Those aren't dire predictions, but a fact of life of the past decade of rising bankruptcies due to unpaid medical bills and the steadily increasing percentage of people utilizing government-based insurance. At the same time, the percentage of people who have private insurance coverage has declined, according to the report.

Six issues must be addressed before any substantial or lasting improvements can be implemented, according to the report's authors who say their research is based on common concerns brought up by providers and consumers during a series of statewide interviews.

Perhaps the largest obstacles are the federal government's regulation that pre-empts any and all state laws related to employee benefit plans. That's becoming the chief difficulty among the 20 or so states trying to improve health care, Kroes said.

Incentives and rewards in the system, which are based on quantity of services, not quality of outcomes, must be realigned, according to the report. The role and responsibility of the individual consumers is a huge factor as well, in particular the abiding notion that health care is a natural resource and staying healthy is somehow beyond personal control.

In order to have a system that is affordable, exactly what affordable is must be determined. With no clear definition of what a basic, affordable health-care plan is, the target will continue to move, the authors of the report said.

Data on outcomes and costs of procedures remain inadequate, and will likely thwart attempts to individualize insurance plans in order to increase access to coverage and allow people to become the conscientious consumers they will have to be in the new era of health care.

Utah Foundation research analyst Laura Summers said the current structure of the U.S. health-care system is like a giant puzzle with pieces that will have to be re-cut or cut out entirely of the picture.

"At this point, no one is certain what that picture looks like," she said. "But one thing is clear, because some pieces are left out, not everyone will be satisfied."

The report makes no suggestions for how the state should proceed and provides another selection of charts, graphs and figures indicating the system, despite the most careful, detailed attention here and nationwide, is simply impervious to change.

The report is online at www.utahfoundation.org.

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E-mail: jthalman@desnews.com