Jim Brexler

In this three photo combo, President Barack Obama speaks to a joint session of Congress on healthcare at the U.S. Capitol in Washington, on Wednesday, Sept. 9, 2009. (AP Photo/Jason Reed, pool)

Health care providers and consumers in Chattanooga agree that medical care often is too costly and excludes too many people.

But those who watched President Obama’s speech Wednesday night remain divided over how much they want the president to change the way health care is delivered. Many suggest that the White House and Congress should take a more measured approach to altering an industry that helps employ nearly one of every five workers in the Chattanooga area.

“We can’t rebuild the health care system in one bold stroke,” said Chattanooga oncologist B.W. Ruffner, president-elect of the Tennessee Medical Association. “My hope is that we can take a few bold steps in the right direction.”

Erlanger hospital President Jim Brexler said the president “did appear to open the door” to alternative approaches to broadening insurance coverage while still controlling the growth in health care spending.

“It’s going to take a lot of negotiations and certainly some time to implement,” Mr. Brexler said. “But I think this is an opportunity for some meaningful reform to be put in place, and thoughtful people are going to work their way through that.”

Parts of Mr. Obama’s health care proposal remain controversial, and U.S. Rep. Zach Wamp, R-Tenn., urged the president to start over with his plan.

“Unless President Obama hits the restart button on health care reform and begins with incremental, bipartisan change, then he won’t win over the American people,” he said.

Jim Brown, state director of the National Federation of Independent Businesses, said small businesses would be hurt by any mandate to provide health insurance or pay a fine. BlueCross BlueShield of Tennessee, the state’s biggest health insurance company, would have to pay higher taxes on its premium plans under the president’s proposal and also might have to compete against new government-sponsored health plans.

Even supporters of Mr. Obama’s reform concede that there may not be the political support to add major new government insurance plans to the market.

Tony Garr, executive director of the Tennessee Health Care Campaign, a consumer coalition backing health care reform, said some type of reform package must be approved this fall.

“The political reality is that we probably can’t get a public option through the Senate, but we can make a number of improvements to reduce the number of uninsured persons, and that is much better than nothing,” he said.

State Rep. JoAnne Favors, a Chattanooga Democrat and registered nurse, said she was encouraged that Mr. Obama proposed a four-year phase-in of the new health plans and rules.

“The president demonstrated he has a good grasp on the complexity of the issues involved in health care and I think, at long last, some reform will move forward,” she said.

Hutcheson Hospital CEO Charles Stewart said most health care providers recognize the need for reform but are worried about how the changes will be implemented.

“It’s not clear to me how this is going to be paid for in the long run,” he said. “Historically when changes are made to limit costs, that means less reimbursement for us.”

Russ Blakely, a Chattanooga insurance broker who works with dozens of area employers, said he worries that government-sponsored health plans pushed by most Democrats further could explode an already-too-costly $2.6 trillion health care system in America.

“We definitely need health care reform,” he said. “But what concerns me is the public option, which I fear will cost many hundreds of billions of dollars beyond what is estimated and will simply cost too much money.”

Health insurance plans are being scaled back by many businesses this year to avoid quoted price increases in premiums averaging 8 percent to 12 percent, Mr. Blakely said.

To limit such increases, Mr. Blakely and others said they want more wellness programs and electronic medical records, limits on how insurers can deny coverage for pre-existing health conditions and new requirements for more businesses and individuals to buy health insurance and better share overall costs.

Tennessee’s U.S. senators urged the president to limit his health reform ambitions.

U.S. Sen. Lamar Alexander, R-Tenn., urged the president to “focus on cost and the five or six steps we can take together to begin reforming health care.” Rather than expand government health care plans, Sen. Alexander said, Congress should allow small businesses to combine resources in order to offer low-cost health insurance to their employees.

U.S. Sen. Bob Corker, R-Tenn., said the president should focus on implementing a less sweeping reform package he said “would go a long way toward meaningful reform” of health care.

“There are a number of incremental steps that both parties can agree upon: making sure Americans with pre-existing conditions have access to coverage, tax code changes allowing individuals to purchase private insurance, cross-state competition, and exchanges like we have here in the Senate,” he said.

U.S. Rep. John Duncan, R-Tenn., said the plan’s additional coverage to 45 million uninsured Americans is unaffordable for a government already operating at a deficit.

“Even if President Obama’s plan was the best plan in the world, we still cannot afford its cost,” he said