In the nearly filled Toyota Auditorium on Wednesday night, Jim VanderSteeg, COO of Covenant Health Systems, began his lecture on health care with a slide of the movie poster from Clint Eastwood's classic film, "The Good, The Bad and the Ugly."

The movie title could not have been more apropos, as Vandersteeg and his chief medical officer, Dr. Mark Browne, explained the positives and negatives of the American system to the audience of students, faculty and community members.

Amid charts, pop culture references and an elaborate allegory between Mickey Mouse watches and American health care, the Covenant Health duo provided two different sides on one of the nation's hottest issues.

"Part of what makes this so unique this evening is that our speakers are coming at it from two different perspectives," said Sarah Hunter, a Chancellor's Honors assistant director who helped organize the event. "We have the perspective of the business part of health care, and then the physician's view."

VanderSteeg's administrative segment focused on how the U.S. arrived where it is today. With the world's highest per capital health care expenditures and swiftly rising Medicare costs, the U.S. is an undeniable outlier among otherwise manageable global health care trends.

As the Eastwood poster suggested, however, the situation is not all bad.

"If you look at our system and you look at how many people travel from all over the world to come to America for their health care ... the American health care system is in many ways a wonderful health care system," Vandersteeg said. "It's maybe not sustainable, the way that we provide healthcare today, but it's also important to know that the American health care system is very important to our economy."

VanderSteeg said that the national problems emerged from a focus on volume of healthcare, not value. Historically, the fastest providers made the most money, and oftentimes the quality of provided care suffered.

"Value has not been in the equation," he said. "October 1st of this year was the first time hospitals actually got their payment affected by their performance. In the past, not too long ago, your performance didn't mean anything. There weren't things that were consistently measured across the country."

Hospitals are paying more attention to those measurements as the nation prepares for the "Silver Tsunami," another name for the aging baby boomers, America's soon-to-be largest age group whose health needs are projected to increase substantially over the next 10 to 15 years. VanderSteeg showed slides of report cards that assessed patients' experiences and doctors' services, explaining that, in the 21st century, value will become the dominant force in health care economics.

With the comfortable air of a trained physician, VanderSteeg's cohort, Browne, joined into the lecture halfway through. He transitioned from administrative initiatives to the practical changes he suspects the U.S. system will soon experience.

Specifically, he highlighted the things that will soon be gone from American health care. Thanks to the advent of technology and the new emphasis on value, the days of filling out charts by hand or working 80 hour weeks are gone. The very way doctors treat disease, Browne said, will change.

"We grew up and built an acute care system; we take care of people when they're sick," Browne said. "The system you all are going to live in is managing population and managing disease. ... A medical home model says, 'I'm going to keep people well, I'm going to do everything I can to keep them out of the hospital and I'm going to get paid to do it.'"

After the 90 minute lecture, a brief question and answer session centered on ideas of socioeconomic differences and the possibilities of adopting other nations' models. Browne personally favors the Costa Rica system and said he could see the U.S. following a similar path.

"Everybody gets some, but if you want more you can buy up," he said. "So they have what they call a social security, which is the health plan for everybody. If you want to go to a private hospital ... you can buy up, if you will, and go to the private hospital. But it's on your dime."

Emma Hollmann, a junior in chemical engineering, attended the lecture. As someone who has considered a career in health care, she said the information presented mostly pushed her away from the field, a direction she has been going in for a while.

For Hollmann, some of the changes Browne and VanderSteeg predicted seemed far-fetched.

"Him saying, 'You're not going to work 80 hours a week,' ... you may not technically work 80 hours a week, but you're going to do what your program tells you to do to get where you need to go," she said.

After the 90 minute lecture, a brief question and answer session centered on ideas of socioeconomic differences and the possibilities of adopting other nations' models. Browne personally favors the Costa Rica system and said he could see the U.S. following a similar path.

"Everybody gets some, but if you want more you can buy up," he said. "So they have what they call a social security, which is the health plan for everybody. If you want to go to a private hospital ... you can buy up, if you will, and go to the private hospital. But it's on your dime."

Emma Hollmann, a junior in chemical engineering, attended the lecture. As someone who has considered a career in health care, she said the information presented mostly pushed her away from the field, a direction she has been going in for a while.

For Hollmann, some of the changes Browne and VanderSteeg predicted seemed far-fetched.

"Him saying, 'You're not going to work 80 hours a week,' ... you may not technically work 80 hours a week, but you're going to do what your program tells you to do to get where you need to go," she said.