To the editor:

As someone who started a small business 12 years ago and has seen our firm’s health care premiums skyrocket while our co-pays declined precipitously over that period, I would like to offer a related perspective on the current debate regarding public options and private insurers.

Despite the hard work of our health care providers, we pay more for health care but get less than citizens of other countries. What’s the problem?

To convince voters that insurers are not part of the problem, private insurers have recently reported very small profit margins. But if these numbers are accurate in the face of skyrocketing increases in premiums and declining benefits, then these companies are incredibly inefficient and should lay no claim to the efficiency benefits they are trumpeting in the media. If, on the other hand, they are efficient, then their figures must be masking huge expenses related to executive salaries, bonuses, marketing and PR expense, lobbying, etc. And if such expenses account for their apparent narrow margins, then the managed care organizations have even less claim to the high ground in the current debate over health care reform.

I have no doubt that employees of the private insurers are capable and well intentioned, but the time has come for the insurers to support their claims of efficiency and efficacy, not via clichés and scare tactics, such as references to “socialized medicine,” but by performance-based data. And the time to do this is now, while public option and other possibilities are on the table.