"David C. was the challenge side of the governor's job that has had the real reward of Utah having a model child welfare system," Leavitt said.

Lurking behind David C. was an issue that would define a big part of Leavitt's life up to now — health-care reform. The self-described federalism geek viewed it as a rare-if-ever chance for his and other states to wrest away some control over federal programs that were overwhelming local budgets and just weren't being run all that well.

Leavitt still sees that opportunity and believes reform is more urgent than any issue he's had to deal with the past three years. He also believes the answer won't come from the federal level. "States must each tailor their approach to health-care reform, with some help from the federal government, not the other way around."

As governor, Leavitt made reform attempts and achieved so-so success, advocating for much more personal involvement in procedure decisions, not just to try to get a handle on health-care access, cost and quality of health care, but to give people more responsibility in staying well.

What he lacked in first-hand knowledge of the medical industrial complex he's tried to make up for with a common sense, Highway 89 approach to governing: Do what's "real and right," he likes to say. He kept the phrase in mind overseeing 67,000 HHS employees and a $580 billion budget — enough to buy 19 I-15 reconstruction projects, the first phase of which he oversaw as governor.

Critics said the phrase sounded good but was as colloquial as anything heard around the cracker barrel, and would be about as much help to the nation's poor, the disabled, seniors and health-care system as handing out pitchforks.

"He's always been a big picture guy, despite some people completely mischaracterizing him as a rube and his city as place where the only good thing is the mountains around it," said Tommy Thompson, a former HHS secretary, during a visit to Utah announcing a set of federal requirement waivers Leavitt proposed to help Utah increase the number of people covered by Medicaid.

"But innovation isn't place-driven," Thompson said. "A good idea is a good idea, no matter where it comes from. Some issues need to be boiled down, and he has a way of doing that pretty effectively, no matter the audience."

Issues like health care, and an audience like the nation's leading medical authorities and practitioners who Leavitt invited to a special two-day summit in Deer Valley a few weeks ago.

Leavitt's been known to sound the alarm before, with predictions of a pandemic of bird-borne influenza two years ago. He was prudently following the advice of public health authorities worldwide, and the pandemic remains a matter of when, not if.