Are you expecting good healthcare?

>>It's one of the biggest industries in the nation and especially in Southwest Florida, and it affects every one of us, but the problems in healthcare have become so overwhelming that our leaders have backed down from any significant discussion. (The exception might be the Clintons, but as Lee Memorial Health System president Jim Nathan has pointed out, Monica Lewinsky gossip stole the limelight.)

Nathan and health economist Paul Keckley spoke at the Regional Economic Outlook conference in December about some of the healthcare system's greatest challenges. The new executive director of the Deloitte Center for Health Solutions, Keckley formerly headed up the Vanderbilt Center for Evidence-based Medicine.

What they had to say was grim.

Southwest Florida is at the leading edge of the nation's healthcare crisis, Nathan said. Our population is older and growing, increasing the demand for healthcare (most healthcare dollars are spent on older folks). At the same time, costs are skyrocketing and, with fewer employers providing health insurance, reliance on government funding has increased dramatically, with about 60 percent dependency on Medicare and Medicaid. Nearly a quarter of our population is uninsured. Meanwhile, the number of healthcare workers, including physicians, who are trapped between rising costs and legal risks and declining Medicare reimbursements, is dwindling.

Keckley pointed out that money is pouring into healthcare, yet the quality of care is declining in this country. People are even traveling out of the country for medical care.

Other points he made:

> Most medical students are bypassing primary care to pursue more profitable, less demanding specialties.

> Quality of care is lower in for-profit than not-for-profit hospitals.

> Healthcare in the U.S. is 40 percent more expensive than anywhere else in the world; 46 million people in the U.S. have no insurance, including 35 million workers.