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A version of this report first appeared in the June issue of Kern Business, our monthly magazine for business owners and managers. Read all the stories and columns from the magazine at bakersfield.com/news/business/kern.

BY JARROD MCNAUGHTON, Vice president, San Joaquin Community Hospital/Adventist Health

Imagine being in line at a grocery store, waiting to purchase a gallon of milk priced at $5. There are four other people in front of you waiting to purchase a gallon of milk as well. However, you notice each person is paying less than $5. One buys it for $2.50, another for $1.50, another for $3 and one doesn't pay anything at all. When you get to the checker, he charges you $18, enough to pay for yours and the leftover balances of everyone else's.

Welcome to the world of health care in the United States. In health-care terms, if you're the last person in line who pays $18 for the gallon of milk, you're the one with commercial insurance like Blue Cross or Blue Shield, which pays a higher price for the same service. That higher price helps pay for all the people in front of you who don't have the ability to pay for their health care.

Today's health-care system is under enormous financial pressure. Healthcare premiums and costs are increasing, yet reimbursement rates from government and some private insurers still fail to cover the cost of providing care.

While the system continues to struggle, hospitals are on the front lines delivering care to patients first, and worrying about payments and reimbursements later. We operate an emergency room, provide critical care, meet demands for the latest technologies and treatments, and provide care for all patients -- whether or not they can afford to pay.

Any proposed fixes to our health-care system must start with changes that address the millions of Americans who have no health coverage, and the millions more covered by government programs like Medi-Cal, which pay only a fraction of the cost of care.

BY CLAYTON M. KOERNER, President, Human Resources Outsourcing Inc.

Our health-care system and the consumers who depend on it are facing an unprecedented crisis of rising costs and an increase in the number of uninsured Americans. This unsustainable trend demands that policymakers find real solutions that help Americans have access to affordable health care.

I believe there is no one magic answer to the problem of the uninsured and rising health-care costs. Health-care reforms need to build on the best aspects of the American health-care system and unleash the creative power of a competitively driven marketplace. Some of the public policy components that I feel would help ensure lower health-care costs, improve quality, create greater efficiency and provide better access to care include:

Medical cost transparency. This is a critical part of the solution because medical care is perhaps the only service American consumers regularly purchase without having any up-front knowledge of the actual price. Consumers need to become educated about how to shop for good medical care on the basis of price and quality of service

Expansion of consumer-directed health care like Health Savings Accounts. This will help curb the problems and costs associated with over-utilization of health-care services.

Promoting wellness initiatives. Achieving a healthier America is one way that we can reduce health-insurance claims and overall health-care costs.

Medical liability reforms. Passing such legislation would ensure that medical malpractice liability laws provide adequate compensation for those who are truly injured while reducing frivolous lawsuits and extraordinary damage awards so more Americans have access to affordable health care.

It is important to elevate the issue of the uninsured every day. We will continue to work with members of Congress and state legislators to find sensible solutions to this national crisis because insuring America is in everyone's best interest.

BY DR. DAVID SCHALE, President, Kern Radiology

Health-care reform is desperately needed, requiring action from Washington to accomplish a careful, thorough overhaul. Optimally, there would be revolution rather than an evolution of American health care.

Extensive change requires a broad diversity of involvement. As a radiologist in a private practice employing about 185 and volunteer team physician for Foothill High School, I have a few observations.

Lack of access to quality health care is the fundamental problem. As heavily taxed as we our, this should not be an issue. Our system is currently far too inefficient to deliver without ridiculous increases in expenditures.

Reform in the delivery system will increase efficiency and quality. One source of wasteful spending is "physician self-referral," where doctors invest in expensive equipment and then use it on their patients, resulting in over-utilization and increased health-care costs.

Aggressive care for patients with hopeless conditions, when comfort care would be more appropriate, dramatically increases costs. This "futile care" demands a society-wide discussion of priorities in health care.

Pharmaceutical advertisement of prescription drugs directly to the public dramatically increases pharmaceutical costs without significant patient benefit.

The Joint Commission for the Accreditation of Hospitals intermittently inspects all hospitals wishing to be reimbursed by Medicare. We are forced to discard perfectly good, non-outdated sterile supplies, driving up health-care costs in the name of "quality assurance." Other expensive requirements placed on hospitals are questionable and lead to staff frustration and high turnover rates, especially among nurses. We must reformat "quality assurance" to focus on patient well-being.

We must also consider restructuring physician pay (primary care specialties are underpaid); personal responsibility; the insurance industry and cost structures; HMOs and emphasis on preventive health; keeping health care in the primary care office; and controlling legal costs.

Obviously health care is a behemoth topic, but I fervently hope for a positive outcome.

BY ROBERT SEVERS, CEO, Managed Care Systems LP

Double-digit health insurance premiums continue to plague national and local businesses, and no relief has been seen for several years. The cost of health care increased 100 percent from 1996 to 2006.

Health-care costs are predicted to be 25 percent of Gross Domestic Product (GDP) by 2025, and 49 percent by 2082. The reasons are multiple and very complicated, and they will not necessarily be eliminated with any reform movement.

Some of the major concepts being discussed as part of the national debate over health-care reform are: (1) mandating employers to provide coverage; (2) creating a public health plan similar to Medicare; (3) taxing health-care benefits (revenue enhancement); (4) requiring all Americans to carry health coverage either through an employer sponsored plan, the public health plan or private insurance. Moving toward reducing the number of uninsured should provide some rate relief for employers currently providing health insurance for their employees.

Whatever "reform" takes place I am very pessimistic that it will reduce costs for businesses across the country. The reason: Controlling health-care costs will not happen by government intervention or necessarily through competition of public plans versus private plans. Yes, advocacy of electronic medical records, promoting wellness and providing greater access to insurance will have positive impacts on cost.

Real reform will only come from within the health-care system itself and with more consumer participation. While it is a highly contentious subject, most experts are now saying that unless we change "the amount" of health care we consume we will never solve the problem.

Estimates today are that 30 percent to 35 percent of health-care services are totally unnecessary. Unless we eliminate this amount or redirect the consumption to the previously uninsured, it is very unlikely businesses will see reductions in the cost of health care.

BY KATHLEEN ALLMAN, CEO/ administrator, Millennium Surgery Center

While it remains true that many Americans are uninsured or underinsured, the solution is not as simple as "universal care for free." Free enterprise and free health care are difficult to blend.

The solution requires cost control, government policies that support patient choice and electronic access to medical record information.

If the pieces of the health-care puzzle independently controlled their costs, the whole system would benefit. Ambulatory surgery centers (ASCs) are a perfect model to look at as we consider restructuring health care.

ASCs provide high-quality, efficient care at a reduced rate. They are reimbursed 59 percent of what hospitals are reimbursed for the same procedure. Patients need to consider what site is the best facility for the services required. A Medicare patient's co-pay for a cataract at a hospital is $495.96; the co-pay for the same procedure at an ASC is only $192.94. Insurance companies, Medicare and patients all save money when patients choose ASCs.

Patients who choose to have the surgery they need in ASCs also benefit from the top-notch patient care and customer service they receive there. In fact, many patients who have surgery in an ASC say they never want to go anywhere else if they ever need surgery again.

One way the federal government could help patients make wise choices about where they receive care is to collect and publish comparable data from various surgery providers that patients could understand and compare easily.

Finally, a National Electronic Medical Record Software program that would allow all health-care providers to access radiological, laboratory tests, all prior medical records, as well as medication reconciliation to coordinate patient care would be one of the most useful improvements that could be