For parents awakened by the cries of a sick child, health care is not nearly so complicated as the voluminous federal Affordable Care Act suggests.

What matters most at 4 a.m. is good care, readily available, accompanied by a medical bill that doesn't induce bankruptcy.

In essence, that's the goal of the Affordable Care Act: To contain soaring medical costs, to cover more people who are without health insurance and to produce better results for patients.

But for health care officials, turning legislative aims into tangible medical benefits means navigating uncharted waters.

Dr. Tom Radosevich, clinical assistant professor with the University of Wyoming Family Medicine Residency Program at Casper, thinks increased patient access will occur as the reforms roll out, provided doctors are paid fairly and there are enough medical providers.

"I think one of the things we really need to work on is an expansion of our primary care work force," he said.

Radosevich expects the family practice clinic will continue treating lots of people as the law shakes out. The program has 40 doctors on staff and a target of about 30,000 patient visits per year.

"What we would hope for is [uninsured] people have some way to get health coverage so they're not paying completely out of pocket," he said.

On the question of cost, Radosevich referred to a journal article. Its conclusion: "You're not going to get lower costs unless you do less medicine," he said.

Some estimates suggest 70 percent of what's done in medicine is unnecessary, so Radosevich doesn't think bending the cost curve is impossible. But the business of medicine is such that the more you do, the more you get paid.

Moreover, medicine does not compete on lower cost, but rather, on newer procedures, nicer hospital rooms and better technology, he said.

Even outcomes in medicine are not always easily measured, and poor outcomes don't necessarily reduce financial rewards.

"In fact, if you have to do something again, you get paid again," Radosevich observed.

Radosevich sees expanded care, limits on exclusions for pre-existing conditions and more emphasis on preventive services as opportunities in the reforms.

But more generally, he thinks the law is just too complicated.

While the American Medical Association endorsed health care reform -- something it did not do when Medicare passed in 1965 -- the largest doctors' group in the U.S. did so with trepidation because the act is so complex, he noted.

A single-payer system would be much simpler, Radosevich said, but that's not going to happen in the U.S., at least for now, due to political opposition.

Implementing health care reform could pose special problems for small town hospitals.

South Big Horn County Hospital is a six-bed critical access facility in Basin. The hospital cares for about 350 patients each year, while 2,500 people visit the emergency room. Typically, hospital officials expect 30 percent of patients will have no health insurance.

Hospital administrator Jackie Claudson said the hospital doesn't deny access to anyone. But access worries her nonetheless.

Claudson fears people might have less access if health care reform results in larger regional centers that replace small town hospitals.

Whereas hospitals like South Big Horn County came into being as a way to increase access in rural areas, "now I think it's less about access and more about cost savings," she said.

Claudson also thinks that implementing reforms could be a bigger financial burden proportionally on small hospitals than on large ones. So installing technology to support electronic medical records, for example, could be a challenge.

"Upfront, those are going to be significant, substantial costs," she said.

Claudson views health care reform as a mixed bag. Its emphasis on preventive care is a good feature; but costs associated with new regulatory requirements are not.

Mostly, Claudson has more questions than answers. "I never know from one day to the next exactly where we stand," she said.

That's a sentiment shared by many officials, including Bob Kayser, a long-time member of the board for Memorial Hospital of Converse County in Douglas.

"We've kind of taken the stance that we know something's going to happen to us," he said. "We're just not sure what it is."

Converse County is fortunate to have many railroad and mine workers with good health insurance. A relatively small share of care provided by the hospital is uncompensated.

For people who are underinsured or who can't get insurance, Kayser said a statewide exchange could be useful. The exchanges will be online marketplaces where people can shop for and purchase health insurance.

But the Douglas hospital is financially sound and takes seriously its social contract to provide good health care, he said.

"If I had my druthers, I'd just as soon leave it the way it is."

Contact Business Editor Tom Mast at, or call 307-266-0574. Follow him on Twitter @masts.


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