The health-reform challenge

All sides in the politically charged debate over health care ought to at least agree on the extent of the problem. They can start with the fact that health care costs more per capita in the United States than it does in most of the rest of the industrialized world, and that this is not only unacceptable, it is unsustainable.

Then they ought to agree that the large number of uninsured Americans — about 46 million according to estimates — adds to the runaway costs. Many of these people use emergency rooms as their only interaction with doctors, and they don't go there until they are quite ill. Emergency-room visits often cost $1,000 or more, whereas regular preventative care in a physician's office is much cheaper and much more likely to lead to better health.

They also ought to agree that the medical industry needs to be more transparent. Patients should have access to accurate, easily available public information to determine where to receive the best and least-costly care. Obviously, people with emergency needs are not going to solicit bids from hospitals, but complete transparency, including reports about mistakes and deaths, will bring down costs and improve quality over time.

Beyond this, health-care reform is bound to be a contentious tug-of-war among competing interests and political ideologies this year. But it's too important to end up in the political trash heap once more, the victim of ideological gridlock.

President Barack Obama already has jumped feet-first into this by promoting a proposal that includes a "public plan." This, he insists, is not socialized medicine but a public safety net, of sorts, that would compete with private plans. It was the first contentious shot fired across a busy and battle-ready bow.

Frankly, we fail to see how any public plan backed by the seemingly endless resources of taxpayers could ever compete fairly with private plans. Just as any local-government decision to give tax breaks to one business makes it harder for all other competing businesses to make a profit, a public plan would poison competitive health care, not enhance it.

A better alternative would be to create risk pools of uninsured people and to require private insurers, on a rotating basis, to cover them. That coverage could be underwritten by taxpayers. Meanwhile, it also makes sense to require all people to be insured, just as the state requires all drivers to have auto insurance.

This, too, is a contentious idea, but anyone who understands how much of the economy is currently consumed by health-care costs would have a hard time arguing effectively against it.

Private solutions are better than public ones — but only if the private sector, including insurers, is forced to truly compete in transparent ways. And state-driven solutions are better than one-size-fits-all programs centered in Washington. Utah lawmakers already are well on their way to devising a unique system.

But no solution will be acceptable without some way to pay for it. Given the current state of the economy, this suggests an emphasis on private-sector solutions rather than expensive new public plans.

The next several months are likely to test the political wills of all sides. But the battle will be a little easier if everyone can at least agree on the problems.