The fever for healthcare reform is running high in Washington, D.C., and politicians are lining up on both sides to offer "treatment plans." But policy makers are missing many of the key opportunities to address what is really broken about the system.


There are six main issues that should be clearly addressed for health care reform to truly make a difference.

  1. Restore competition in the marketplace. The four largest carriers in the country have 99 percent of providers in the network, and in most states the No. 1 carrier has 60 percent to 70 percent market share. In any other industry, this would raise antitrust issues, but for health care, no one seems concerned. 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 health care. 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. Do away with fragmentation in the health care 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 health care – crisis. The nation is hysterical over 18,000 cases of swine flu, yet we have 100 million obese people in this country. 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 health care.
  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. 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, 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.

Complete your profile to continue reading and get FREE access to BenefitsPRO, part of your ALM digital membership.

  • Critical BenefitsPRO information including cutting edge post-reform success strategies, access to educational webcasts and videos, resources from industry leaders, and informative Newsletters.
  • Exclusive discounts on ALM, BenefitsPRO magazine and events
  • Access to other award-winning ALM websites including and

© 2024 ALM Global, LLC, All Rights Reserved. Request academic re-use from All other uses, submit a request to [email protected]. For more information visit Asset & Logo Licensing.