We asked our readers what wasbroken about the health care system or benefits industry, and whatcan be done to fix it. There's lots of work to be done!

Clear the clouds

The overall transparency to the end user is still extremelyvague at best, considering all of the tools and mechanisms in placetoday. Until this is resolved, we will continue to face an uphillchallenge in providing quality treatment at a customizable levelfor a fair price.

To assist us, greater hands-on involvement and communication ofthe “how” and “whys” will bridge that gap and allow us to meet thepotential customizable needs of each individual end user as well asthe group as a whole.

Trevor J. Garbers, vice president, practice leader, HUBInternational Limited

Income vs. outcomes

Our health system is fixated on fee-for-service and providingmultiple services to generate revenue and isn't willing to providea firm quote prior to the services being provided.

Credentialed providers outside the U.S. have been doing this foryears, and don't understand why U.S. providers won't. Theseinternational providers are truly fixated on outcomes. All theircharges are on a bundled, fixed-quote basis. Employers who makehealth care abroad an option will often realize significantsavings, even when including airfare and hotel and waivingdeductibles. Employees love it, and while not a cure for the U.S.system, the more employees who go abroad for care, the more likelyU.S. providers will take note as they see volume decrease.

Tom Garner, executive VP operations and network development,SkyMedicus Inc.

Siloed benefit programs

Many traditional medical brokers ignore or overlook the gains ofintegrating health insurance with other benefit offerings.

As traditional medical carriers have recently moved into theancillary and voluntary arenas or formed strategic partnershipswith non-medical carriers, there are new opportunities to uncoversavings. Additionally, increased participation in a voluntaryprogram can drive savings to both employer-funded ancillary andmedical lines. Lastly, there are value-adds that are oftenoverlooked or lost in the implementation process, including medicalcross-sell discounts, outsourced FMLA solutions, marketingallowances, technology offsets, wellness fair reimbursements,telemedicine and EAPs.

Kevin Kennedy, benefits consultant, TriBenInsurance

Can I get a price check?

Health care is the one thing on a retail platform that doesn'thave a price tag. We all know that our health care system isbroken, but the ignorance of how to utilize health insurance andnavigate health care by most of America is just adding fuel to thefire.

I'm not sure how we “fix” our broken industry, but I firmlybelieve we can improve it through education and transparency.Consumers only see the tip of the iceberg, which consists of the“discounted” cost. What isn't seen is the enormous remainder of theiceberg hidden under the water—the total cost of care. Thisshouldn't differ based on where you seek care, but it does and willcontinue to; therefore, we have to help consumers becomesmarter.

Devan L. Sebek, director, benefits management, MosaicEmployee Benefits

Recognizing the problem

The lack of understanding about how the entire process works isthe biggest concern I have. For years, members thought, “myinsurance will cover it.” Or “I have insurance; who cares.” No oneunderstands how insurance works.

Who funds the insurance and pays the premiums? How much does aninsurance company make? What if I never use my insurance? We don'tslow down enough to think about the bigger picture. Think aboutyour car or liability insurance for a second. If you get a rateincrease, it's typically due to claims. Why does your healthinsurance increase? Typically because of an increase of claims. Nowthe fun starts: How do we control the frequency and severity ofthose claims? Before we implement solutions, we have to educate thepublic on how the system works and how it is broken.

Taylor Y. Lindsey, partner, Employee BenefitConsultants

Profit distraction

When health care became big business, we all transitioned frombeing patients to customers. Profit distraction is a systemicissue, and until we truly balance cost and quality, it always willbe. Patients pay many times over, not only in rising cost ofservices, but in rising health insurance, and when quality care,better practices and lower cost alternatives are overlooked. Weclamor for cost transparency, but also need to focus on qualitytransparency.

For a recent surgery of mine, more time was spent pushing theidea that I pick up prescribed medications at the hospital'spharmacy than was spent describing how to change bandages and carefor the wound. No wonder readmissions and post-op infections are onthe rise!

Here's a suggestion for hospitals: Why not send patients homewith a no-cost “get well soon” kit, which includes hospital-gradebandages, visual instructions, a 24-hour post-surgical video chat,and more? Instead, members are left to their own devices, wanderingthe aisles of CVS and phoning a friend.

Derek Winn, benefits consultant, The Business BenefitsGroup

Better shopping experiences

If the provider market functioned like other markets, we wouldbe able to shop around for elective services like we do for otherproducts or services. I should be able to determine my cost beforeI get the procedure done, rather than being billed after thefact.

If I choose to shop around, I control the choice of provider andthe cost. There are some great services emerging that help withthis, but not everyone has access to them. I believe that placingthis control back in the hands of patients will help bring down thecost of care, just as it has with Lasik surgery.

Jacqueline St. Hilaire – D'Alessandro, evangelist,NextAgency

Drugs of choice

One of the most misunderstood items is Rx pricing and the brokensystem of discounts, kickbacks and lack of transparency. Consumershave no idea how the system works and only think about their $10generic copay, not the real cost of the drugs. They don'tunderstand that there are less-costly alternatives or generics, andbrand name drug coupons raise insurance premiums. The system needsto be changed or we will never control health care costs.

Barry S. Cohn, president & CEO, Really Great EmployeeBenefits

Access points

In recent years, we have reversed the emphasis from access tocare first and catastrophic coverage later to catastrophic coverage(high deductibles and referenced-based pricing) first andfirst-dollar access all but eliminated. Our philosophy for low-wageworkers is to provide low-cost, first-dollar benefits withvoluntary catastrophic ancillary coverage for the low percentage ofemployees who may need it.

William Hammett, principal officer, Hammett InsuranceServices

On-demand pricing

The disconnect between cost and the purchase decision is, andhas always been, the thing most broken in our health care system.Patients today still have very little knowledge about the cost ofservices, and they don't care because they aren't paying for itdirectly. Most of the cost is being spread across a group orcarrier's block of business so the patient's decision has a minimalimpact on his or her own health care costs. Even if plansincentivize the patient, the pricing is often very difficult toget.

The fix to this isn't simple, but I think the first step isprice transparency. Providers and facilities should be forced topublicly share all pricing or, at a minimum, provide pricing infoon demand to a patient who requests it. Once we all know the cost,we can start working to control it.

Brad Vernon, health actuary, Benefit Innovators,Inc.

Robbing Peter to pay Paul

With health care premium expenses increasing year after year,the decision to degrade coverage to curb costs seems simple andintuitive. But employers' tunnel vision surrounding the need tocontrol costs has made them miss the costly consequence: increasesin talent management costs. The tight talent market has employersbattling to recruit, but they struggle to do so without attractivehealth benefits. Unwilling to spend more on benefits, employersturn to taxed bonuses and compensation, driving up expenses inaddition to recruitment costs. When you factor these in, employersreally aren't controlling costs at all.

Caroline Moore, marketing and communications manager,ArmadaCare