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Northern Virginia business leaders are grappling with the complexities of health insurance reform, including how to cover spiraling costs of health insurance, according to Greater Dulles Regional Chamber of Commerce president and CEO Eileen Curtis.

At a meeting hosted by the Dulles Chamber for nearly 100 area business people and professionals Nov. 2 at Lansdowne National Conference Center, four leading health care experts laid out the challenges and complexities of reforming the way Americans get access to health care and how to curb its escalating costs.

P.J. Maddox, a professor who chairs George Mason University's Department of Health Administration and Policy, told the forum that there were significant areas of partisan disagreement -- including the establishment of a "public option" for health insurance as well as taxing high-income earners -- but that Democrat and Republican lawmakers have also found a good deal of common ground in recent weeks.

According to another speaker, Doug Gray, executive director of the Virginia Association of Independent Insurers, Congress may be planning a major overhaul of how insurance is bought and who buys it, but shies away from some of the most effective techniques to slow the runaway increases in costs of premiums and co-pays.

"Third-party insurance shields people from costs," said Gray.  "Anytime there's a third party, like an insurance company or the government, paying the bill, there will be more use. In the end, if you don't have to pay the bill, you overuse the service."

Even so, Gray and Hogan -- and Inova executive Todd Stottlemyer and McLean-based health cost expert Dr. Sreedhar Potarazu -- said they expect Congress to take giant steps towards reforming the system.

In fact, just days later, Congress took a major step forward in the overhaul of the nation's current patchwork health care system in a dramatic showdown in the House of Representatives. The landmark bill was passed by a vote of 220 to 215. The bill's fate is now in the Senate's hands.

"This is our moment to revolutionize health care in this country," declared U.S. Rep. George Miller (D-Calif.), one of the chief authors of the bill. By 2013, the bill would require that most Americans acquire health insurance, just as all drivers must now by law obtain auto accident liability insurance, or face tax penalties.

Also starting in four years, most employers, with exemptions for small businesses, will have to provide insurance to their employees or pay a tax penalty of up to 8 percent of payroll. The bill would also greatly enlarge Medicaid and offer subsidies to help moderate-income individuals buy insurance from private insurers or from a new government-offered insurance plan, designed to compete with the private companies as a way to curb cost increases. It will also establish a national insurance exchange where people can shop for the best coverage at lowest cost.

Together, these measures would bring an additional 36 million Americans into health insurance plans.

Employers currently pay about three quarters of their employees' premiums, said Hogan. Even so, out-of-pocket spending jumped by 34 percent from 2004 to 2007.  The average annual cost of family coverage today is around $13,000; and $5,000 for single people, she said.

The most critical perspective on cost drivers came from Gray, who pointed out that "people over-utilize medical services because they can."

"The way your delivery of health care comes to you is going to change," Gray continued. "It's going to be telling you 'no,' because we all want to have choices, but this doesn't lead to efficiencies."

"What do you have to give up? Choice. What do you get in return? Better outcomes and costs savings."

Gray also predicted that in the future, most health care will be delivered by nurse-operated clinics.

"Nurses will step into the breach to help address a shortage of physicians," he suggested. 

What Congress is changing in the current legislation will have to be matched by these other changes, said Gray, to really start to bring costs down and raise quality at the same time.