Health care reform is a hot topic in Washington, D.C., but Utah may have an edge in actually making progress toward practical solutions.

Utahns generally have access to care, and doctors and hospitals are working to become more efficient, according to Kimball Anderson, chief operating officer of MountainStar's Utah County network. The Beehive State's health care costs already are among the lowest in the nation.

Yet even we can't entirely dodge the waste and inefficiency of the current health care system.

For example, in Utah hospitals, there was a 56-percent increase in "sentinel" events -- safety mishaps -- from 2007 to 2008, according the Utah Department of Health. Of the 89 reported sentinel events, 28 ended in the death of the patient, and another six caused major permanent harm.

Even conservatives who rightly shudder at the thought of government running the health care system should acknowledge the flaws of the current setup. The nation wastes more than $1 trillion each year on unneeded or ineffective health care. Much of that is caused by a lack of incentives to cut costs, because insured patients don't see the real bills for their treatment.

Then there are perverse incentives that actually drive up costs. Dr. Brent James, Intermountain Healthcare's chief quality officer, has in the last few months testified before congressional committees about this issue. He notes that doctors and hospitals often find it more lucrative to treat symptoms and run tests than to do the harder work of making people healthier.

He cites a story about a doctor at LDS Hospital in Salt Lake City who, in the 1980s, found a way to use antibiotics more effectively to reduce the percentage of infections in the hospital from almost 2 percent to 0.4 percent. That saved patients time in the hospital and additional complications. But it cost the hospital about $35,000 for every patient who didn't get treated for infections. Multiply that sort of thing many times, and it's no wonder the system wastes so much time, money and resources.

But despite the hype about health reform, real answers are a long way off. Politicians "don't have a clue in this world about how to make it work," James said. "You can't travel the world and find anybody who has figured this thing out."

That is an argument for going slowly. Rather than searching for a magic bullet, as the Obama administration seems to be doing, incremental reforms may work best. And Utah may be among the best laboratories for testing solutions.

The Utah Legislature has created a Health System Reform Task Force that is now in its third year of a planned decade-long drive to reform health care. Its leaders say the panel intends this year to start implementing more of the ideas it has worked out.

At the same time, it would be naïve to think the Beehive State can avoid difficult choices. Some choppy waves are already developing. As of July 1, Utah generally won't pay for new Medicaid patients to get a particular drug to treat Alzheimer's disease.

While Aricept will still be available to patients who are already taking the drug under Medicaid, it will be replaced with two drugs, Namenda and Exelon, that are believed to have the same effect but will cost the state less.

Will this limit care? Or is it a reasonable step that won't seriously affect patients? In either case, this may be a hint of what's in store in health care.

Dr. James says the best system would be one in which doctors have the incentives to be more creative and effective, where health care providers encourage prevention and health, and where insurance companies pay for less and thus charge lower premiums. All that, if achieved, could give Americans better care at less cost.

"Here in Utah, we're going to do it anyway," James said. "The mistake is to believe that real health care reform will come out of Washington."

That's for sure. The more the current proposals coming out of Washington are examined, the more frightening they appear. Utahns should cross their fingers and hope health care "reform" stalls in D.C., giving Utah a chance to craft its own solutions.