Most people who are employed get their medical insurance through their employer; it's been a large part of Corporate America for a long time: you work for a company, and one of the benefits provided is medical insurance. Your employer receives a great rate because your employer gets it for the entire company, thereby taking advantage of group rates.
If your'e self-employed, you get to pay for your health insurance and you don't get to take advantage of group rates since you're purchasing it only for yourself and your family. The group rates are a form of economies-of-scale; the term sounds as frightening as a spleen biopsy. It's rather innocuous; it simply means "cheaper by the dozen".
Suffice it to say, while your employer is providing medical insurance to you, it has come at an ever-increasing cost. It used to be a couple of decades ago, your employer paid the entire cost. When medical costs and thus the insurance to cover them began to rise in the 1980's, companies could no longer absorb the entire amount, so they passed part of it on to their employees. Today, this part is growing more and more. In order to remain competitive in a global marketplace, companies have had to pass a large part, if not all, of this cost onto employees. However, it's still a much better deal than if you had to go out and purchase it individually.
This means you've seen a further decrease in your purchasing power because you're taking home less, thanks to the fact your employer is having you pay more of the cost of your medical insurance, and is passing that on to you. Whew...the combination of a lack of an increase in wages and an increase in food prices combined with having to pay more for insurance should make for a real rosy picture.
Where will you find the money to pay for the increases in cost along with the flat income? Knowing where your money is going is the first step.