As many states — and Utah is one of them — become ever more involved in health care, they become eager to expand the ranks of dependents by using federal Medicaid money.

"The efforts my home state has under way are intended to address those very deep local, minute characteristics of the system as it is now," Leavitt said. "That's why some folks out there aren't joking when they say, 'If you think medical care is expensive now, wait until it's free.'"

Leavitt, during an interview at Deer Valley, illustrated the health-care problem with a question: What if buying a car were like getting a knee operation?

"If that were the case, the dealer would say he does not know the final cumulative price, so just select a car and begin using it. Soon the bills would arrive — from the chassis manufacturer, the steering-wheel manufacturer, the seat company and paint manufacturers. The dealership would charge you for time spent in the showroom and an additional charge to cover the salesperson's time helping you.

E-mail: jthalman@desnews.com