A recent article in The Wall Street Journal describes the division in healthcare idealism: the idealistic desire to provide every American with health coverage and the practical awareness of how to pay for it. The "timetable is looking challenging" and there are many issues still yet to be addressed. Further estimates from the Congressional Budget Office are necessary before lawmakers can expand coverage and finance the entire plan. Yet before we rush ahead, I feel it's necessary to take a step back and truly examine the costs for involved parties (that is, government and hospitals) versus the potential savings and full results of these changes, lest we risk putting the cart before the horse.

The entire nation seems in a mad dash to enact legislation leading to healthcare reform. While I agree with the direction in which we're headed, I also think there are further studies that must be done before we initiate such binding moves.

On a state level, for example, physician integration, a key point in the Senate Finance Committee's proposal, is limited in California. Adventist facilities in California could not employ physicians. Our Oregon facilities, however, did so successfully, which was advantageous to contracting and managing care.

Thus, before we enact sweeping legislation, it is critical to fully identify exactly how each state (and ideally - though impractically - each facility within each state) could be affected by overhauling the healthcare delivery system. It's a different ballgame for rural hospitals than urban hospitals. Resources may be aplenty at some teaching hospitals, while they may be scarce at certain non-teaching hospitals. Not only will facilities vary in resources, they will also vary in adoption pace - regardless of the incentives "carrot-ized" in front of them. These must all be fully examined before final estimates and legislation can occur.

Let's look logically at what needs to be done and then create a sensible timeline around those steps. Let's review state laws and processes and the effects that reform changes could have on facilities within each state. Then and only then will we gain an overall picture on extended coverage and a redeveloped health system for which we must budget.