Conservatives' Health Care Reality: Not Wealthy? Fuck You! "Your individual rate reflects a combination of what Blue Shield pays for healthcare, as well as factors that are specific to you in particular, the product you purchased and your age." That may be true. But it also reflects a healthcare system so wildly out of whack that adequate insurance is quickly growing out of reach for all but the wealthiest Americans. And with coverage remaining primarily in the hands of the private sector, it's unlikely prices will come down significantly even when the bulk of pending healthcare reforms take effect four years from now. At that time, individual policies will be offered through "exchanges" intended to promote competition.