Skyrocketing healthcare costs and increasing numbers of uninsured patients have brought doctors, hospitals and insurers to the table in support of healthcare reform. But if the Triangle is an indicator, the final product is still far from decided.

WakeMed Chief Executive Officer Bill Atkinson sits on an American Hospital Association task force on the issue. He said the three keys to reform are things his hospital has been focusing on for years - access, cost and quality.

"Incentives for everyone involved need to be tied to outcomes," he said. "Not just doing fee for service...the traditional, pay you to do something, whether it has a positive outcome or not. It needs to be tied to outcomes."

Atkinson said government involvement is the only way to get healthcare on the right track. Federal standards for electronic medical records, for example, could eliminate costly duplication of services and tests.

But insurers, doctors, even the American Hospital Association caution that too much government would inflate healthcare costs. Blue Cross and Blue Shield of North Carolina has taken that message to You Tube with a taped message from Chief Executive Office Bob Greczyn.

"We believe that a reformed healthcare system, built on the strengths of the employer based healthcare system that we have today, will achieve these important goals," said Greczyn. "We don't think it's necessary to include a government-run health insurance option." (listen to Greczyn's entire statement here)

North Carolina Hospital Association (NCHA) spokesman Don Dalton said without a firm policy from Washington, it is difficult to pass judgment on the President's reform agenda. But he cautioned that a government-sponsored insurance plan could hurt hospitals. He said an estimated 70 percent of commercially insured people would migrate to the government plan, giving hospitals less ability to shift costs to maintain operating margins.

Atkinson, a former chair of NCHA, said the problems with healthcare demand the government's attention and intervention.

"I just think it's a mistake when people say what's being proposed out of Washington is a government approach, I don't think it's that at all," he said. "I think government is the only group big enough to sort of kick everyone off their pedestal and say, start again and get this right."