Wednesday, July 8, 2009

Six Ways to Fix the American Healthcare System

(BUSINESS WIRE)--The fever for healthcare reform is running high in Washington, D.C., and politicians are lining up on both sides to offer “treatment plans,” says Samuel H. Fleet, president of AmWINS Group Benefits. He adds, “But policy makers are missing many of the key opportunities to address what is really broken about the system.”

Today, Fleet released a healthcare reform position paper, “The Six Ways to Fix Our Healthcare System,”, which chronicles the main issues that should be clearly addressed for healthcare reform to truly make a difference.

Summary includes:

1. Restore Competition in the Marketplace

The four largest carriers in the country have 99% of providers in the network and in most states, the #1 carrier has 60-70% market share. Fleet comments that “in any other industry, this would raise antitrust issues, but for healthcare, no one seems concerned.” His solutions – break up the BUCA monopoly (Blue Cross Blue Shield, United Healthcare, CIGNA and Aetna) and restore competition to the marketplace.

2. Enable the American Consumer to Become an Astute Buyer of Quality Healthcare

Fleet insists that the key to cost control is to bring transparency to pricing. For example, a California patient who needs a chest X-ray is charged anywhere from $120 to $1,519; in fact within a few blocks in Sacramento the price climbs from $451 to $790 from one hospital to the next. The solution – every provider must disclose the net prices that they charge and consumers need to know how to find high-quality care.

3. Eliminate Hidden Revenue Streams

Fleet says to do away with fragmentation in the healthcare delivery system, and instead, all Pharmacy Benefit Managers must fully disclose all sources of revenue or profit, block doctors from owning the diagnostic machines they refer their patients to, ban trips, money and other incentives from drug companies to doctors and force hospitals to disclose profitability and markup to implant devices.

4. Our Health – NOT Healthcare – Crisis

“The nation is hysterical over 18,000 cases of Swine Flu, yet we have 100 million obese people in this country,” said Fleet. He contends that the current administration should create an aggressive public campaign to promote a healthy lifestyle, restore funding for physical education in schools, as well as institute the use of prevention-based healthcare.

5. Facilitate Administrative Efficiency

Real savings can be realized by ensuring that the government define a standard for claims submissions between providers and payors, drive a set of rules for dealing with pended claims that makes sense, among others.

6. Protect the Risk Pool

Finally, Fleet insists that the only way to make universal coverage work is to make sure it’s universal. The first step – mandate that all employers offer insurance or force them to contribute to a government fund. In addition, Fleet asserts that, “we need to limit coverage to basic minimums set nationally,” and to ensure that everyone can afford coverage, we should require carriers to pool risk above a certain amount per claimant.

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