Webb: Health-care costs are increasing at unsustainable rates. More and more Utah employers are entirely dropping employee health insurance. More than 300,000 Utahns have no health insurance at all. The cost of employee health insurance has emerged as the No. 1 worry of Utah business leaders.

The director of the Congressional Budget Office says the rising cost of health care, reflected in huge Medicaid and Medicare expenses, threatens to swamp the federal budget and is a far scarier problem than Social Security and other entitlement programs. I'm personally aware of a number of young families whose chief breadwinners work for a small companies that don't provide health insurance. For them, this isn't just a theoretical problem. It's a crisis.

Clearly, our state and our country have a big problem and, thankfully, policymakers are focusing on it. Health-system reform is quickly emerging as the top issue for 2008.

No perfect prescription exists for comprehensive reform. It will be a long and difficult task requiring many compromises and the cooperation of many stakeholder groups. No one will be totally happy.

But it can be done, especially here in Utah. We have a young, healthy population, a strong economy, a culture of cooperation and collaboration, and current health-care costs that are far more reasonable than in most states. We also have a very supportive federal administration, especially Health and Human Services Secretary Mike Leavitt, willing to grant waivers and flexibility in federal/state programs. We have "best practices" from other states and countries, plus the best recommendations of top think tanks and national experts.

Two of the Legislature's top leaders, House Majority Leader David Clark and Senate Assistant Majority Whip Sheldon Killpack, are leading the charge, supported by able legislative staff. Gov. Jon Huntsman Jr., his top policy advisers and experts in the Department of Health are fully engaged with lawmakers. In addition, the state's top business leaders and nonprofit organizations have been studying reform proposals for several months. (I have provided consulting work for that coalition, including the Salt Lake Chamber.)

Most importantly, the key stakeholder groups, including consumers, doctors, hospitals and insurance companies, brokers and agents, and many others, have agreed to work cooperatively to find solutions. They obviously don't agree on every matter but are at the table in good faith.

Clark and Killpack, along with the governor's office, have already outlined a framework for consideration in the 2008 session. It takes a fiscally conservative approach to health-system reform, relies on the private market, encourages personal responsibility and provides consumer information and choice. It's a promising start to a lengthy and tough challenge.

Pignanelli: Last year, my family spent countless hours analyzing quality data, comparing prices and reading consumer reviews. After considerable agonizing mental gymnastics, and several budget adjustments, we finally made the important decision ... on the best flatscreen TV. We spent zero minutes conducting similar price and quality research on the family's health care. Indeed, few Americans expend the critical thinking on health care they utilize in dozens of purchases every day.

A former state governor, prominent on the national political scene for his good looks, intelligence and adherence to the LDS faith, offers the most practical solution to this dilemma. No, it is not presidential aspirant Mitt Romney. The pragmatic prophet is Mike Leavitt, secretary of HHS. Leavitt is currently preaching the value-driven health-care philosophy, based on the four cornerstones of interoperable health information technology, access to quality data, transparency of medical services prices and efficiency through competition.

As an attorney who has lived in the health insurance world for 15 years (former general counsel and current attorney/lobbyist to Regence BlueCross BlueShield of Utah), I have experience and strong opinions. Government has a role to assist the poor, the elderly and the young in accessing health care. But no government agency can promote the efficiency the system commands. As Leavitt articulates well, the only institution that provides this fundamental activity is the marketplace.

Huntsman, the Salt Lake Chamber and the United Way (especially Scott Anderson and Lane Beattie) deserve credit for launching a serious discussion of reform in the state. The Chamber/United Way proposal is a good effort but does not go far enough and is in the wrong direction. True reform will occur only when all the shareholders (insurance companies, providers, consumers etc.) dramatically alter their view how health care is purchased and delivered. Instilling market dynamics will cause major societal readjustment and can only occur when our state leaders take the huge political risk of dragging the special interests out of their comfort zone. Tough decisions and demands, bordering on ruthlessness, will be required.

The Beehive State offers the best laboratory for an experiment of Leavitt's principles. Intermountain Healthcare is recognized nationally for developing quality values that can be utilize statewide. Our business community is hungry for action and will support commonsense directives from the state Capitol.

Political insiders are predicting well-respected lawmaker Dave Clark is crafting a revolutionary, but market-based, legislative solution (aided by Sen. Sheldon Killpack). In less than 90 days, we'll know who shares their courage and vision.

Republican LaVarr Webb was policy deputy to Gov. Mike Leavitt and Deseret News managing editor. He now is a political consultant and lobbyist. E-mail: [email protected]. Democrat Frank Pignanelli is Salt Lake attorney, lobbyist and political adviser. A former candidate for Salt Lake mayor, he served 10 years in the Utah House of Representatives, six years as House minority leader. Pignanelli's spouse, D'Arcy Dixon Pignanelli, is a Utah state tax commissioner. E-mail: [email protected]