BEHIND the spectacle of town hall brawls, death panel paranoia and pundit jabber, there is a real effort by powerful people to change the way Americans receive and pay for their health care. Nearly everyone agrees that the industry needs reform, but questions over what role the government will play and how any of it will be paid for has the nation bitterly divided.

Santa Cruz Weekly spoke with two health industry experts and asked them to cut through the noise and give real answers on what health-care reform means, and how Central Coast residents can stay abreast of the facts and avoid the fiction.

Stephen Shortell is dean of UC-Berkeley's School of Public Health and has been in Washington several times recently advising White House health-care strategists on what's needed in reform. He says the country's health-care system is on a "disaster course" and that the truly "scary" part of the debate lies in the possibility that nothing will change.

"The three big questions are, first: how do we expand health care to every American? Second is the issue of how we pay for it. And third is a question that's been largely ignored, and that is: How do we pay for it over time and make it sustainable?" he says. "It's important to remember that health insurance reform is not health-care reform. The other half of that is health-care deliverance reform, and we need that as well."

Shortell says that increased competition among insurance carriers, transparency of governing health-care bodies and standardization of medical records and procedures is essential for any efforts to be labeled as reform. He points to Kaiser Permanente and the nonprofit Mayo Clinic as models of how health care should be run. Shortell does not, however, unequivocally support President Obama's "public option," which would make government health insurance available to anyone who sought it.

"The devil is in the details, and we don't know enough about the details," says Shortell of the public insurance option. "The key idea is to create competition on the exchanges of cost and quality, and to have all insurance plans be able to list their quality of care matrix and the price they're going to charge us for different benefit packages. And once that is done, and you have standardization of insurance claims, and you have portability of insurance, and you remove the pre-existing conditions, that's going to go a long ways in providing coverage for all people."

Scott Seamons is a regional vice president with the Hospital Council of Northern and Central California, which represents dozens of hospitals and clinics in 50 California counties. He has a hands-off-my-health-care approach to expanding government involvement in the health industry, which puts him in line with many conservatives rallying against public insurance. Some of those same folks, however, might balk at Seamons' insistence that undocumented workers be insured.

"I understand the passion that people feel that [illegal aliens] don't pay into it, so they don't deserve it. But we're already paying for their care. When they show up to the ER, we have to treat them or we get hauled off to jail. Who's paying for that care? Hospitals," says Seamons. "We're not in favor of one public option. We favor choice. But having one public option doesn't get us anywhere. We want incentivised care, but where the government is writing the checks, not running the program. They goofed up everything they've touched big time, so we can't have them playing in this sandbox."

Both Shortell and Seamons agree that reform can't wait, and that partisan bickering needs to be reined in for the sake of the American people. Both dismissed myths about government "death panels," euthanasia and added federal funding for abortions. And both also said that a solid financial support structure needs to be hashed out before anything is passed.

"Any health-care reform needs a balanced approach with four cornerstones," says Seamons. "One: shared responsibility; two: universal access and affordable coverage; three: a focus on quality and improvement of cost of care; and four: aligned financial incentives. Without those, it's not reform."

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