"That's a big indictment of doctors," said committee cochairman Sen. Allen Christensen, R-North Ogden, a dentist and among the 25 percent of Utah physicians who treat Medicaid patients. "That might be the nature and structure of things but that doesn't mean physicians are naturally opposed to shifting direction."

Big picture shifts was also the topic of a discussion earlier Wednesday keynoted by Newt Gingrich, former U.S. speaker of the House and current health-care reform advocate.

Speaking as the founder of The Center for Health Transformation, Gingrich told a noon gathering that small changes or reactionary fixes to separate pieces of the current systems "have not and will not work. We need a systemwide transformation."

The gaps in the layers of the current system, whether Medicaid, Medicare or employer-based insurance programs, changes so far have been "tinkering around the edges. Transformation requires both a big vision and reform proposals that resonate with the public and with providers."

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E-mail: jthalman@desnews.com