COEUR d'ALENE - U.S. health care coverage gets complicated fast, according to Joe Morris.

"No other country has so many different (coverage) systems as we have," the CEO emeritus of Kootenai Health said on Thursday.

Americans insured through their employers, he explained, follow the German coverage model. Those 65 and over rely on a Canada-like system of government-provided health care.

For the uninsured, it's the Cambodian version: Paying out of pocket.

How well is it all working?

Well, there are 51 million uninsured people in the U.S., Morris said, with 217,000 uninsured in Idaho.

"Seventy-nine percent of Americans want a fundamental change or complete overhaul (of health care)," Morris said, speaking at the Coeur d'Alene Public Library. "It's just hard to agree on the details."

Like with the new federal health care reform, he said.

At a presentation hosted by the League of Women Voters of Kootenai County, Morris laid out the dry facts: How American health care coverage isn't what it should be, and how it will be impacted by the Patient Protection and Affordable Care Act that President Obama signed last March.

The motive for U.S. health care reform is obvious, Morris said.

"We don't stack up very well against other countries when it comes to health care outcomes," he said.

Like the 25,000 to 45,000 who die each year from lack of coverage, he cited. The number of uninsured is rising, he added, and health care bills are the leading cause of bankruptcy in the U.S.

This results in inferior care for the uninsured, Morris said.

It also leads to cost shifting, where providers heap costs on insured patients to make up for the uninsured ones.

"Twenty-nine percent of patients at Kootenai (in October 2010) had commercial insurance. The rest were on Medicare, Medicaid or were uninsured," Morris said. "Twenty-nine percent of people to cost share to is difficult."

Obama's health care reform will change some things.

Provisions effective this January include that no plans can cancel anyone for getting sick, or discriminate based on salary. Dependents can remain on parents' insurance plans until the age of 26.

Seniors on Medicare will receive free preventative services, plus discounts on brand name drugs during their coverage gap.

"If you're insured through your employer, you should not see a substantial change," Morris said.

The number of uninsured will continue to rise until 2014, Morris predicted, when the kicker of the reform begins.

That's the mandate for all Americans to have health care coverage.

"This is the most controversial part of the bill, that has led to numerous court cases," Morris said. "Can you require an individual to consume a product, or buy insurance?"

The reform act will help them do so, he said, by providing subsidies and state-run insurance exchanges.

Also by 2014, insurance companies won't be able to deny coverage due to pre-existing conditions.

"Another big question is, 'How will this all be paid for?'" Morris said.

The answer, he said, is a combination of new revenue, reductions and expenditures. Those include a tanning tax, and a tax on families with incomes of more than $250,000. Hospitals are also giving up $157 million in future reimbursement.

The reform is predicted to drop the number of uninsured from 50 million in 2010 to 23 million by 2019, Morris said.

He doubts it will be repealed, he added.

"There will be changes, I think, to the bill," he acknowledged. "The individual mandate could become voluntary. But the question is how to provide very strong incentive, without a mandate?"

Steve Moss, who attended the presentation, said he wishes the reform could cover all the uninsured.

"It looks like 20-some million will be left out," the 65-year-old said.

His wife, Bev Moss, also 65, said she hadn't realized the health care disparity for the uninsured.

"We hear our health care is the best in the world," she said. "This was sobering, because what it seems to me is it's the best in the world if you're wealthy."

Carole Enna said she worries that many don't understand health care coverage or the reform act.

"I think they just hear sound bites on the television and are totally misinformed," she said. "I'm not optimistic."