MONROE — Carl Spencer launched a start up cabinet company with just two employees in 2005.

Now Spencer LLC has a payroll that has grown to 13 employees.

With three to four years of steady growth, Spencer decided this year for the first time to provide health insurance for his workers.

“We were worried about starting it and not being able to afford it and we didn’t want to start and stop,” he said.

Spencer said his initial reaction to the Supreme Court’s decision on the federal Affordable Care Act was “great anxiety.”

The best way to explain his reaction, he said, was to compare it to his former work in computer programming.

“What I found was if you try to just sit down and start coding and come up with a program from start to finish, you have a lot of bugs in it,” he said. “And when fixing the bugs, after a while it dawns on you that in order to fix one bug, generally it generates unintended consequences.”

Rather than making sweeping changes, he would have preferred laws making smaller incremental changes in the federal health care law.

“It has nothing to do with the social need for good medical care,” he said. “It just has to do with how systems work.”

As a small businessman, he said he’s found that things work best when competition plays a role.

As one example, he said he’s watched as the cost of Lasik eye surgery, a procedure generally not covered by health insurance plans, dropped to as little as $599 per eye, from $2,000 an eye.

Spencer said he can’t buy insurance from any company outside Washington.

“There’s only a handful of suppliers,” he said. “If all these guys had to compete against each other like the cabinet companies, then the price would go a lot lower.”

He’s also frustrated by a system that generally doesn’t tell a patient in advance how much a particular procedure will cost.

“We have to foster a culture of responsibility,” he said. “It’s hard to do that unless you know the cost.”

Too often, people don’t put enough attention on steps they can take to prevent illness, he said. Over the past five years he said, he’s offered to reimburse employees for the cost of a flu shot, but few take him up on the offer.

In a small business like his, the absence of just one employee can have a big impact on production.

“We make a commitment to our customers,” Spencer said. “You bet I want them healthy — for a whole bunch of reasons.”

Sharon Salyer: 425-339-3486 or salyer@heraldnet.com