After much ballyhoo and chest-thumping by community and political leaders, the road to comprehensive health system reform has taken some interesting twists and turns. An impressive health-reform framework was developed over several months by some 130 community leaders, led by the United Way of Salt Lake, the Salt Lake Chamber and others. Legislation now being considered would send many of the major reform provisions to a legislative task force.

This action raises questions related to health care (which requires analysis from people far smarter than us) and politics (perfect for us hacks).

What is the REAL reason that the health-reform initiative was sent to a task force?

Pignanelli: The weird factor. Everyone appreciates the United Way for its tireless benevolent activities. But when this charity became the designated pilot in guiding health-care reform (with the chamber and governor's office as wingmen), politicos were stunned. The United Way crafting government policy was too strange for lawmakers. Although House Majority Leader Dave Clark (and one of their own) played a larger role in developing the proposal in the past several months, the Legislature wanted more. A number of legislative power houses have focused their political careers on health concerns, including Sens. Mike Waddoups and Pete Knudson and Reps. Jim Dunnigan, Rebecca Lockhart and Mike Morley. A task force keeps the issue in the hands of the legislative branch. (Of course, observers are wondering why Huntsman abandoned this opportunity to plant his flag.)

Webb: Despite all the conspiracy theories floating about, this is really simple. Health-system reform is incredibly complex and difficult. It will impact every person in Utah and revolutionize a multibillion-dollar industry. It's not something that can be fixed in a brief 45-day session with myriad other priorities demanding attention. It's also not something that can be done by any outside group and then handed to legislators to simply enact.

This effort absolutely requires the attention of a legislative task force with committed members who will spend enormous time and effort. United Way group did a terrific job of framing the issues and establishing principles. But all the really hard work and hard choices remain to be done. No legislator wants to vote on such difficult issues without having full understanding. This issue demands intense interim focus by lawmakers themselves.

Remember that this issue is so difficult that no state (or the federal government) has found a comprehensive solution, although many have tried.

Utah has the best chance of any state in the country to find real solutions for a consumer-driven, market-based system that places responsibility on individuals empowered with good information and choice. But it's going to require a few years of hard study and implementation. Anyone who thinks otherwise is terribly naive.

Is this the death of health-care reform in Utah?

Webb: If so, this death is greatly exaggerated. Health system reform is alive and well and Utahns ought to be greatly excited about what is ahead. Virtually every relevant institution in the state is committed to comprehensive reform. And the effort is not starting from scratch. It will build upon the excellent work done by the United Way, the Chamber and others. HB133 lays out the elements that must be resolved, in addition to making significant tax improvements and moving toward an information system so consumers can make better choices.

Pignanelli: No. When a legislator of Clark's conservative and business credentials is willing to overhaul the system, anything is possible. His legislation, in addition to establishing the task force, implements important first steps toward reform (i.e. expanding availability of health-care data to consumers). Although a number of advocates and health-care stakeholders (including my client Regence Blue Cross Blue Shield of Utah) were disappointed more complete legislation was not proffered, experience demonstrates the task force is a necessary course in this complicated issue. The proposal offered by the United Way consortium late last year was well intended but clumsily constructed and incomplete. After Clark had reworked it, the draft legislation was exponentially better. At least in this issue, legislative input will be a positive dynamic.

What is the short-term and long-term political fallout?

Pignanelli: True comprehensive reform that increases access and stabilizes costs will require sacrifices by all stakeholders — including consumers — with the risk of angering the entire population. Most politicians run from such scenarios. Thus, legislators are in a box: If they make the tough decisions required, large constituencies will be upset. If nothing happens, they will be viewed as ineffective and insensitive. The technical minutia of health policy is stifling, but its reform in Utah promises an exciting display of political courage ... or artful dodges.

Webb: I see significant political fallout, all favorable for Republicans if they frame it smartly. The health system is broken. Rising costs are unsustainable. Too many people are living on a knife edge without insurance. And the Republican leadership of this state is going to fix it. They will deliver. They are problem-solvers. They act on the practical needs of residents. Not a bad way to go into the 2008 election.

Republican LaVarr Webb was policy deputy to Gov. Mike Leavitt and Deseret News managing editor. He now is a political consultant and lobbyist. Webb assisted the Salt Lake Chamber with its role in the comprehensive health system reform. E-mail: [email protected]. Democrat Frank Pignanelli is a 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].