ANNAPOLIS -- About 400 people, including Gov. William Donald Schaefer and a congressional delegation, gathered yesterday at a plush hotel here to begin a two-day examination of what ails Maryland's health-care system.
What they got from the five-hour "health-care summit" was a healthy dose of facts, figures, opinions and rhetoric, from state officials, business and academic leaders, congressmen and a senator.
But there was little indication that the General Assembly will be able to give birth to a comprehensive reform plan by the end of its 90-day session.
"The best hope is to pass a bill to get a demonstration project in place" to reform the state's health-care system, said Delegate Casper R. Taylor Jr., D-Allegany, one of the sponsors of the summit. "The worst case is if we can't complete that process, and we have to continue it over the interim and into next year."
The summit is important not only to employers being crushed by the high costs of providing benefits to workers but also the 570,000 Marylanders who have no insurance.
Congress and the Bush administration, if they can't pass a reform package of their own, hope to learn what might work best for the nation from a model plan launched first by a state.
The dangers of sticking with the status quo are looming, according to Stuart Altman, dean of Brandeis University's graduate school of public health. "We have put together the ricketiest, flabbiest kind of system that is barely holding us up," he saidat yesterday's conference. "I can't tell you at what point it's going to collapse."
It's clearly starting to crack, he said, both from the cost and the failure to insure everyone. Health spending as a percentage of the gross national product, a modest 6 percent in 1965, rose to 12.4 percent last year, or $676 billion.
What's even more alarming is that the rate of growth is accelerating: By the year 2000, the United States could be spending at least $1.8 trillion on health care, or 20 percent of its GNP, Dr. Altman said.
Mr. Schaefer told the audience that, when the health-care summit was first proposed to him, he "did not meet it with great enthusiasm, because of the great frustration that could be built up if something dynamic did not come out of it."
But moved by the gravity of the problem, Mr. Schaefer said he agreed to lend his name and office to the summit.
"Don't try to solve the whole world," he warned the participants, who will meet again this morning to begin the process of dialogue and compromise.
"If you can bring just one or two things out of here today," he said, "we can accomplish a miracle."
So far, four options have been addressed at the summit.
Among the ideas the General Assembly is expected to consider are proposals that would:
* Require all employers to offer health coverage and set up a publicly administered program for the unemployed, funded partly from taxes on employers who don't offer coverage.
A variation of this "play-or-pay" plan, also called "employer choice," has been introduced by the Democratic leadership of the Congress. In Maryland, the Governor's Commission on Health Care Policy and Financing has endorsed play-or-pay, though Mr. Schaefer hasn't expressed an opinion on it.
* Require all citizens to buy their own coverage, but give them a progressive tax credit to pay for it. President Bush reportedly will unveil a version of this approach, called "consumer choice," next week as his alternative to the Democratic plan.
* Replace the current system entirely with a "single-payer" system, like Canada's. Under the single-payer approach, which Maryland has adopted in part for its hospital care, the private insurance system would be replaced by a government-run program that sets all prices for health care and pays all bills.
* The most modest reform, and the one given the best chance of being passed by the legislature, would help small businesses avoid annual price increases much larger than those of bigger companies. Some sort of mechanism to pool costs among small employers would have to be created under the so-called "small group market reforms."
"Just creating programs, open-ended programs, is not the answer," said state Secretary of Health and Mental Hygiene Nelson J. Sabatini. "We aren't going to solve the problem all at once. It won't work, it's too big."
"But let's not say: 'It's too big, so let's not talk about it.' "