is to survive by making a profit. The biggest driver of job creation in America is small business. For quite a few businesses, the cost of providing medical benefits (typically about $4,000 to $6,000 per employee per year) is more than they can afford. If forced to provide those benefits, they'll either go out of business or have to shed employees. Either way, the employees lose.

Believe it or not, you can go to a doctor without health insurance. Very often, you can negotiate with a doctor for a substancial discount if you pay your bill immediately because they don't have to go through the weeks long effort of getting paid. Imagine that, doctor's bills being treated like any other expenditure!

The outsourcing issue has gotten quite a bit of attention this year but has actually been going on for decades (just go to any small town throughout the South and you'll likely find a closed textile mill). In recent years, some 1 million American jobs have been outsourced to places like India. At the same time, some 6 million other jobs have been created by foreign companies here, including Honda, Toyota, BMW, Mercedes, and the like. Effectively, we've become Japan and Germany's India.

We could try to set up some protectionist policies to stop the flow of American jobs overseas. However, if history is any guide, other countries will likely follow suit. Protectionism is one of biggest drivers that turned the 1929 stock market crash into a global depression. Been there, done that. Got the tee shirt. Don't want to do it again.

The idea that employers should pay medical benefits dates back to WWII. At the time, companies were competing for employees and also had to comply with federal wage controls, so adding benefits was a way to attract employees. This practice continues to this day. Companies that have the resources can invest in their employees by including medical benefits, education benefits, training, etc. Those that lack the resources are at a disadvantage when it comes to attracting and retaining employees, but they have to face economic reality.

One recent change to the law that might help is Medical Savings Accounts (MSAs). People can put up to several thousand pre-tax dollars a year into their account and use it to cover things like routine office visits, drugs, etc. Hospitalization is covered by an insurance policy with high deductables. Any money in the account that isn't used in one year can be rolled over to the next year (I wish my flex plan would do that). It isn't a perfect solution, but it seems a good step forward.