A health insurance executive, a doctor, two legislators and about 45 Pittsburgh-area residents tussled over health-care reform during a forum last night at Rodef Shalom Temple.

United by a belief that change is necessary but divided over how that should be accomplished, they covered a wide range of issues, from broad ethical principles to the relative happiness of different types of doctors. (Geriatricians top the list because their patients are overwhelmingly insured, said Dr. Andrea Fox, of the Squirrel Hill Health Center.)

The forum was sponsored by Rodef Shalom's social action committee and moderated by state Rep. Dan Frankel, D-Squirrel Hill.

"For the first time in my lifetime, our country is really poised to deal with comprehensive health-care reform," said Mr. Frankel. "The status quo, quite frankly, is unacceptable."

After presentations by Dr. Fox, state Rep. Josh Shapiro, D-Montgomery, and Diane Holder, president of the UPMC Health Plan, Mr. Frankel fielded questions from the audience.

Ms. Holder said that the current health care situation is both "the best of times," because of the increasing power and scope of medicine, and "the worst of times," because of the increasing number of uninsured and undercovered people. She said one of the most important issues that remains mostly unaddressed by legislation is "cost containment."

She said the ballooning cost of health care was partly due to a growing prevalence of chronic disease and partly due to other issues, like administrative and procedural duplication, like when a patient is given multiple MRIs.

Audience members and panelists alike seemed to agree on a number of issues. Among them were that everyone should have access to health insurance and that health care has become too expensive.

But they quibbled vehemently over other issues, such the political viability of a single-payer model of health insurance, in which one agency uses public funds to pay private health-care providers.

During the question-and-answer session, several audience members expressed profound dissatisfaction with the current health-care system.

Sandy Fox, of Squirrel Hill, castigated the high administrative costs of some insurance companies.

"That is not health care," she said. "That is waste."

Ed Cloonan, of Munhall, cited the closure of the UPMC Braddock Hospital as a failure of the current paradigm.

He asked whether there is "an inherent, unresolvable conflict" between the idea that health care is a human right and a for-profit model of health care.

Evelyn Stypula, of Verona, asked when insurance companies will stop telling disabled individuals that certain technology, like a special wheelchair, is "medically unnecessary."

She said she was informed by Medicare that it was "medically unnecessary" for her to have artificial legs.

Mr. Shapiro answered her question candidly, admitting he did not know how the reforms currently proposed would affect patients like her. He promised to find her an answer.

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