SANDY — It might be a huge understatement to say proponents of health-care reform in Utah have their hands full. Some evidence could be gleaned from a Thursday health-care conference attended by more than 100 stakeholders.

Remarks from representatives of different parts of the industry showed they could not agree on even the most fundamental question of whether the current health-care system is broken, or, if it is, to what degree.

John T. Nielsen, health-care reform adviser to Gov. Jon Huntsman Jr., said "the status quo is unacceptable and unsustainable." Lane Beattie, president and chief executive officer of the Salt Lake Chamber, called for "real," comprehensive reform, adding, "We have got to make changes." Judith Hilman, executive director of the Utah Health Policy Project, said there is "no doubt the system is broken."

But Kelly Atkinson, executive director of the Utah Health Insurance Association, said the existing system merely "needs refinement." Dave Gessell, vice president of government relations and legal affairs for the Utah Hospitals and Health Systems Association, described the current system as "a good system" that nonetheless needs "reform and improvement." Norm Thurston, health economist for the Utah Department of Health, said the existing system may be "great" for people who work at the 60 percent of Utah businesses that offer health insurance coverage but "not great" for employees at the remaining 40 percent.

Those and other speakers discussed a variety of topics at the conference, presented by the National Federation of Independent Business. Each suggested ways to approach reform, but differences abounded.

State Rep. Jim Dunnigan, R-Taylorsville, warned that any government solution might have unintended consequences. Nielson, however, said a single-payer, government-sponsored system "is still on the table." Atkinson cited studies that indicate most people think government needs to play a role.

Beattie said reform will take two to three years to put in place, while Hilman said it would take three to four years and should be sure to address cost, quality and access simultaneously. Gessell said the big issues should be addressed first but that reform is "not going to happen if we do it incrementally." Atkinson pushed for sequential change, saying that unless costs are controlled first, the result will be adding the many uninsured to a "sick" system.

Several speakers favor reforms that put more control of health care — and therefore more responsibility and accountability — in the hands of consumers. One option is a health insurance "exchange" that would help people buy insurance that would follow them if they switch jobs, would be paid for using pretax dollars, and would offer consumers more information and choices about their coverage.

That's what the United Way is touting, with Beattie saying Thursday that "health system reform is very tough stuff" and self-interests need to remain "at the door."

An exchange, he said, relies on the private market, and any suggestion it is socialized medicine is "false" and "deceptive." To think otherwise is "either because of the lack of understanding of narrow-minded individuals or basically just uninformed people," Beattie said. "The bottom line, this is not socialized medicine. It isn't even close to socialized medicine."

Also, people who think the current system is not mandated health care is "terribly uninformed," he said. "The problem is who's paying for it, and primarily small business and businesses are paying for it."

Without naming names, he was critical of people who "want to disguise intelligent conversation with scare tactics."

Atkinson pushed for a debate that focuses on facts rather than emotion, citing questions raised from several studies on health-care matters. Studies show most people are satisfied with their insurance coverage but bristle at the high costs. And he added that Utahns already have the lowest insurance premiums in the country.

Atkinson said much of the rhetoric claims the health-care system cannot be fixed "and so we should throw it all out. In the Utah Health Insurance Association, we take exception to that. We know that the system needs refinement. We know it's a system that's expensive. We know that there's a certain segment of the population that's not served by the system. Those are all facts that we need to address. But simply to say that it's unalterably broke, that it can't be fixed, we don't think is a meaningful exchange and adds to the dialogue that's taking place."

Brad Kunhausen, health policy consultant for the Utah Association of Health Underwriters, said the idea of an insurance exchange has been around for 15 years but no one has "actually put together a plan and lowered cost." His group advocates "consumerism," which would change from a system where doctors are paid by procedure — billing for as many as possible and the most expensive ones allowed — to one where consumers get credits to pay for certain procedures but can pocket the difference into their own health-care accounts.

Dr. Mark Bair, president of the Utah Medical Association, said controlling costs is a key to health-care reform, but if consumers do not save money, "we've only created another program that costs money."

Gessell said Utah is in a "pre-tsunami stage" of health-care reform. Earlier efforts have failed because providers and the business communities were not fully supportive of change, but that has improved, he said.

"We've also heard a lot that it can't be done," he said. "You know, probably to be honest, for many years I was in the camp that 'it can't be done.' But I finally got to the point of saying that we need our best minds, our best efforts from all of us here, from all of the citizens in this state, to make a good system better. ... I wouldn't go so far as to say our system is broken, but the system does need reform and improvement."

Most of the speakers did not quibble with stats showing about 306,000 uninsured Utahns, or 12 percent of the state population; that since 2000, insurance premium costs have doubled; that Utah businesses offering coverage for their employees has slipped from 70 percent to 60 percent since 2000; and that people fear losing their jobs because they'll lose their insurance with it.

"Of all the major things we've done in the state, there's nothing that compares to what we're talking about here, in major reform," Gessell said. "That might scare many of you. Many of you might be excited about it."

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