilot program for self-employed people and students, and it’s designed to be 20 percent cheaper than traditional insurance for entrepreneurs. So, good things are starting to stir, but we need some ground rules for insurance companies that are cherry picking its members.

The shape of health care in the country keeps shifting these days. The term for it now is “cost shifting,” which means that costs your employer once paid for are now your responsibility. The bill for a hospital stay, for example, can put people in severe financial harm because their “portion” of the bill has grown. New data shows that the number of people working for companies that pay 100 percent of the premium is dwindling rapidly. In fact, only 18 percent of employers offer health insurance to their employees. So, there is going to be a huge shift in the medical industry and how people afford health care. The money has to come from somewhere. That’s why Clark thinks employers should no longer pay for our insurance. It’s backwards thinking, in his opinion. But, three generations ago, Congress decided to allow employers to take an unlimited deduction on their taxes if they provided health care for employers. It made the company the customer of the insurance company, not the workers. The system is broken and it needs help. For now, just remember that if you work for a company that has been generous with providing health care, get ready for a lot less generosity in the coming years. We need to buy our own insurance and companies should receive community ratings that help people choose. The alternative is socialized medicine, and we certainly don’t want that.

It’s become very hard for individuals and small business owners to find affordable health insurance. But the warehouse clubs are starting to offer very viable solutions. Costco Wholesale, for example, is offering its own branded health insurance for small group. Because of the buying power Costco has, the company can offer group buying power and better rates for groups. We’re talking about real health insurance policies, not just some slip to go see a certain doctor. The San Francisco Chronicle also reports that Costco is going to offer individual policies. The company is going to start this in California only at first, but it will eventually branch out to other states if it’s successful. We’ll see if it works. If so, Clark expects warehouse clubs to start offering HSAs (health savings accounts). This could be a terrific thing for small businesses and for our health care system in general.

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In other medical news, Target is starting to set up “Minute Clinics,” where people can stop in and see a nurse practitioner for certain ailments. If the problem is more serious, the patient will be sent to an emergency room. But people shouldn’t have to go to the emergency room for a minor emergency and pay extreme amounts. The cost at the Minute Clinic will be between $25 and $75. So, Clark commends Target and the warehouse clubs for their efforts to help consumers.

About 50 million Americans have no health coverage right now, and it seems like nothing can be done about it. The same number of people have no health care insurane in Mexico, but its citizens are taking a different approach. In Mexico, a man named Victor Gonzalez has opened non-profit clinics, complete with pharmacies next door. And he sells generic drugs that he makes himself. The people can see a doctor at the clinic without having insurance and they can buy drugs at his pharmacies for much less than what they'd pay at a brand name pharmacy. And, reports show the drugs are perfectly safe and effective. It’s a one-stop shop for people who normally would never be able to see a doctor or have access to the medicines they need. The clinics are doing so well that Gonzalez is up to 2,500 stores in Mexico, Guatemala and Argentina. And 800,000 Mexicans are going to his clinics each month. Maybe we should take a hint from Victor!

Clark has been pushing for more simplified health plans for many years. He’s also been an advocate of buying pools that can negotiate plan prices with companies. Well, it’s finally happening. People in the pool will be eligible for low-cost health care from a handful of plans. Employees from 60 different companies are in the pool, and policies will range from $5 to $300 a month. Sears, McDonald’s and GE are some of the companies involved. Plans will become available in April. To be eligible, you must be a part-time or temporary worker with no health care coverage, independent contractors, consultants and early retirees. This is exactly what Clark has been hoping for and he hopes more companies get involved.

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.

Clark gets calls every week about how to shop for and buy affordable health care insurance. In many cases, the callers are self-employed or the owners of small businesses. CareerJournal.com had a good article about this very topic, and Clark wants to share that with you. The Feds have put together a glossary of definitions that help you navigate through this confusing industry. For instance, you may have heard of POS plan, or you want to know what HMO and PPO really mean. This list tells you all of that. You can find it at ahrq.gov/consumer. Another one Clark really likes is ehealthinsurance.com. Clark believes it is the best site for shopping for health care insurance. Another one that has gained popularity is healthchoices.org. Clark had not heard of this site, but it’s supposedly very good for deciding whether a provider is okay. Also, you may know that each state establishes its own mandates for health plans and what they must cover. It’s different in every state, and insurers go bonkers trying to figure out how one state requires something but another doesn’t. Health insurance costs are influenced somewhat by these state mandates. But there is a guide on the Internet showing you what each state must cover. That site is called healthinsuranceinfo.net. The exception is if you work for a large employer, in which case none of the state mandates are relevant. That’s because these employers don’t provide you with health insurance; they provide you with health coverage. It’s what’s known as a “self-insured plan.” Employers with 1,000 or more employees are almost always self-insured. So, the state rules do not matter, Instead the plans are governed by a federal act known as ERISA (Employee Retirement Income Security Act). Under that plan, the employer can cover whatever it wants and change the health plan at any time. The states can’t say anything about it. If Clark were the emperor of health care coverage, he would end state control of health care coverage and create federal standards. We need some form of national or international system that is easier to understand and uniform. It would offer a certain number of policies and the consumer chooses how much coverage he or she wants based on how much you’re willing to pay.

