One of the biggest problems with today’s healthcare debate is that we have two separate factions vying for control; the politicians whose prime objective is winning votes and support and the insurance companies whose prime objective is making a profit. The politicians espouse grandiose visions of universal healthcare for everyone without focusing on who will pay the bills, and the insurance companies preach freedom of choice and a privatized system while increasing rates and cutting benefits. The average consumer is caught in the middle with a big screw being constantly driven into the heart.

The question in this writer’s mind is “how do we bring these factions together to create an improved and functional healthcare system?” How do we create affordable healthcare for everyone without the healthy having to pay for the sick; the rich having to pay for the poor? The only real answer is compromise.

Let’s start by looking at the current system. One of the biggest problems that I face as a health insurance broker/consultant is the lack of uniform disclosure legislation requiring all insurance companies to state benefits and exclusions in a complete and uniform manner. Some plans may exclude certain services that others may not. Some plans may not even offer an out of pocket maximum liability cap. Many times, possibly by design, the consumer is not made aware of these “exclusions” when purchasing a policy. Too often it’s all about making the sale. It is this writer’s opinion that insurance companies should be required by law to uniformly state the major benefits and exclusions of their plans without all the asterisks and fine print. I believe that an educated consumer who knows the limitations of the plan he or she is purchasing can make the proper decision on how to manage healthcare.

I also believe that there should be uniformity in legislative control as opposed to individual state management of healthcare. It is rather absurd to me that a person residing in California cannot transfer a policy to another state should he or she move to say Arizona. Federal legislative control will lead to more uniformity and better understanding for the consumer. Yes, this will require change from the insurance carriers, but some change is necessary and inevitable.

In order in guarantee coverage for the poor and the ill, a study should be undertaken to determine cost of universal care clinics to treat the poor and subsidies to assist in paying for those whose medical conditions preclude them from procuring individual coverage. The care clinics can be along the lines of what is being proposed and initiated by several large retailers where clinics are manned by registered nurses with rotating physicians on call for treatment of more serious issues. Those with certain declinable medical conditions would be eligible to receive subsidies to assist in paying higher premiums necessary to offset the overall risk factor involved in issuing them coverage.

In summary, this writer believes that a combination of universal healthcare and a privatized healthcare system should be the ultimate objective. Health insurance for everyone is a worthy and noble goal for this country. However, unless the insurance companies and the politicians can find a way to create compromise, the current system runs the risk of shifting to a much more costly system of healthcare management, and no one is focusing on the amount of this cost and who will be responsible for writing the check. There is no doubt that the American public in general is fed up with the current system, however they have not been offered alternatives that will actually work and be functional. It’s time to set aside the politics and profit motives and find a way to create positive and functional change.

So many people will visit a carrier’s site or a massive agency’s site and will never speak with a live person. They select a plan from the deli menu that often is not appropriate for them or their family. They get no advice about pre-existing conditions, surcharges. In the end, they are unsatisfied with the carrier’s decision or they end up in the wrong plan.

The system is convoluted, but that also means there are many opportunities to benefit applicants and members. As long as you have a good agent and you use their talents and know-how. Thank you for bringing up these overall topics.

Mark Goodman conveys a point that illustrates why information is so vital for change to come in the current system, “Consumers shopping on line and who choose not to work with an agent buy at their own risk. Generally their research comes down to buying the cheapest. Then they find out what they bought when they are stuck and can’t move.”

Then, the ultimate question is asked, who is responsible for providing this information to the public? The answer lies in the total commitment from all the key players involved in the system to dedicate there efforts to change. This change will generate rewards, for all involved, which greatly out weighs those that are being generated in our current system.

Consumers shopping on line and who choose not to work with an agent buy at their own risk. Generally their research comes down to buying the cheapest. Then they find out what they bought when they are stuck and can’t move.

Along with standardizing forms standardizing coverage should be part of the political discussion. I am not suggesting one plan fits all but like Medicare Supplements you pick an alpha and you can make a concise benefit comparison. Carriers would win customers with network, price and service (not in any order).

At a carrier seminar last week the network manager was saying facilities were looking for 100%-200% increase in negotiated fees.
The clock is ticking and we as an industry have to show leadership and the ability to welcome and embrace change.