Access to health care is not a privilege, it's a right.

That was the theme Tuesday of "Utah Health Care for All Day" at the Capitol. But while the participants - advocates for the poor, the elderly, the uninsurable, labor, employers and others - agree that the health care system is in trouble, they have different ideas on what the solutions are.One-third of the people in the United States are un-insured or under-insured, according to Ed Mayne, AFL-CIO. That means that 37 million Americans don't have any insurance and more than 50 million don't have enough insurance.

"The health care system is suffering deep and expensive wounds. The system is in desperate need of life support or radical surgery," Mayne said. "Cost containment efforts are not working. And cost problems can't be solved on the backs of consumers. They've already given all they can. Workers have paid their dues and it's time for providers" to shoulder responsibility.

The answer, according to Quinn McKay, Utah Health Cost Management Foundation, is a "Utah Health Plan. If there's not a plan, all we're doing is shifting the problem."

While public entitlement programs like Medicare and Medicaid are able to limit their own expenses, McKay said, costs to other programs "shoot up," in response. McKay predicted national health care will be inevitable because the present system doesn't work. But he said it will not come "from Washington down." Instead, it will occur when a number of states have done the research and tried different things to get a system in place. That's already occurring in states like Hawaii, California, Washington and Florida. But, he said, people with influence are going to have to pool together and make it happen by marshaling a large number of resources.

"Do you want to get leadership together and have an impact on the broad system" he asked, "or wait for someone else to do it?"

McKay quoted a satisfaction/expense index that lists the per capita health care expenditures in different countries and rates how satisfied citizens are. The United States, which spends $2,000 per person a year on health care - one of the highest amounts - scored lowest on the satisfaction scale, earning 0.2 points.

Maintaining the existing "safety net" health care programs for vulnerable Utahns is of major importance, according to Bill Walsh, Utah Issues. About 122,000 people are served by either Medicaid or the Utah Medical Assistance Program. But the governor's budget recommendation, which includes a funding increase, falls about $4 million short of maintaining the status quo. Inflation and caseloads have eaten up the increases, he said.

So far, the programs have been able to continue by controlling the reimbursement rates they pay to doctors and hospitals. But that has created access problems. Approximately half of the physicians in the state will not treat Medicaid and medical assistance program patients.

"If we don't maintain the medical assistance budget, we're taking a wrong road," Walsh said.

Lawmakers will consider several bills aimed at the health care system during the session, including creation of a risk-pool for people who are uninsurable. Gov. Norm Bangerter is a proponent of the pool, which with one-time state backing would allow people who could prove they'd been denied insurance to participate by paying a premium one-and-a-half times the going rate for people who are insurable.

Not everyone agrees with the governor or advocates of the risk pool. Wayne Holland, United Steelworkers, predicted insurance companies would use the risk pool as an excuse to drop people with expensive medical problems. "(Insurers) who see this will cut off the people they have and say, `You've got the risk pool.' We need to have national health care for everyone."

The meeting was sponsored by the American Association of Retired Persons, the Utah AFL-CIO, the Legislative Coalition for People with Disabilities, the Easter Seal Society of Utah and Crossroads Urban Center.