Task-force member Sen. Wayne Niederhauser, R-Sandy, said one solution must be to change the system's incentives. They must be switched from more money for more expensive care and emergency room services to ongoing primary care to prevent illnesses from becoming critical. The system is caught in both a moral and financial dilemma, said task-force member Rep. James Dunnigan, R-Taylorsville. Providers are legally bound to provide care to anyone who walks into an emergency room, but the system is being overwhelmed by the cost of providing that care.

Most immediate remedies could involve establishing a basic care package of benefits that everyone could agree on, he said. A second would be requiring individuals to become more directly involved in their care rather than leaving decisions basically up to what the doctor says. As it stands now, insurers offer basic care, but there is no definition of what that minimal care is, let alone what it should cost, task-force members said.

Dunnigan said some people will simply not get involved with their care, and they won't sign up for a minimum plan because they know they can get care by simply walking into an emergency room.

Physicians around the state have told the task force that many of those ER-only patients are on Medicaid insurance and simply expect service on demand. That problem is aggravated by the fact that primary-care physicians are refusing to treat people on Medicaid outright because the reimbursement for services paid by the state doesn't come close to covering a doctor's cost of providing it. Add a layer of daunting and meticulous paperwork to obtain the reimbursement, and many simply won't bother.

"Until this Legislature does something to increase reimbursement, that trend is going to continue," said Sen. Greg Bell, R-Fruit Heights, said. "Reimbursing at 37 percent of what it costs is just not going to cut it."

The task force postponed until its August meeting a full discussion of requiring consumers to be more engaged individually in the process.

As a set-up to that discussion, lawmakers were told that The Centers for Disease Control and Prevention estimate that 30 to 40 percent of all health care costs can be attributed to conditions of consumer lifestyle such as tobacco use, drug use — both street and prescription drugs — and obesity.

Dunnigan said to the extent to which those factors can be modified, considerable expenditures could be saved to the system has a whole. There are some individual programs that offer less premium costs for people who lose weight, quit smoking or lower their blood pressure or cholesterol risk factors, he said. But as a whole, the system has a long way yet to go.

He said he had that lack of involvement in his own care demonstrated recently when he was checking the best prices for a Nintendo Wii video game player, "which my kids were into like a rat on a donut." He was at the time also scheduled for necessary intestinal surgery.

"I realized that I was spending a lot more time finding out about a game than I was checking out who was going to gut me open," he said. "That's pretty sad to think that we're spending a lot more time finding out about the toys we want to buy than what kind of health care we're going to get."

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E-mail: jthalman@desnews.com