With just three scheduled meetings remaining, the only clear-cut piece in the mural-size jigsaw puzzle of health-care reform before a special legislative task force is much more individual responsibility in personal well-being.
Task force members on Thursday got about a thousand more pieces of reality that must be built into the coming self-centered era of a new and improved, cost-contained, easily accessible, transparent, market-driven, prevention-oriented health-care system.
Being reminded yet again just how tediously complex a task it is to rein in health-care costs, lawmakers were once again left searching for metaphors in sizing up how the effort is going.
Co-chairman Rep. David Clark, R-Santa Clara, picked silver BBs as his metaphor of choice.
"There isn't one out there for us," Clark said, repeating an assessment he's made since the Legislature got serious about taking on the health-care crisis this past spring. "Maybe it's a shotgun shell with silver BBs. No other state has a plan that will translate to another state. Some states have a lot more and a lot less money. Whatever design is best for this state, it will require the collective force of a lot of little individual pieces working together to make it all work."
Cadillacs, TV clickers and cheap bandages are elements that best describe the situation for task force co-chairman Sen. Sheldon Killpack, R-Syracuse.
"If you've ever used a cheap Band-Aid, they work for a minute then fall off," Killpack said. "We need to be patient and look for long-term solutions. In a remote-control society, we expect with a click we'll have the answer. This is not going to be that."
In response to suggested options for finding the so-far elusive affordable, bare-bones medical plan for small companies, the self-employed or single individuals, Killpack noted, "If you have Cadillac accessories on every plan, you're never going to have an affordable one."
The meeting got down to brass tacks when legal advisers described the federal pitfalls U.S. government-required medical services and tax issues that arise as plans are developed and practices are refitted to contain costs and make access more available and affordable for everyone particularly the 300,000 uninsured Utahns.
Offering serious premium payment subsidies of $800 to $1,200 targeted at employees who need to get healthier will translate to the small-scale workplace and can be done without any extra money from the employers, representatives of private industry and medical care groups told the task force.
No matter what improvements are made or how much additional responsibility is given to employees for managing their own insurance, a raft of federal guidelines have to be accounted for first, task members were told.
"Bottom line is you can't expand the Utah group (insurance) market without addressing what our individual market looks like," staff counsel Catherine DuPont said, noting that federal code regarding continuing insurance coverage after leaving a job or what can be offered or not on a premium-only basis or on a cafeteria plan through a workplace dictates the course to a great degree, no matter what plans are ultimately offered.
"I'm not saying that's something we can't do, it's something that we'd have to do," DuPont said.
Speaking for one of the citizen focus groups the task force has asked to help plot improvement strategies, Lou Swane said the question before the group is not a hard one: People are asking for insurance with affordable premiums in a manageable benefits plan that pays for what it's supposed to and doesn't avoid payment whenever possible.
That's the bull's-eye on the target, task force members agreed.
Still, after months of discussions, some were showing signs of frustration. Rep. David Litvak, D-Salt Lake, said a lot of the issues that have been addressed so far are in the "better than nothing" category, "but I'm not hearing comprehensive reform anywhere. A more affordable product is fine, but that isn't system reform to me."The task force is scheduled to meet three more times Sept. 18, Oct. 13 and Nov. 20. Members and their advisers will have between then and January to draft reform proposals into legislation.
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