Eric Raymond, CEO of Corporate Synergies Group in Mount Laurel, is the

first to state that the system needs repair, but he does not feel

American healthcare is beyond repair. To get a handle on the several

problems and some common sense solutions, the Human Resources

Management Association of Princeton will present the breakfast

seminar, "Remaking the American Healthcare Model," on Friday, February

22 at 8:30 a.m. at Lee Hecht Harrison in Lawrenceville. Cost: $20.

Visit www.hrma-nj.org. Speaker Michael Gross, a benefits consultant

for Corporate Synergies Group, will present the approaches and ideas

of Raymond.

For the last 30 years, Raymond has spent his career as an insurance

entrepreneur, innovator, and gadfly. Raised in New York, Raymond

attended Wharton School of Business, graduating in l978. In l980 he

formed Insurance Access Inc. – the first company to give prices

online. He wrote the necessary software himself.

In l983 Raymond joined Corporate Dynamics as executive vice president,

helping it become the nation’s largest group insurance broker. In l997

he sold the company to Summit Bank. Five years ago, gathering some of

his old partners, Raymond formed Corporate Synergies. "We try to give

both employees and employers the best possible health coverage at the

best costs, he says."

While almost everyone has a finger to point, Raymond insists that the

American healthcare operations are flawed enough to house many

culprits. The basic problem is that we spend $1.2 trillion on

healthcare annually and not everyone is getting all the coverage.

Further, depending on whose estimates you take, it would take another

$100 to 150 billion to include those currently uninsured. So who is to

blame for this mess?

Hey you, Chubby! "More than the carriers, the pharmaceutical firms or

any popular scapegoat, America’s healthcare problem comes from the

fact that we are supersized," insists Raymond. The average body mass

index in the United States is 38 – 29 is considered obese. In Canada,

the average is 18; in Japan it is three.

The list of health services and costs required by the overweight has

been estimated at five to seven times that of fit folks. Here, is a

repairable healthcare expense we can fix one waistline at a time.

The carriers. Raymond sees carriers rushing in the renewal policies so

close on the heels of the due date that employers don’t have time to

think, or examine alternate forms of coverage. "These renewals come in

every year with raised fees and no options and the poor company owner

is afraid to take time, for fear his whole firm will be dropped from

the insurance coverage," says Raymond. "It is an old ploy, and not a

particularly honorable one."

Lesser evils. Those darn lawyers come in for their share of high

healthcare cost blame, but they prick premiums less than thought. Only

two-to-three percent of healthcare costs are said to go toward court

decisions and legal defense funds.

The pharmaceutical companies, as Raymond sees it, do not have the

greedy and dark hearts with which they are often portrayed. However,

he does point to the discrepancy between what Americans pay for drugs

and the amazingly cheaper costs for which they are sold in almost

every nation in the world. "This means, simply, that we are

subsidizing the rest of the world’s drugs," he says.

Nuts to health. The final finger Raymond points is right back at us.

"We Americans do not know how to take care of ourselves," he says.

Of the people who have insurance, a mere 40 percent get the prescribed

blood tests, colonoscopies, mammograms, and pap smears. Six percent of

Americans have type II diabetes and less than half of them know it,

because they have never taken any test.

And once we know we’re ill, we don’t respond with much more

discipline. Only 50 percent of those knowing they have type II

diabetes address it. Of those who are taking one perpetual maintenance

drug, even among the insured, fewer than half follow the medication

program continuously.

Tweaking solutions. It’s not a matter of scrapping the system, or

denying either corporate or human nature. Corporations, even

healthcare providers, are always going to try to make money. Last year

the top five providers brought in $10 billion and will be shooting for

$15 billion next year. The great mass of Americans, on the other hand,

are not going to go into training and religiously follow every

prescribed medical program as if their life depended on it. Even if it

does.

Instead, Raymond suggests that vendors, healthcare carriers, and

employers might team up in a cooperative, signing five-year contracts.

Companies and their providers would establish what he calls health

identification and implementation programs. When an employee gets a

blood test, the insurance company would not merely be informed that he

had one, but would, by garnering this more exact picture of the

employee pool, be able to develop a better program.

The employer, coincidentally, could initiate a compliance program. It

could tell employees if they do get the periodic mammograms and blood

tests, the firm would pay for it. If not, they might even have their

copay boosted individually. The same sort of record keeping

systemcould be transferred back and forth among involved physicians.

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