Health care costs have taken a bigger and bigger chunk out of our pockets in recent years, especially if you have employer-provided insurance. The most recent data shows that our individual health care costs are up 11 percent in a year. That’s the fourth year in a row of double digit increases. The average family now pays more than $10,000 per year in health care costs. So, things seem pretty hopeless. But there is an answer on the horizon. It’s called an HSA – or Health Savings Account. With an HSA, you have a deductible of $1,000 for individuals and $2,000 for families. So because the first $1,000 is coming directly out of your pocket, you’re going to be more careful about what you spend. You may ask for cheaper or generic brands of prescriptions. And, doctors, if they are smart, will start holding peak and off-peak hours to accommodate money-conscious patients. Medicine is really a fake business right now because there is too much fuzziness about who pays for what. The new system may force medicine to adopt a price conscious approach because the patient is also making the decision. You basically have high deductible health insurance and the rest of the money goes into a tax free savings account. So how do you sign up for an HSA? This fall, you have a 50 percent shot that your employer will offer you an HSA. And in the next year or two, 80 to 90 percent will offer these plans. As for the savings plans, ehealthinsurance.com is offering free accounts. They will work just like regular savings accounts. And, if you change employers, you take your stash of cash with you. Aetna and Signa are already on the HSA bandwagon, so it will soon be an option for you!

In the late 90s, Clark was part of a contingent pushing for a “Patient Bill of Rights.” Clark has always been a fan of this type of bill of rights because HMOs and managed care plans offer patients very few rights. But Congress could never get it together and overcome the power of the health insurance companies that bought their influence in Washington. Then several states passed their own “patient’s rights” laws and they seemed to have real teeth to them. Things were looking up. But then managed care companies fought tooth and nail to stop these laws. Finally, it has reached the Supreme Court. Unfortunately, the court ruled that the rules of ERISA, the Employment Retirement Income Securities Act of 1974, outlawed any other rules or state laws. Despite the fact that HMOs didn’t exist in 1974, the court upheld the federal law saying managed care plans could deny someone care if they wished. Clark thinks it’s a perversion of the law because it means HMOs are above the law. And it’s becoming a serious campaign issue. Clark hopes future politicians realize that consumers should be able to buy their own health insurance. Right now, most people get their health insurance from their employer, which means that either the government or the employer is the buyer. It removes individuals from the process and keeps us under the thumb of these companies.

There are a lot of things we don’t have a clue about when it comes to health care in the United States. But there is some movement in making a difference in the future. General Motors, the nation’s largest automaker, is at a massive disadvantage to Japanese and European carmakers because of the huge health care bills the company must pay. The company could spend billions on making new car models but instead the money goes to current and retired employees. The company wants it to stop, and so does Clark. We have spent about 15 percent of the country’s wealth on health care, while other countries spend about nine percent. So GM has banded together and set up a co-op that will make pharmaceutical companies compete with each other for GM’s business. It’s a great idea.

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In other health care news, Florida has passed a law that requires hospitals to tell you how much procedures will cost. In emergencies, of course, it’s not possible. But most surgeries and treatments are not emergencies. It’s the first move like it in the country, and it makes great sense. Hospitals will also have to provide estimates to customers. Yes, you are a customer! We’re moving into the era in medicine when humans will be treated like customers. With all of these services, the quality of treatment is sure to improve. It’s what happens when you allow free markets to run their course.

There is a real distortion in the health care market today. Seven out of 10 businesses, with fewer than 10 employees, cannot get health care insurance for their workers, according to the Chicago Tribune. Many of them are part-time employees or are independent contractors who don’t “qualify” for coverage. It ends up hurting the nation’s economic strength because many of these small companies are the driving force behind our growth as capitalist society. Thankfully, 50 of the nation’s largest employers recognize this disconnect, so they have come up with a plan to help. They are interested in creating a co-op or coalition for these workers so that they could get coverage more easily. The concept is to create a single pool of uninsured workers and then – in September – seek bids from health care companies. The coverage would then start next year. Sears alone has more than 100,000 people who would be eligible for this plan. So, Clark hopes the idea works. The companies participating in the co-op are essentially saving themselves and the general public money by bringing more people in the insured market.

Weight has become a huge issue with health insurance companies. People who are overweight already pay upwards of 40 percent more than people of normal weight. But now health insurance companies are talking about raising your rates if you are prone to obesity. According to the Wall Street Journal, insurance companies have started asking a number of questions about what you eat and how much physical activity you get. Based on your answers, and the possibility that you could gain weight, you may get clobbered on costs. Clark understands the smoking part. There is a direct medical effect and it’s a conscious choice. But some people are able to burn off calories a lot easier than other people, and it’s not a choice. Where do you draw the line? Should people who are prone to obesity also pay higher rates?

