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
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
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
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.