The generally older, Anglo and polite crowd at the town hall meeting at the Unitarian Universalist Congregation of Santa Fe on the night of Aug. 17 produced none of the sound bites of anti-government rage that have dominated national news coverage of the health care debate. Here, the anger found a different target.

"There are some days when health insurance companies seem like distant cousins of the mafia," Tyler Taylor, a physician in Los Alamos, told the audience.

On the campaign trail, President Barack Obama promised to take on big insurance companies and deliver "universal" health care, reportedly saying in 2007: "We can't afford another disappointing [reform] charade in 2008, 2009 and 2010…It's not only tiresome, it's wrong."

But since Obama took charge, Democrats have defined expectations downward.

"The goal is to have affordable insurance—that's the goal for any reform legislation we pass," Jude McCartin, spokeswoman for US Sen. Jeff Bingaman, D-NM, says.

Whatever "reform" turns out to mean, the White House argues the current situation is untenable, with serious consequences looming for public health and the economy. That may be especially true in New Mexico, which ranks toward the bottom of most comparative studies on access to health care.

Among all states, only Texas has a higher percentage of uninsured residents than New Mexico, according to a March study by the Robert Wood Johnson Foundation.

The study also found New Mexico had a higher percentage of uninsured workers—28.1 percent—than any other state. The nationwide average was 18.4 percent.

The study compared data from 1995 and 2007, the last year for which comprehensive figures were available. Over that time, the rate of uninsured workers increased 8.5 percent—meaning, for whatever reason, 52,700 fewer New Mexico workers had health insurance.

Those figures predate the economic crash. Over the past year, thousands of New Mexicans have lost their jobs and the accompanying health insurance.

Even those who have kept their jobs and insurance now pay more. According to statistics compiled by the federal Department of Health and Human Services, health insurance premiums now cost New Mexicans more than double what they did nine years ago.

That increase is in line with the trends so far this year, according to Anne Sperling, employee benefits manager at Daniels Insurance in Santa Fe and board chairwoman of the Santa Fe Chamber of Commerce. Sperling says premium costs have risen between 8 and 15 percent so far this year, depending on the insurance plan.

"It's very frustrating for employers. They're saying, 'We didn't even use the plan this year, and we're getting this increase?'" Sperling says.

While costs haven't yet risen to the point at which employers are dropping insurance coverage, Sperling says many companies are threatening to do just that. To compensate for rising premiums, Sperling says, local employers are laying off workers, reducing their hours and cutting the share paid toward employees' insurance premiums.

The rising costs "are putting us brokers into a real tailspin," Sperling says. "We don't have that much choice in New Mexico, as far as health care options. They're forcing us to get real creative."

Most New Mexico employers are too small to qualify for anything but off-the-shelf plans offered by the big insurance companies.

"There's no negotiation, really, to speak of, until you get to a group size of 50 or more employees," Sperling says. "The little groups don't have a prayer."

Santa Fe Chamber of Commerce CEO Simon Brackley says his members have not taken a formal position on the various reforms. But the national Chamber of Commerce—from which the local chamber recently split over a separate issue—has taken out television ads in states across the country attacking the "public option" health care plan favored by some Democrats. The public option would create a government-backed health insurance program to compete with private insurers, with the intent of lowering costs.

New Mexico Center on Law and Poverty Executive Director Kim Posich says fears over a government takeover of health care are misplaced; government already plays a huge role in the health care of many, if not most, New Mexicans.

"Right now, when you include Medicaid, the State Coverage Insurance program and Medicare, there's over 800,000 New Mexicans already covered by government health care," Posich says. "There's somewhere around 300,000 New Mexicans who are uninsured. That leaves fewer than 1 million with private insurance."

Sperling says the local chamber tried to arrange town hall meetings on health care with US Rep. Ben Luján, D-NM; US Sen. Tom Udall, D-NM; and Bingaman, but "lo and behold, they didn't have time."

That changed last week, when Luján's office accepted an invitation to the Aug. 17 health care meeting by the Unitarians.

Bingaman also has begun to schedule town halls around the state this month.

Approximately 360 people attended the town hall featuring Luján, Taylor and Health Action New Mexico Board President Lydia Pendley. All the panelists favor a public insurance option; so did most of the audience. The forum was significantly calmer than those that have been spotlighted around the country. But Luján spokesman Mark Nicastre says at forums in other parts of New Mexico, misinformation has taken more hold.

"We were in Clovis on Saturday, and some of the things you hear on Fox News did gain some traction," Nicastre says. However, he adds, Luján was able to persuade a few people that talk-show-fed fears of government-sponsored euthanasia and mental health concentration camps for conservatives are unfounded.

Nicastre says several thousand people have contacted Luján's office over the past month, the majority of whom support some kind of "reform."

But as a freshman, Luján's say in this debate is limited, especially next to Bingaman, who is one of three Democrats in a Senate "group of six" meeting outside of ordinary committee procedure to reach a compromise with Republicans.

Bingaman, a moderate, still supports a "public option" plan, even though the Obama administration has begun to back away from it. Leading Democrats now appear to be promoting a system of health care "co-ops," though it's unclear what that would mean. "There's not a single definition for it," McCartin says.

Under such a scheme, states might be able to form various consumer-owned cooperatives to either provide insurance or negotiate with existing insurers on behalf of members.

The Law and Poverty Center's Posich fears such a "reform" might amount to a person behind a desk handing out brochures.

"It sounds like [co-ops are] an option being put forward to keep the government from being involved," Posich says. "And from my perspective, it's because the insurance companies don't want to have a low-cost alternative."