In a free market economy the duty of the enterprise is to maximize returns to its shareholders.

An insurer charges premiums and makes its return after costs and claims are paid. Thus, to the extent an insurer can avoid insuring sick people, deny coverage, reduce or delay payments or transfer costs, it optimizes its returns. This leaves the uninsured sick to sign direct contracts with providers that put the entirety of their personal savings and homes at risk before care is provided.

The net of our current "free market" system is a tacit agreement between insurers and care providers. The insurers take the premiums and profits from statistically healthier groups while providers financially squeeze the uninsured and underinsured remainder into poverty or bankruptcy. The result is that nearly two-thirds of U.S. bankruptcies are health care-related.

Such a market allocation would ordinarily violate restraint of trade laws. Yet, our very laws and regulations are used as a shield to protect insurers and providers when coverage is denied and exhorbitant individual payment later extracted.

For example, in this past Utah legislative session, laws were passed with respect to insurance coverage requirements and exclusions for selected illnesses, thus legislatively allocating and regulating risk. In addition, the rules on patient record confidentiality allow insurers to obtain access to confidential patient information providing a basis for coverage exclusion. Yet, when coverage denial is challenged, these very "confidentiality" rules are used as a shield to deny accountability.

Insurance companies and providers maintain this protected position and cash flow by employing lobbyists and forging laws and regulations protective of their selective and limited coverage and maintenance of profitability. Insurers prefer the current system protected by existing law and regulation. This system allows insurers to take premiums from select groups such as the young and healthy while denying coverage to groups such as older and more at-risk individuals and the sick and infirm.

Insurers prefer the current U.S. employer-based system as it provides statistical assurance that covered groups will be relatively healthy. People with jobs are, by definition, not too ill to work nor incapacitated or suffering from the stress of no job and no income. The only fair health care regulatory system would spread the risk of illness across an entire population and a lifetime.

It is absurd that a working individual pay for health insurance coverage for 25 or 30 years, lose a job and, because of job loss, lose health insurance. An additional and significant intangible but real cost to our current health care system is the fear that now permeates our society -- a fear that we are weary of.

We are weary of the fear that job loss will lead to loss of health coverage and possibly to bankruptcy, weary of the fear of going to a doctor because, if found ill, subsequent coverage will be denied, weary of the fear in the eyes of young parents with a sick child not knowing if taking care of their child will mean that they can't pay the rent, weary of the fear that a lifetime of work and savings can be lost in a single illness.

These fears are no longer acceptable.

The only way to establish coverage fairness and health care assurance is community-wide rating that effectively spreads risk across the entire population and the entirety of life and ends the practice of denying individual health care coverage.

We have government regulation now. Let's move to a comprehensive system that benefits all and not the select few.

Andrew Buffmire has been an executive with two Fortune 500 companies and a senior executive with four wireless technology startups. He was an assistant attorney general over trade regulation and antitrust in the Utah Attorney General's Office and the primary author of the Utah Antitrust Act. He is a graduate of the London School of Economics.