Construction worker Ken Adams, of Astoria, had health insurance for 15 years until his employer retired three years ago and Adams lost that insurance.

Although he hasn't been in the hospital for 25 years, he was turned down for health insurance because of his cholesterol count.

"If I get sick," Adams told a health forum Saturday, "I'm toast."

Sponsored by state Rep. Brad Witt, D-Clatskanie, the health forum in Astoria brought together a panel of local health care experts to discuss the status of Oregon's and the nation's health care system.

Although the United States spends 16 percent of its economy - more than any nation in the world - on health care, it ranks only about 38th for life expectancy, said Witt.

"Health care is the largest single expenditure in any category of the economy. ... The theory is that by spending more money, the public will become more healthy," Witt said. But, said panel member Ellen Pinney, director of the Oregon Health Action Committee, Oregon has done more in the past two years than any other state to improve health care, especially for children.

"One option off of the table is the option to do nothing," she said. "We have to address how to get everyone under the (health care) tent and how to control costs."

Pinney said the state's Health Advisory Board is discussing legislation to provide every Oregonian with coverage within the next five years. Oregonians would be able to select from a "mall" of health insurance providers that would cover all health care needs at an affordable cost.

As it stands now, Pinney said, 60 percent of U.S. bankruptcies are caused by medical bills, even though those filing for bankruptcy have medical insurance.

At any given time, 1.1 million Oregonians younger than 65 years old are uninsured, Pinney said.

Every time there's a 1 percent drop in employment in the United States, 1.1 million people lose their health insurance, noted Dave Ford, CEO of CareOregon. which provides benefits for the 130,000 Oregonians served by the Oregon Health Care Plan.

On the North Coast, Ford said, a structure is needed that enables residents to have access to health care without having to drive to Portland and to have an adequate supply of doctors and nurses who stay here permanently.

"We have got to take health care into our own hands and not depend on others to decide for us," Ford said. "It will take a degree of activism. We're encouraging folks to decide how they can do it together."

Although the economy forced the Oregon Health Plan to shed 80,000 people from it rolls a few years ago, 60,000 are gradually being added back, said Jeanine Smith, M.D., administrator of the state Office of Health Policy and Research. The state wants every child to be covered, Smith said, and it provides the Oregon Prescription Drug Program to every business to reduce prescription prices.

In Clatsop County, 16.5 percent of the population - the number of residents could fill the city of Seaside - were uninsured, said Jim Coffee, CEO of the Coastal Family Health Center.

But even those who have insurance cards won't always have access to health care. "It just means you have an insurance card," Coffee said.

The number of primary care physicians is shrinking because, comparatively speaking, specialty medicine pays higher salaries.

"Physicians go into medicine because they want to care for people, but it's a business. The cost of malpractice insurance is high. If they're in a high litigation area, they shy away," Coffee said.

The challenge in the North Coast area, said Lon Martin, a shop steward for the SEIU union at Columbia Memorial Hospital, is "getting an insurance company wanting to cover us. We have to go with those available."

While the hospital covers employees at no cost, employees must pay to cover their children, which, Martin said, could amount to $400 a month or more. Finding low-cost prescriptions in the area also is difficult, he said.

Of the 30 people attending the forum, several, like Emily Smith, of Astoria, told personal stories about family members who had lost jobs or were sick with life-threatening illnesses and couldn't pay for medical care.

"We have a lot of loggers, fishermen and Realtors," said Smith, herself a Realtor. "What's going to happen to our community?"

Clatsop County District Attorney Josh Marquis, who also was in the audience, said people with medical needs and no insurance are using the county jail as a medical resource.

"We have an inmate in custody for a serious charge, who decides if he's in jail he can get help for his diabetes," Marquis said. "We can't afford to have this person in jail to pay for his medical bills or a procedure that might cost $5,000. I get a call, and I have to say let's get him out of jail, so we're not stuck paying his medical costs.

"Counties our size would be destroyed if we ran up a $50,000 to $80,000 bill because we're responsible for their health care."