A Thursday public hearing was organized primarily to seek input from small business owners on ideas floated by economic and health advisers to Gov. Jon Huntsman Jr. to reduce Utah's ranks of uninsured. But it turned into a platform for insurance brokers and underwriters to unveil their own reform blueprints.

The event, the first of many to come, drew more than 100 people.

John T. Nielsen, the governor's point person on health reform, acknowledged "this is tough stuff." But the problem - 306,000 uninsured Utahns and health costs outpacing wages and inflation - isn't going away, and is getting worse day by day, he said.

The alternative to taking "bold action" now is waiting for the federal government to impose a solution, said Nielsen, former president of Intermountain Health Care. He warned the "agenda" of a government-run health care system "is alive and well" in Washington, and could take root depending on who is in charge.

Nielsen painted the Utah plan as the antithesis to a socialized medicine.

At its crux is the creation of a basic benefits package for purchase by all Utahns through an exchange - sort of like a stock exchange - using pretax dollars and employer premiums.

The idea is that by harnessing the purchasing power of Utah's uninsured, many of them young and healthy, premiums will drop for everyone.

Details, however, are sketchy, including how much the exchange will cost and who will pay for it.

Proponents and opponents agree that, for it to work, the state will have to mandate the purchase of health insurance.

Mandating coverage, warned insurance lobbyist Kelly Atkinson, means investing more in government programs for the poor, such as Medicaid.

Currently, thousands of Utahns are entitled to such programs, but haven't enrolled. Also, the state would likely have to subsidize coverage for working poor families, said Atkinson, president of the Utah Health Insurance Association.

Atkinson did not object to a basic benefits package, as long as it's designed to discourage unhealthy behaviors, such as poor eating habits and smoking.

But he recommended that Utah first tackle the root of soaring health care costs by passing laws to curtail malpractice lawsuits and direct advertising of prescription drugs.

Underwriters offered a different perspective of what's driving inflation: the current practice of billing insurers procedure by procedure.

Doing so creates a "perverse incentive for providers to bill as many procedures as possible," said Brad Kuhnhausen, a consultant to the Utah Association of Health Underwriters.

Kuhnhausen recommends a "consumer-driven" fix in which insurers would give beneficiaries a lump sum credit for surgeries and other planned care. The patient would then take the credit and shop around for a team of providers who agree to charge a single fee.

kstewart@sltrib.com