The president of a national group benefits company says Congress and President Barack Obama are missing key opportunities to fix the nation’s health care system, including breaking up the “monopoly” among the four biggest health insurers and forcing employers to provide coverage.

Samuel H. Fleet

Samuel H. Fleet, president of AmWINS Group Benefits, based in Warwick, R.I., made those proposals and others in a healthcare reform position paper.

Fleet, who has more than 20 years of insurance industry experience, wants competition to be restored in the marketplace, where he says the four largest carriers have 99% of providers in most states and the top carrier, Blue Cross and Blue Shield affiliates, has a 60% to 70% market share nationally. He wants leaders to break up the “BUCA monopoly” – Blue Cross Blue Shield, UnitedHealthcare, CIGNA and Aetna.

“In any other industry, this [market control] would raise antitrust issues, but for healthcare, no one seems concerned,” Fleet said in a statement.

Fleet suggests the only way to make universal coverage work is to make sure it’s universal by mandating employers to offer coverage or force them to contribute to a government fund.

“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,” he said.

Fleet also suggests 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; yet within a few blocks in Sacramento, the price climbs from $451 to $790 from one hospital to the next. He wants every provider to disclose the net prices that they charge so consumers can make informed decisions on care.

Fleet, who took AmWINS from a small regional company to a national firm, would eliminate all hidden revenue streams. He says pharmacy benefit managers should fully disclose all sources of revenue or profit. Doctors should be blocked from owning the diagnostic machines they refer their patients to. He wants trips, money and other incentives from drug companies to doctors banned, and he wants hospitals to disclose profitability and markup to implant devices.

He is encouraging a national campaign against obesity, which is a costly health issue, and he is asking the government to establish a standard for claims submissions between providers and payors. He also wants a set of rules for dealing with pended claims that makes sense.