The Utah Medical Association Bulletin recently took a look at a topic in which it's keenly interested for obvious reasons, health-care reform. That's a hot topic at both national and state levels, as rising health-care costs and large numbers of uninsured continue to team up for a race in which the finish line may be financial disaster.

What is the right way to reform the health-care system is likely to become increasingly important in the ramp up to the presidential election in November, once the process to select each party's candidates is completed. It's also a topic that Utah politicians have targeted for some remedial action.

In particular, the bulletin examined local efforts for meaningful reform by The Utah Hospitals and Health Systems Association and the local United Way.

UHA spent a year on the issue, resulting in a proposal that the United Way's Health Care Working Group used as a starting point for its own study of the issue. That panel, which included about 40 participants, then added its own enhancements, emphasizing that any mandate for people to have insurance must include a mandate for insurance companies to insure the people who apply, pooling risk and not merely offering the product to those least likely to use it.

It also suggested ways to make it possible for those who cannot simply afford it to access health insurance coverage.

One of the least talked-about factors in the rising costs of health care also received attention: There's a lot of overuse, underuse and just plain misuse of resources, all factors that impact the overall quality and cost of health care.

It's a topic I've been following with considerable interest, both as a consumer of health-care services and as a reporter whose beat assignment is medicine.

There are a number of points that have become clear in the course of the many debates. We are moving toward financial crisis without some reform. Prevention must be a centerpiece. There are two Americas when it comes to accessing services, peopled separately by the haves and the have-nots. And it's not something that lends itself to tinkering.

The stakes are too high to make room for slapdash efforts that may do more harm than good. Fixing the broken pieces of the American health-care system must be done with care and requires input from all the stakeholders. That has been a great aspect of UHA and United Way efforts. They've looked at the issues from many different viewpoints and involved a variety of voices in the process.

The single parent who's working two jobs to make ends meet has a different perspective — and different needs — than someone who can write a check to cover what insurance won't. And it's not just the cost of insurance. Personal economics play a role in how someone cares for himself, down to food choices and lifestyle factors.

The end product may not turn out to be quite the same for the two. But you have to understand both their perspectives to get anything approaching meaningful reform.

The other thing that's clear is that special interests of all types are going to have to practice some give and take for reform to work. That makes legislation-driven reform a bit scary, because special interests are often entrenched in the legislative process at all levels of government.

Policymakers must not be allowed to exempt themselves from the provisions they adopt for the larger community. They have to be actual stakeholders, as well. And all the stakeholders need to take part. You have a body, so you're going to be affected. Now's a good time to join the debate.

Deseret Morning News staff writer Lois M. Collins may be reached by e-mail at