Health care reform is a tremendously important issue. We at Premera strongly support health care reform, especially that which improves access to coverage for all Americans and helps bring down the ever-rising health care cost trends.

We support many of the reforms to the health insurance marketplace that are currently under discussion in Congress -- for example, guaranteed issue for all regardless of health condition. But we join Sen. Lisa Murkowski in having very serious concerns about a government-run "public plan" because of its potential impact on health care providers and negative impact on consumer choice.

The only way a "public plan" can achieve its stated goals is to pay doctors and hospitals less than what private health plans pay for the same services. Current experience with Medicare should be a caution to all that a government-run "public plan" would have a traumatic impact on patient access to care, in a way that would be particularly problematic to Alaskans.

Doctors and hospitals in Alaska already lose money on Medicare, and make up for their losses on current government programs by charging everyone with private health care coverage more for the same services. Expanding those government-funded shortfalls would place even greater pressure on providers already struggling to see new or current Medicare patients.

That issue is already a huge problem in the Anchorage area. A recent study by the University of Alaska Anchorage showed only five doctors in private practice are currently taking new Medicare patients. Clearly, Alaska doctors are already making the difficult choice between losing more money or limiting the number of patients on government-funded programs.

This should already be of great concern to us as Alaskans, especially as the Baby Boom generation approaches Medicare eligibility.

A government-run "public plan" would make this dilemma worse rather than better. Current proposals for a "public plan" would place unsustainable financial pressure on doctors and hospitals. Some of the proposals suggest paying providers rates close to that which Medicare currently uses to underpay health care providers. Others suggest "negotiated" payments, but the pressure to suppress provider payments would be hard to resist. Either way, the current problematic situation for patient access to care could well become a crisis.

This issue is illustrated by the experience of the Mayo Clinic, an organization routinely praised by the Obama Administration as an example of health care done right because of that organization's focus on improving patient health rather than on volume of services delivered and billed.

A June 23 Time Magazine article on cost-effective care said: "Last year, Mayo lost $840 million on $1.7 billion in Medicare work. It compensated by charging private insurers a premium for the Mayo name, but (health plans are) starting to balk."

Mayo's CEO Dr. Denis A. Cortese was quoted in the New York Times on March 24, saying:

"Medicare has systematically been underpaying for services." ... If more patients are enrolled in a Medicare-like program, "your very best providers will go out of business or stop seeing patients covered by the government plan."

If the Mayo Clinic, lauded as the best of the best, can't cope with current Medicare payment rates, how could any provider reasonably handle losing more money under a government-run "public plan"? We don't believe local doctors and hospitals should face the difficult choice between unsustainable financial pressure and turning new patients away.

Premera members depend on us to provide access to an extensive, high quality network of providers. We place great importance on having strong, collaborative relationships with great doctors and hospitals in the communities where our members live. This is why we are so concerned about what a government-run "public plan" will do to local health care providers and their ability to deliver high quality care to patients.

Meaningful health care reform is necessary. Policies that move us toward more sustainable health care costs while promoting high quality care must be the focus of such discussions in Washington, DC. But the federal government must give very careful consideration to how such reform is structured. It's clear a government-run "public plan" could be devastating for local doctors and hospitals. That isn't an outcome of health care reform that any of us want.