The single, most-important change health-care reformers must make if they are to have any hope of actually improving the way the system works in Utah is fully realizing that a single, most-important change doesn't exist.

Not only that, three nationally known health-care experts told members of the Legislature's health-care reform task force Monday, the system today defies logic, common sense and every attempt so far by states nationwide to craft a remodel strategy that isn't abandoned within six months.

First, there is no No. 1 thing that must be done, there is a whole list, John Graham told the Deseret News after a round-table discussion with lawmakers. And even if there was a single approach or even a top 10, there's no reason to think that one agency or expert has it the way it will work here, Graham said.

"I say that not to endorse the job security of people like me, but to assure people who are saddled with revamping a system that has broken down in so many ways that there's no single or sure way to go about fixing it," said Graham, who was in Salt Lake at the request of the Sutherland Institute to provide some help in addressing one question no one seems to be asking, let alone answering: Who owns health care?

In comments Monday and in several briefing papers for the Pacific Research Institute where he is director of Health Care Studies, he asserts that despite health care being vitally important to each and every individual citizen, citizens have almost no say whatsoever in the access to or operation of health care in the United States.

And the part they could participate in through workplace-based insurance plans or how our health-care dollars are spent, Graham said, has become such a morass of government regulation of a system driven by sickness, not staying healthy, that bewildered is the most common state of mind among care providers, insurers, the patients themselves and the experts on health-system reform panels now assembled in almost every state.

In the past half century, the level of government control over Americans' health care has increased massively and intrusively, Graham said, noting that almost half of the $2 trillion annually spent on health care in the most expensive system in the developed world is determined by government, not the patients nor the providers.

Doing things in the name of the public good has done a lot of damage and in effect ruined the capacity to pursue or even the notion that people ought to pursue their own health care, Graham said.

"In countless ways, government has prevented individuals from acting in their own interests without harming others," Graham said. He added that allowing people to act free of government control would improve health care.

His research, which is cited in his latest white paper for the institute, "The 2008 U.S. Index of Health Ownership," details reasons reformers and the general public shouldn't be so quick to impose more government regulation on an industry that is failing under the weight of it already.

The villains in the health-care story aren't the ones who get portrayed as such, Graham said.

Before people get too quick to judge — as they do in survey after survey — and cite health insurers, managed care companies and drugmakers as the least trustworthy organizations in the country, they should understand that the total burden of health regulation in the United States is $170 billion annually, or an average of $1,500 per family.

Health ownership isn't necessarily the end goal of reform but an effort to facilitate citizen understanding and fully appreciate that regulation plays a big role in their ability to engage in health-care services, Graham said.

The system as it stands today is the result of those interest groups that benefit from government intrusion and lobby hard for public policies they favor, he added. Citizens, who ultimately prefer to be left alone, have no real incentives to either inform themselves about the harm being done or to organize against what is being done in the name of the public good.

Graham urged task force members and anyone interested in reform efforts here and elsewhere — "which should be everyone" — to consider two clarifying comments:

"No nation has ever unleashed the forces of market competition on its health-care system," and, "The only constant in health care is the anxious anticipation of change that never actually occurs."

E-mail: jthalman@desnews.com