We are fortunate to live in a state where both the governor and the Legislature have committed to do something about what is an increasingly troublesome and embarrassing situation.

The United States is the wealthiest nation on Earth, we spend more money than any other country for health-care services, yet we have fewer healthy people than all other industrialized nations. The term "health-care system" is a misnomer — there is no system but a conglomerate of public and private health insurance programs with various levels of coverage, and 15 percent of our citizens have none. Public health clinics do their best to fill the gaps by providing basic primary and preventive care for the needy, but they constitute a pretty leaky safety net.

Gov. Jon Huntsman Jr., along with the Legislature's Health System Reform Task Force, led by Sen. Sheldon Killpack and Rep. Dave Clark, have made expanding health insurance coverage a priority, and rightly so.

Having health insurance is clearly linked to better health, and those who are covered are more likely to seek care when they need it and in the appropriate setting; e.g., NOT an emergency room for non-urgent problems. But improving the overall health of the public should be of fundamental concern if we wish to truly reform the health system. As the task force continues to develop its plan, I encourage legislators to consider the following:

First: Full coverage of basic oral health services and preventive care services, such as vaccinations (for children and adults) and screenings recommended by the U.S. Preventive Health Services Task Force, such as screening for cancers.

Second: Public health officials must have the capacity to prevent disease and illness by having an up-to-date disease surveillance and monitoring system. Such a system can better detect new and evolving diseases, foodborne illnesses and poor air and water quality. We must implement the National Electronic Disease Surveillance System, or NEDSS, to replace Utah's current cumbersome and outdated system.

Third: Promoting personal responsibility and rewarding healthy behaviors will reduce health-care costs. Incentives need to be in place for all to have a "medical home," a single source for primary and preventive care, and for those with a chronic disease like diabetes, hypertension or asthma to participate in the management of their own illness.

Some have criticized Utah's deliberate approach to health system reform for not having made more progress toward universal coverage and expanding public programs. In my view, these criticisms are not well-founded, and, in fact, those states that have attempted broad reforms have foundered or failed. I believe the Legislature's deliberative approach is more likely to succeed over time.

Furthermore, many don't appreciate the progress that has already been made. Thanks to legislation sponsored by House Speaker Greg Curtis, Utah is now one of only 11 states to ensure all qualified children will have open and ongoing access to the Children's Health Insurance Program (CHIP).

Last year the Legislature authorized the development of a statewide electronic medical records exchange that will save money and lives by enabling doctors and hospitals across the state to have immediate access to a patient's medical information (with their permission), thereby reducing unnecessary tests, X-rays, medication errors and costs.

We live in one of the healthiest states in the nation thanks to a population that largely supports and promotes healthy living. Nonetheless, we all suffer when the increasing costs of health care limit what can and should be spent for other compelling social problems such as education, transportation and improving the quality of the environment.

As we proceed along the path to health reform, let's be sure to enact policies that will likely have the biggest payoff by including and emphasizing public health principles and practices that actually improve our individual and community health.


David N. Sundwall, MD, is the executive director of the Utah Department of Health.