The private health insurance system is not working well, but it can be changed so that insurance companies will insure risk rather than avoid risk, says Rep. Bill Gradison (R-Ohio). The ranking member of the Health Subcommittee of the House Ways and Means Committee, Gradison served as vice chairman of the Bipartisan Commission on Comprehensive Health Care (the Pepper Commission). At HFMA's National Convention in June, he received the Board of Directors' Award, an award established to honor persons or organizations who have contributed materially to the healthcare financial management field. Recently, Gradison spoke with HFMA President Richard L. Clarke, FHFMA, about rising healthcare costs, the structure of the U.S. healthcare system, and proposals for reform. Following are highlights from the interview.