While I did not know him intimately, Robert Whiddon made quite an impression on me the first time we spoke. He needed an article on health care, but he could not guarantee it would be published unless it was a) informative b) "edgy" and c) raised awareness around issues that needed to be advanced in our business. Now, that was pressure!

A mere 35 years old, and editor of Employee Benefit Adviser, he was a tireless advocate and opinion leader on health care and benefits-related issues. His last request to me days before his untimely passing was "to keep pushing the envelope."

Whiddon wanted to challenge the industry to step up and help lead the country in the health care reform debate. It seemed to him that if we did not stand up as employers, brokers, consultants and insurers, we would be reading the memo on health reform instead of writing it.

In Whiddon's memory, I am offering up seven challenges to the current stakeholders. While everyone's fingerprints are on the cracked glass of health care, the troika of employers, brokers and insurers still has it within its power to mend the leakage and recreate a better the future for our system. As with charity, change begins at home. The question is: Can we change?

Improve transparency

Where there are opaque practices, there is room for excessive profit-taking and abuse. Insurers need to stop hiding behind HIPAA and release claims experience for employers with more than 100 employees. The practice of not releasing data and only offering non-participating, manually rated insured programs drives better loss ratios and profits, but limits the appetite for employers to engage in cost management programs such as wellness and population risk management. Guys, the gig is up. It's time for co-ops and consortia purchasing.

Brokers need to be comfortable disclosing all fees and commissions and to stop avoiding the tough conversations about value. If you are worried that you are charging too much in commissions, you probably are. Value is outcomes divided by cost. If you cannot show a numerator greater than your denominator, find a new profession. You are giving the industry a bad name.

Employers, start asking what your broker makes and put the carrier and the broker at risk for outcomes consistent with what you want to achieve - cost containment and trend mitigation. A nice lunch or great bedside manner is fun, but at the end of the day, a good insurer or broker it is about providing value. Caveat emptor!

Watch the money flow

How you make money in health care is important. Insurers, the party is over on making all your money on small group and individual insurance programs. Better get used to 85% loss ratios, just as brokers may have to get used to fees instead of commissions or reduced distributions payments. Employers, you must drive these market changes and be prepared to pay incentives and rewards to those who drive value and savings. Insurers, how about taking 1% of profits and providing it to support the communities in which you mine those profits? Your foundation is nice, but it is usually someone's public relations pet and not a true philanthropy mechanism to reinvest back into the communities where you make your money.

Get a backbone

Employers, understand that your unwillingness to accept disruption - changes in drug formularies, hospital contract disputes, losses of specialty care, etc., actually forces insurers to blink in the face of large medical systems that are demanding and getting larger increases. These increases are passed on to you in the form of higher facilities and specialty trends. At some point, you must say "no" to a large hospital system increase and offer a smaller, concentric network that focus on quality outcomes. We must return back to gatekeeper-based integrated delivery systems. Only when employers demand these programs will insurers reform reimbursement practices that are driving primary care and community hospitals out of existence.

Health care is a privilege

Folks, freedom and health care are privileges, not rights. We must insist there be a covenant between every citizen who benefits from public health care and the government to lead a healthy lifestyle by promulgating and legislating compliance-based plans. Let's quit invoking ADA when someone has eaten their way out of their pants. Despite Washington's rhetoric, the enemy is disease, not the insurance industry, and half of that chronic illness is self-inflicted.

Restore primary care

The most trusted ombudsman in the health care transaction is being driven into extinction by the stop-gap reimbursement mentality of insurers who peanut butter spread cuts evenly across all providers instead of focusing on higher quality and better outcomes over an entire episode of care. Primary care doctors cannot afford to practice medicine, and they hold the key toward managing 60 million Americans at risk for chronic illness back to well and stable health profiles.

Know thy enemy

Disease is the enemy, not one another. Employers, it is tempting to want to drop health care if the government comes out with a public option. Privately, those of you representing more than 100 million of the nation's insured confided to the Lewin Group in a recent study that you would drop private care in favor of a government public plan option, rapidly ushering in a single-payer system. Be careful what you wish for, as it may one day be you lying on that gurney.

Show your worth

We must prove our value. Insurers and brokers need to prove that they can materially impact the health and well-being of an employer's employee population. Employers need to stop looking at health care as the third rail of management (you touch it, you die) and start treating population risk like occupational health risk. A good risk manager first seeks to eliminate, mitigate, retain and then, finally, transfer risk. In health insurance, we seem to first seek to transfer the risk instead of owning the responsibility.

We must all show we can bend medical trend, or we may end up wards and bystanders in a system we no longer recognize or believe in. Impacting trend, driving transparency and forcing stakeholder change is our raison d'être for the next decade in American health care.

As Whiddon would have liked to say, "You are either part of the solution or part of the problem. You choose."

Turpin has served as a health plan regional CEO and national benefits practice leader for brokerage and consulting firms in Europe and the U.S. over a 26-year career. He is currently EVP with USI Insurance Services, the nation's largest privately held insurance broker. He can be reached at michael.turpin@usi.biz.