In order for health-care reform to move ahead, a look back — way back — is in order, according to an economist and special consultant to a number of states trying to overhaul their health-care systems.

Len Nichols was in Utah recently, helping government leaders, businesses, those in medical care and those who receive it find some historical and geographic bearings. How the system got here must be understood, and a reconnection with older laws must be made before the new one that is calling for drastic health-care reform can hope to be designed, Nichols said.

The problem is modern and as ancient as the book of Leviticus in the Bible, he said. Those words lay out the problem, what should be done and what people over the ages have forgotten, Nichols said. In more recent scripture, namely chapter 4 of Mosiah in the Book of Mormon, the way is laid out for humans again.

"It says there to visit the sick and heal them, both spiritually and physically," Nichols said in between meetings with various businesses, government agency heads and advocates. "The message in Leviticus, which was taught to and is repeated by Jesus, is when the crop is harvested leave food in the field for the widow, orphan and stranger. Recipients didn't have to be Jewish or local, they were included in those who must be given food. Preventable starvation was breaking a covenant of God.

"Health care is the food people must have these days," Nichols said. "If we don't change things, we'll continue to have a fine system for a smaller and smaller fraction of the population."

During the past two or three decades, the system has been focused on defining who's in and who's out, he said.

"Is medical care for the community, or just for the elect? We have the best specialists, and they're the best at what they do. But gosh, most of America doesn't get to benefit from that. A top-ranked specialty is much less important than doing something about the crisis of primary care physicians resulting from all the specializing."

Nichols directs the Health Policy Program at the New America Foundation, which has specifically targeted expanding access to and reining in the cost of health care in the United States. His visit to Utah was cosponsored by the state, the Salt Lake Chamber, AARP, the Association for Utah Community Health, United Ways of Utah and the Utah Health Policy Project.

The cost of underwriting health care as it is puts an albatross on everyone's back, he said, noting that the most common source of medical insurance coverage — a workplace benefit — is also waning under financial strain. Employees pay a lot, but their employers pay three times that to provide medical plans. And those who don't have coverage basically don't have it.

"We basically say today that we want insurance providers to make money by excluding the sick," he said. "We need to make sure they profit by making us healthier."

Bottom line, everyone needs to be able to buy into coverage regardless of health condition or chronic illness that keeps them shut out now, Nichols said. The system has been treated as if providing health care is the same as selling ice cream.

"What we have lost in the name of the free market is a sense to exercise stewardship," Nichols said. "For us to make this work, whether as a nation or in Utah, we've got to take care of everybody, we've got to pay attention to the poor and the sick. LDS Church founder Joseph Smith said the community should take care of those in the community, whether they are believers or not."

The new community approach needs to be what Nichols calls enlightened self-interest — looking out for No. 1 in a way that serves the common interests.

"We look down the road and see we're headed for a really big pothole. We'll get around it and perhaps get to the promised land if we do everything we can to improve things, and all we can to make sure everyone's in on it."


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