Kathy Locke, like so many other self-employed small business people, is feeling the pinch. She has run a successful small advertising business in Novato for 20 years. It is a labor of love, with Kathy’s hours definitely not 9 to 5. Her husband is also self-employed, a contractor.

Kathy and her husband have always taken care of their own health insurance, and have managed well enough. They have not had major health problems.

In the past seven or eight years, however, she has watched her premiums creep up, and then rocket up. "I’m 52 and my husband’s 53," she says. "As we’ve gotten older, our premiums have started to double and triple."

Not that long ago, Kathy’s premium under Blue Cross was $120 a month. Now it is $420 a month. She has to multiply that figure by two to include her husband, and they get no dental or vision coverage. The deductible is $2,500 a year per person.

It’s a classic squeeze, similar to what other self-employed and small business people are enduring. There is something basically wrong with an insurance firm or anyone else making a customer pay more money for fewer services. But that seems to be the way the bizarre health care system works in California.

What can Kathy do? Not much. She is thinking of changing to Blue Shield, and taking out a higher deductible, which will bring the premiums down a bit. She could just drop all coverage, but when you are on the far side of 50, the notion of not being covered at all seems less and less realistic, even if you are, as Kathy describes herself "at the end of the hippie generation" – a generation that once disdained such things as insurance coverage. Of course, they were young then, and now they have to consider that "something really serious" could go wrong, as Kathy puts it.

So she and her husband will continue to try to scrape up the money, while staying healthy and hoping nothing goes wrong. The extra money going to health insurers will of course come from other places. "When you go to the grocery store, you buy less food."

Kathy understands that the health insurance crisis is damaging all kinds of people. She has no answers as to what to do about it under the current rules and regime. Perhaps, she thinks, something drastic – by U.S. standards – should come into being. "I think there should be universal health care."

Until that happens, she and tens of thousands of other small business owners and self-employed people will pay more money to medical insurers for poorer care.