I am the managing partner of an 11 attorney commercial real estate law firm, with 17 employees in all. We have always provided individual medical and dental coverage for our employees free of charge (actually, $1 per pay period, which we charge solely to avoid a quirk of enrollment procedure that would require us, if we did not charge anything per pay period, to enroll any employee who signs up for the plan after they are first employed -- for example, because a spouse's coverage lapses -- back to the first day of their employment with us, even years earlier in one case, and even though they were covered under their spouse's insurance during that same period . . . one of a million examples of how ridiculous and eff-ed up the current system has become, with its bizarre rules, private insurance underwriting practices, claim denial practices and other flaws).

Anyway, we have always paid extra for better coverage (although the recession and real estate bust of the last 12-18 months is testing our ability to continue doing that) and we had been using a fairly well known insurance company PHCS plan, which was some of the best health insurance available, until 2007. That coverage was really excellent, particularly good with alternative treatments (e.g., acupuncture, chiro), mental health coverage, etc. But by the end of 2006, a family policy in our plan cost $36,000/yr, and individual coverage was just over $12,000/yr, which was almost three times what we were paying when we started with the same plan 9 years earlier (15-25% premium increases annually, like clockwork). Our employees had to pay $24,000 annually to cover their families by the time we switched to a less expensive plan because our love of the coverage was outweighed by the ridiculous cost involved. So switch is what we did -- to a reasonably upper end plan run by industry giant Blue Cross Blue Shield (Carefirst) which left our benefits mostly unchanged (some increase in deductibles, a pretty hefty increase in prescription drug co-pays from $4 and $8 to $15 and $30 in patient responsibility, a little less benefits for alternative medicine and mental health, and a $2 MM lifetime cap). The change hit the people who used the plan for an increased patient contribution, which seemed fair to us, and our people could now afford to get the family coverage they needed for a little over $10,000 annually (instead of $25,000). And the switch literally brought the firm's annual premium cost down by half, which helped us to avoid firing people when the economy got ugly in 2008. The BC/BS coverage is typical, with a lot of paperwork, a fair degree of claim denial that the patient must weed through to get reimbursed, and yet another set of rules and procedures. Fortunately, because we have more than 15 employees, Maryland law protecting small businesses requires the insurance companies to comply with certain mandated requirements -- for example, it is illegal in Maryland for an insurer to deny coverage for a pre-existing condition . . . but only if your company has more than a certain minimum number of employees and is covered by the legislation. Those are the types of things the federal legislation will mandate nationally, which is a very good thing

In my mind, Obama has it dead right. We need a single payer system to be able to afford universal heath care as a society, and we have a moral responsibility to do that. But we can't simply change from what we have now -- many different plans run privately -- to a single payer system without a 5-10 year transition (that will involve a trade off where hte citizens get less than the full loaf we need in exchange for the ability to get it done politically before its too late). Once in place, the transition to single payer (with private augmentation for those who want it) will be much easier, because fear of a broader single payer system will fade once people see that the public option is not some Orwellian system epitomized by death panels and fascist images. The public option is the key, which is why the insurers and pharma companies are fighting it so violently. With a public option, a singel payer system (call it Medicare E) will emerge that mandates a minimum level of benefits for everybody, but which allows people to purchase private insurance enhancements, etc., to enable freedom of choice on a level resembling what we have today. Rich people have always been able to buy more health care with their superior resources, and I don't really have a problem with that, as long as everybody has a minimum level of coverage nationally that is at least excellent (using Mayo as the model of well managed care).

As an employer, I see the public option as a means to bring costs down further without reducing coverage appreciably, and to help lead us to less paperwork, and less variation from plan to plan in practices and procedures, so that doctors and patients alike do not have to wade different mazes of obstacles and landmines established by each carrier to make it more difficult, and less likely that a patient or doctor will actually be reimbursed in full.

Finally, I think the degree of vitriol and antagonism that now epitomizes this debate has two clear components -- first, I see a political component, championed by right wing media figures (radio, Fox, etc.) and GOP leaders, which is aimed at making this issue the one we they use to bring Obama back down to earth, or better yet (in their minds) to destroy his presidency altogether; and second, I see a corporate component, which is about industry using vast resources to twist and distort an issue in order to defeat something that will cost them billions in windfall profits, to be accomplished by taking people whose fear and hatred of Obama is so strong that they will believe the lies that are being perptrated, and to use a media that is bought and sold by those very corporate interests to make arguments that are complete lies seem legitimate, thus making it seem increasingly more likely that these hate filled crazies may actually act upon their ignorant beliefs in violent and horrible ways (see, e.g., recent calls by some teabaggers for supporters of their movement to bring handguns with them to the Town Halls and protest rallies, to show us liberals what American values are really all about, even if they have to drive that point home with hollow point ammunition).

It's a crazy, disgusting, disgraceful, and quintessentially American piece of political theater, and as an employer struggling to make it through 2009 without firing people, it makes me sick to my stomach to see the waste of energy that is taking place here, with conservatives being incited to violent and disruptive protests in the name of lies being perpetrated by those who stand to benefit if reform is defeated, and with a media that is apparently unwilling to call a false statement a "lie" (no, the false claim that Obama's plan involves death panels and a higher likelihood of euthanasia is described in the NY Times, no less, as a "questionable claim" and not a falsehood or lie). Anyway, that's how one employer feels about it.