Problem #1 Cost
Solution: Take the job away from the insurance companies. Give it to the best corporate cost cutter: Walmart (home of the $4 prescription) Add some competition: Give half to Target for those who have aesthetic issues and to keep it competitive. Insurance companies only handle paper. Handling paper is generic and can be totally automated.
Problem #2 Quality
Solution: Open clinics at Nordstrom, Macy's, JC Penney and any other retailers that understand how to deliver good customer service. Add Zappos, Amazon, Google and Yahoo on the Internet to the mix.
Lastly, require that all systems be open source and full integrated. Google knows how to do that and Oracle and SAP, I am sure would welcome the business.
Final Analysis and Rational
Insurance companies have not done their job: improve quality and reduce costs. Fire them. Bring in successful companies that know how to do both. Open up the market to competition. HMO's can be useful. That 15% that we currently spend on overhead is a big incentive and an opportunity. Take 5% of it and offer it as additional profit to HMO's for the first 10 years. Reduce overhead to 5% like Canada and give 5% back to the American people.
The biggest hurtle here is Congress. We need to lay this out in a simple, transparent way and then take it to each member of Congress and have them sign off on it. We have the resources. The Internet always wins, but only if it is used. In a capitalist society, we have so many choices, but many times not enough gumption to show Congress the way. It really is time to get tough on the people that we hired to do this job in Washington. Not in a hysterical way, just being supportive of common sense solutions. Ask yourself, what would Ben Franklin do?