In separate meetings with medical professionals at Missoula's two hospitals Tuesday, U.S. Sen. Jon Tester, D-Mont., heard deeply felt frustration in the voices of his constituents.

During the hourlong sessions at St. Patrick Hospital and Community Medical Center, Missoula's medical experts never got far afield from some core concerns they have about the health care reform Congress will address in coming weeks. Chief among them:

How can Congress fix a national health care system it doesn't fully understand?

Why is Congress rushing to pass a historic bill that is being drafted without public input and affects one-sixth of the national economy?

What will be in the bill?

"The lack of specifics scares me," said Brad Pickhardt, a physician at St. Patrick Hospital. "The only thing I'm hearing is that 'It's very complicated - trust us.' And that makes me nervous."

When asked to explain what is in the health care reform bill and what will be presented in Congress, Tester didn't quell the collective unease.

"Everything is up in the air until the bill gets going," Tester said, answering a question asked by Jeff Fee, St. Patrick CEO. "Everything is open for negotiation at this point."

The bill won't likely be a complete overhaul, the senator said, "but what it is trying to accomplish are two things: efficiency and coverage."

Tester said he expects and hopes the bill will make health insurance more affordable, and provide for people with pre-existing conditions. He expects the issues of portability will be addressed; that is, allowing individuals to shop for insurance across state lines or be able to take it with them wherever they go.

He also expects Medicaid and Medicare will be streamlined to prevent such things as duplication of tests for patients, and that it will also put a halt to situations in which a patient is released from the hospital one week only to return the next week because of lack of collaboration between medical providers.

Tester didn't hear any criticism of those notions; however, the Missoula medical experts hammered home the point that the real challenge at the heart of American health care isn't being talked about.

At issue: None of the variety of plans that either political party is talking about addresses the high cost of malpractice insurance and its ripple effect, "defensive medicine," said medical professionals at both hospitals.

The glaring absence of those topics, they said, is proof enough that Congress doesn't understand the nation's health care system.

Physicians don't want to practice "defensive medicine" - whereby they order more tests and imaging than necessary, driving up the cost of treatment - but in a litigious society, it is necessary, explained Lawrence Gerstel, a physician at Community Medical Center.

What Congress doesn't grasp is that the threat of lawsuits comes with a crippling burden, said Chriss Mack, a neurosurgeon at St. Patrick Hospital.

The cost of malpractice insurance eats up 15 percent or more of a doctor's practice and that expense in turn gets passed on to patients. The insurance is also so expensive that it is discouraging medical students from practicing primary care.

The end result is that with fewer primary docs, people seek out emergency rooms, where treatment is more expensive, where doctors aren't familiar with a patient's medical background and therefore order a battery of tests to rule out worst-case scenarios, said Greg Kazemi, director of St. Patrick Hospital's emergency medicine.

"Twenty-five to

50 percent of what we do there is just defensive medicine and that's not enhancing the care of the patient," he said. "We have got to restructure that. We shouldn't be taking excess testing to avoid that one-in-a-million chance for a lawsuit."

There has to be room in the system to accommodate errors and bad outcomes when medical solutions fail, which is about 5 percent of the time, said the roomfull of physicians during the meeting at St. Patrick Hospital.

By all accounts, the collective Missoula voices said Congress must address this matter for any kind of health care reform to happen.

There is no reason this country can't find a solution - other countries have figured this out, and so, too, have other business sectors such as the auto industry, said Matt Maxwell, a cardiovascular surgeon at St. Patrick Hospital.

Adding to the morning's fodder, Pickhardt said: "In America, I believe we have come to expect a level of health care we can't afford. Everybody can't have everything this society is going to demand."

Although the atmosphere at each of the meetings was vastly different - at St. Patrick Hospital, Tester heard from a room full of male doctors, and at Community Medical Center he heard from a mix of male and female professionals representing a cross-section of health fields - the senator heard a unified voice on unified issues.

The frank discussions, Tester said, are enormously helpful to him as he does his part to guide the bill's direction when it hits the Senate floor.

"I want to know the world as you see it," Tester told his expert audience. "I want to know what are the great opportunities for failure and success.

"The finance committee will roll the bill out by mid-September, and then it will merge with a bill out of the health committee," he said. "From there it will be debated on the Senate floor."

Reporter Betsy Cohen can be reached at 523-5253 or at bcohen@missoulian.com.