American medical care costs more than anywhere else in the world yet doesn't do enough to keep us healthy. Doctors are paid for treating illnesses, not for preventing them. Too many people are uninsured and get so sick they land in the emergency room.

What people can't seem to agree on is how to fix it.

Now, two sets of proposals -- one from a task force appointed by Gov. Tim Pawlenty and one from a legislative commission -- are before the Minnesota Legislature.

Dick Pettingill, president and chief executive of Allina Hospitals and Clinics, weighs in on what's at stake.

Q Can you assess the proposals going through the Legislature?

A The nice thing is [that] there are more similarities than substantive differences in the two proposals -- the elements of universal coverage, payment reform, medical homes and linkages to the public health sector. These are all very important.

We have the most expensive health care system in the world and we're still not producing the value we're looking for. We focus on acute, critical care within the walls of institutions and not enough on wellness and prevention, such as health-risk assessments and dealing with problems such as childhood obesity. We don't have the model wired correctly.

Q You mentioned the buzzword "medical homes." How is that different from an old-fashioned primary-care provider who coordinates your care with specialists?

A It's far more complex. The current model of primary care is overly burdened. There are not enough physicians and we have one physician to one patient. With a medical home, you get connected to a pharmacist, to a nutritionist, to a behavioralist ... it extends beyond a one-to-one relationship.

Q Why do you need the Legislature to act? As the biggest hospital group in the Twin Cities, can't you do a lot of this within Allina now?

A Yes, we can. But we have a higher calling of trying to raise the overall quality of the delivery system for everyone.

Plus we need payment reform. Right now, the more units you produce, the more money you make. We need to go upstream to pay for prevention and wellness.

Q What do you see as the hurdles to change?

A The state just announced a deficit. If we want to expand coverage, where are the resources going to come from?

Q There are so many vested interests in health care. In the months since the two groups started working on the proposals, I've received e-mails from groups criticizing various aspects. Can you talk about where you expect opposition to come from?

A We at Allina really try to play a facilitating role, try to get the right issues on the table. You'll have folks advocating for universal [insurance] coverage. When the portability of medical records comes up, you'll have issues around privacy and security.

We need to use better tools, have an electronically connected community. These are new models of care, and people will be in very different places on this. What are the implications for outstate and rural providers? Will they be left behind?

This is not the first time we've studied these issues in Minnesota. But this session, we are much better positioned to advance the agenda.

Q Some are saying with the 35W bridge collapse, health care is likely to be sidelined by transportation this session.

A It's a possibility. We hope we can stay the course.

Chen May Yee • 612-673-7434