1 To what extent do our health-care systems actually deliver cost-effective care to consumers?

l How many consumers have reasonable access to providers?

l How are Medicaid and other public health-care systems implicated in the IHC question?

l How are we defining charity care? Are the practices of IHC with respect to billing and financial assistance policies consistent with our definition of charity care?

There is a problematic assumption running through the language of Senate Bill 61, which launched the task force: that IHC's large size and scope is interfering with the functioning of an otherwise effective free market. Is the problem really with IHC's size? Has the free market proven its ability to deliver cost-effective health care to all in need? Is the free market making it easier or harder for employers to cover their workers? Is this in turn pre-empting our plans for sustainable economic development and job growth?

If the problem lies with IHC's size, why is the Heritage Foundation saying that we need even larger risk pools, as it argued at Gov. Jon Huntsman's summit on the uninsured earlier this month?

If we look at what's happening in our health-care market, we've got:

l Double-digit health-care inflation, making it harder for employers to cover their workers.

l Many of us who are one catastrophic illness away from being priced out of the market. Although insurance companies cannot just drop you outright when you get sick, they can raise premiums for small groups so high that coverage slips out of reach.

l Continuing inefficiencies in the form of uncompensated care and cost shifting to private payers.

l 60 percent of U.S. health-care spending coming from taxpayers. And we call this a free market?

l According to the New England Journal of Medicine, the overhead of Utah's private health-care systems adds up to $1.6 billion per year, enough to fund medically necessary care in Utah.

These are the laws of the marketplace at work, at least on the supply side.

Now let's look at the demand side: Is health care a commodity in the first place? Do you buy chemotherapy because it goes on sale? I hope not. Will you refuse to buy a quadruple bypass for your underinsured husband because it's so darn expensive? Probably not. Health care is anything but a commodity, which means that there is no basic unit of exchange in our dream of a free market economy for health care. So now what?

Let's look at what we do have in IHC. We have outstanding quality in a state-of-the-art integrated health care system. You can't say this about the rest of the health care system.

Here's my wish list for the task force. As you prepare to study the largest health-care system in the state, don't pass up the opportunity to address our most formidable health-care challenges; you might as well. In the tangle of questions around IHC, are there perhaps solutions to the growing problem of Utah's uninsured?

While you're at it, look for answers for our sisyphean struggle to maintain Medicaid. Medicaid is a very lean, well-managed program with less than 5 percent overhead. What can we learn from it as we set about to design a more rational health-care delivery system? Until we figure this out, we should keep Medicaid intact and urge Sen. Orrin Hatch to do the same at the federal level.

Please use a portion of your $300,000 to verify the savings that would be achieved by reducing the bureaucratic waste in our current so-called "market" system. The reputable Lewin Group has conducted these studies for other states; they could probably do this here for less than $50,000. Also consider conducting the type of study done in Maine: As we look at what we spend now on "primary care sensitive" uncompensated care see about reinvesting some of this spending into cost-effective coverage.

In summary, we simply can't take for granted that market forces are working for health care. Please use this task force to think outside the box and build lasting solutions to Utah's health-care crisis.

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Judi Hilman is health policy director for Utah Issues, a statewide nonprofit research organization in Utah.