As a self employed person I have to go out every three years or so and get a W2 job with a big company so I can get on COBRA, which is expensive, but affords far better coverage than I can get independently. What we need are large groups and choices creating REAL competition. The groups must and should be completely independent of the employer. An instance of an illness or injury should be covered for the duration of the illness or injury, provided the insured was covered at the onset regardless of if the insured is able to continue coverage. Far too many get injured, lose their jobs and then their insurance etc. The other problem we run into a lot is gouging, where a simple aspirin is charged at a rate of $5 each or prescription drugs cost $500+ a month where the same company sells to clients in Canada for a fraction of the cost. The other big issue, Cash clients are often charged many times more than insured clients, where Insurance should be reserved for ONLY catastrophic illness and regular care should be provided to ALL clients at the same rate. This would also go a long way to allowing smaller providers on the field.

Fines for not participating and reductions in existing coverage, higher taxes etc are not necessary IMO.