ABSTRACT In the United States, employer-sponsored health insurance is in great danger of becoming less effective due to an escalation of health care costs and a rapid increase in international trade, not withstanding the Health Care Act of 2010. Most working Americans obtain their health insurance through their employers. Rapidly rising health costs are such that employers often attempt to reduce their impact by shifting as much of the costs as possible to employees. At the same time, many American employers compete with international businesses that have much lower wage levels or operate in countries characterized by an existing broad based national health system. These foreign companies are, therefore, far less affected by health care costs. The leaders of many major U.S. industries acknowledge that health care costs are putting their financial structures in jeopardy; nevertheless, many still stand firm against any major change in the U.S. health care payer system. The foreign company advantage affects U.S. exporting companies as well as those U.S. companies in competition with imports into the U.S. from other nations, which includes most American businesses. U.S. exports often cost more to produce than similar goods produced in the U.S.'s major trading nations. Imports into the United States are usually sold at prices lower than U.S. produced goods. While this is not all bad, it does put some businesses and most American workers at a disadvantage. Imports plus exports is now about 30% of Gross Domestic Product. This very large figure poses a tremendous handicap to American commerce and labor.