How does Flagstaff stand to gain or lose under health care reform?

That might sound like a selfish question — what's best for Flagstaff, a small, isolated city, might not be best for the rest of the country, medically speaking.

But we tend to think just the opposite: Flagstaff's health care system and the community that supports it should strive to become a model for high-quality, accessible health care at an affordable price.

And from what we've seen of the various proposals in Congress, the reforms will help Flagstaff achieve that goal, not hinder it.

The first is expanding the pool of insured patients through mandates on employers, insurers and individuals. In a small city like Flagstaff with just one hospital that aspires to big-city care, the bigger the base of paying patients, the lower the charges will be for individual care and, by extension, insurance premiums.

As Cyndy Cole reported last month, Flagstaff Medical Center has created intensive care units for a variety of patient conditions, from premature babies to heart valve failures, along with a regional trauma center. It now has on-staff, round-the-clock physicians and has attracted to the region a variety of top-flight specialists, allowing patients to stay in Flagstaff for even the most complex procedures rather than travel to Phoenix.

MORE PAYING PATIENTS NEEDED

But all of the above comes with a higher price tag, and for two main reasons. The first is mainly demographics: There are fewer people in the region to draw from as patients than in the Valley. The second is based on how this country's health insurance system is structured: Of those patients, a significant portion are not insured or underinsured, leaving FMC to foot the unpaid bills.

So the first and most important goal of national health reform — increasing the number of insured — will be of particular value to isolated places like Flagstaff with community hospitals that strive to be high-quality as well as self-contained. Higher volume alone isn't everything, but it has to help.

How we get there as a nation will almost surely require some kind of government mandate — the free market simply hasn't worked. But the underlying principle — universal coverage — makes sense from a health standpoint and, particularly for Flagstaff, economically.

TALKING ABOUT COST CONTROL

The second main area of reform falls under bringing the soaring cost of health care under control, thus reducing insurance premiums and, it is hoped, finally giving employees actual raises.

Again, this is important in a city the size of Flagstaff, where competition in an isolated market is limited. Absent bringing in a second hospital and doubling or tripling the number of specialists, which is unlikely, reform in Flagstaff should set up a system of incentives and, in some cases, penalties to encourage not only the best care but care that avoids wasteful and inefficient treatment. This can come in a number of ways, including better hospital infection control, sharing medical records electronically, better preventive medicine to avoid the high cost of chronic illnesses like diabetes, and end-of-life care that eliminates futile treatments.

One of the challenges with cost control in medical care is simply learning how to talk about it without devolving into shouting matches over "rationing" and "death panels." At the least, Congress needs to pay for research into what treatments really work best, then allow Medicare and private insurers to pay preferentially for the best ones, not simply those that a doctor or patient orders up and later prove to be unnecessary. Unless a patient is paying completely with private funds, he or she simply shouldn't have an unbridled right to treatment that is inferior and more costly than it should be.

A COMMUNITY EFFORT

Finally, Flagstaff as a community has a good start on becoming a model for good health. Its citizens are breathing some of the cleanest air in the country, and just by adapting to daily life at 7,000 feet, they are in better cardiovascular health than most other citizens. The stunning natural beauty of the region encourages many to engage in healthy outdoor exercise, and as a college town, it has a base population that is more educated about the need to eat and drink sensibly.

We'd like to see Flagstaff's employers, in concert with health care providers, set up a healthy community challenge whether health reform passes or not. National regulation can help to push market-driven medicine in the direction that benefits Flagstaff. But in the end, good health is up to all of us.

CALLING NEW EDITORIAL BOARD MEMBERS

Got an opinion about what's in the news? Interested in finding a larger audience for your views? Consider joining the Daily Sun Editorial Advisory Board. It took a holiday break this week, but usually it meets once a week on Wednesday at noon and is looking for new community members starting in January. Just send an e-mail to Editor Randy Wilson at rwilson@azdailysun.com with a brief description of yourself and, for the sake of board balance, where you sit on the political fence. If you've applied before and are still interested, just send a reminder.

Our View: Expanded insurance coverage and incentives to bring down costs are vital in a small city with a high-quality hospital serving a limited population, many of whom are underinsured.