If you own your own business, you know how hard it is to get good, affordable health care. It’s a topic that underlies this year’s presidential election because people are concerned about affordable health care. Economists have proposed a new theory that the job market has remained so crummy because of the cost of health care. Companies that would normally hire people full-time are choosing to hire contractors and part-time workers because health care is so expensive. GM just announced that medical care for its retirees has just crossed the $60 billion mark. So, if it’s happening to the bigger companies, it’s hurting the small business owner even more. Families USA reports that people are also getting ripped off everywhere because they buy into phony health insurance plans that cost less. You may not know it, but Sam’s Club is now experimenting with group health insurance offerings for small businesses. They’re trying it in 10 states initially. They are: California, Georgia, North Carolina, Illinois, Iowa, Indiana, Missouri, Ohio, Tennessee and Wisconsin. So, companies with fewer than 100 workers will be able to try it out. If it works well, they will offer it in the other 40 states. The idea is people will have group buying power and will be able to participate in a PPO. And Clark is excited about this opportunity for you!

As the former owner of a business, Clark used to provide health coverage to his employees. And, although it seemed like a lot at the time, he was paying peanuts compared to what people are paying today. The expense and affordability of health coverage is a huge problem for people owning their own businesses. Prices have gone up so much that criminal rings are now selling phony insurance – at much cheaper rates - to these companies. A new report from Congress shows that 15,000 employers got duped by phony non-insurance companies. Bills would go unpaid, and finally the company would learn that there never was any insurance. Imagine if one of your employees got a serious or chronic illness and there is no insurance to cover it. It’s very easy to find out if someone is selling you real insurance or not. All you have to do as an employer is to call your state insurance department and ask about the company or supposed company. The criminals have been operating in three states in particular – Georgia, Florida and Texas. There have also been minor problems in Alabama, Illinois and New Jersey. There could be many other states out there with these problems and they don’t even know it. So, have your employer call right away.

You’ve probably heard Clark talk about Medical Savings Accounts or MSAs. These were health insurance plans that were available to people who owned their own businesses or worked for small businesses. If you had an MSA, you would have a high-deductible insurance policy coupled with a tax free savings account. It was available to a limited number of people for a limited number of years. So, it was ultra successful, but very limited. Now Congress has graduated the MSA program into HSAs or Health Savings Account, and there is no longer a limit on who can participate. It’s no longer an experiment and is now the law of the land. Consumers are having trouble finding information about these plans, however. But what we need to remember is that when something is signed into law, there is a period of “promulgation.” It means that Congress has to write the rules of the road about how it will work, and no one in Washington D.C. knows yet. Once the rules are published, you will start seeing more of these plans. But for now, we need to be patient. A lot of the plans being offered today are MSAs with the HSA name attached. So, you will want to pay attention to this. As long as you buy a high deductible plan of $1,000, you will be eligible to have a tax-free savings account with anyone you want. The other key component is that the maximum out-of-pocket expense is $5,000. Why is Clark so keen on these plans? Well, until now, we’ve never cared about what procedures cost under our plans. We just know that each year there is an increase in what we pay. But the patients have had no control over the pricing. But if we’re responsible for paying, we have a direct reason to care how much things cost. And the healthier you are, the more beneficial these plans will be for you. On the other hand, if you’re not that healthy, these plans will not be smart for you. We’ll keep you posted.

If you ask small business owners what is the hardest obstacle they face today, nearly all will say it’s the cost of health insurance. Based on a survey by the National Federation of Independent Business, nothing is even close. Taxes can really beat up a small business owner, but they do not cause nearly the hardship that insurance does. In fact, insurance has become so difficult to obtain that there are now some state and local governments that have tried to provide a partial solution to the health care situation. The real problem is that premium increases are being thrown our way even when no one is getting sick. So, small businesses are coming up with an alternative idea of their own. Small businesses are “self insuring.” Instead of having a health insurance company absorbing the risk of someone getting sick, you are your own insurance. If someone goes to the doctor, you as the business owner pay whatever portion of the cost that you’ve agreed to pay. But if someone gets really sick with cancer, heart problems or other chronic illnesses, you have a catastrophic policy that handles that coverage. So, you pay all of the ordinary expenses. Then you buy a policy to cover outrageous expenses. And, you pay an insurance company to handle all of the paperwork. The Wall Street Journal estimates that a company can save about a third of the cost of what you’re paying for health care. As an employee you need to consider a few things. If your employer goes to a health reimbursement plan, the state has no say-so over what benefits are offered and what claims are denied. So, you better trust the company you work for. But this is something to consider if you own a small business. We may be 10 to 15 years away from figuring out the smart ways to do health care. And the most recent addition is the HSA – or Health Savings Account. It’s a modified method that allows you to pay for most of your health care expenses out of pocket. Then, you have a policy for the bigger expenses.