Seven months of what promises to be an arduous task of designing the first phase of a health-care system in Utah that works for everyone began in earnest Thursday.

Weighing in on both demands and wishes for the undertaking, 11 members of a special legislative task force got going on what one of its co-chairman calls "the most complicated, most stirring public issue" he has dealt with as a legislator.

"It will take both mind and muscle to get this thing moving," said House Majority Leader David Clark, R-Santa Clara. "We must become an action committee, not a study committee," he added, referring to at least two previous health-care fixes that died on or shortly after leaving the drawing board.

The imperative carries more weight than a House leadership directive. It is impelled by frightening predictions and statistics, such as: In less than 20 years, the cost of insurance premiums will equal the average Utah household income.

With 2.1 million Utahns who have insurance covered through their employers the status quo cannot be sustained, not by consumers nor businesses nor insurance carriers nor care providers, said panel co-chairman Sen. Sheldon Killpack, R-Syracuse, assistant majority whip.

The closed nature and even the vocabulary of the system as it now is must be opened, from how much medical care really costs to making insurance a fair playing field, Killpack said. "This means jobs, access to jobs for consumers and employers and its consequences are long-term."

What the group will be moving toward are three goals for the system: transparency, affordability and portability. The panel must have proposed legislation by November to prove they have made progress.

The daunting list of challenges includes sharing of costs, patient medical data and patients taking more active role in their own health status as better health-care system consumers.

Aspects of affordability — why health care really costs so much — will be reviewed, including the 12 percent to 25 percent in administrative costs of providing care. Minutia such as lag time between billing and payment, whether by an individual patient or an HMO, will also be studied.

Consumers and medical industry providers of all stripes can expect things to get more portable, i.e., care will be less driven by the protected revenue streams of HMOs and hospitals and more toward coverage that's tailored to individuals and more widely accepted by providers.

Perhaps bringing some of his experience as a professional basketball referee to bear, Clark several times during the meeting stopped the discussion to remind the group that the clock is ticking and to keep attention on "the sense of urgency" of the job before them.

He also strongly advised the group of stakeholders in attendance to get their heads in the game.

"The first question I ask you is, if we expect the system to change, what is it you're willing to give up?" Clark said, noting that too often when he asks industry representatives that question he's told what is wrong with everybody else. "If you are unwilling to change, I hope this is your last meeting. I will uninvite you. If you stay I will take that as a willingness to change."

Killpack said he the process will be open to public input, will be fair and must be fair on the input side as well.

Many people keep comparing health-care insurance with automobile insurance, which the state mandates and could ultimately mandate for health insurance if a consumer/market-driven approach isn't successful.

"Let's compare apples to apples in that discussion," Killpack said, noting that a driver after a rollover accident can't just stop by a local body shop and expect it to be fixed. "If you haven't sufficiently insured yourself, you have a different responsibility."

"Everybody's ox is going to get gored," said task force member Sen. Greg Bell, R-Fruit Heights. "I'm not really interested in cry babies. I don't want conversations in the hall where people are telling me why this is stupid or that is stupid."

John T. Nielsen, special health-care adviser to Gov. Jon Huntsman Jr., who did not attend on doctor's orders following shoulder repair surgery on Wednesday, has said the system is fundamentally flawed and therefore needs fundamental change.

"When someone is sick and is considered uninsurable by commercial companies, this has to change," Nielsen said.

Task force members took no action Thursday but must develop a reform plan by the end of November and scheduled meetings each month except July.

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