The Obama administration's plans for healthcare reform could mean relief for almost 50 million uninsured Americans, a healthier workforce less likely to call in sick and emergency rooms no longer clogged with people who can't afford primary care.

But it could also mean this: the loss of billions of dollars to the South Florida economy, some hospitals consolidated or closed, and the disappearance of untold number of jobs in the lucrative healthcare field.

That's because if you want healthcare reform, you have to pay the trillion-dollar tab. One way to help do that is to save money by eliminating bloated spending on unnecessary hospital visits and tests. In few places are healthcare costs more bloated than South Florida, especially Miami.

On average, a senior citizen in Miami costs Medicare nearly two and a half times what a senior citizen in Minneapolis/St. Paul costs the government healthcare provider -- ''an inexplicable and unwarranted variation,'' according to Manuel Anton, chief operating officer at Mercy Hospital in Miami.

South Florida has more doctors referring more patients to more specialists and ordering up more high-tech imaging tests than other areas. As a result, employer-based health insurance is 20 percent more expensive here.

And yet, we're no healthier and we don't live any longer.

With so much at stake, you might expect South Florida's medical establishment to be aligned against reform. Not true. They acknowledge that the present system is wrong and needs to be changed.

''What's happening here now is not sustainable,'' said Brian Keeley, chief executive of Baptist Health South Florida, the largest nongovernment employer in the region.

''There is no question we're going to get hit,'' said Linda Quick, president of the South Florida Hospital and Healthcare Association.

Many patients are desperate for fast action. Cathy Price, a 59-year-old South Dade resident, lost coverage last month, when her husband's plastering business plummeted in the recession and they couldn't afford the premiums. ``It's not easy, I'll tell you. We've been taxpayers for a long time. I think something needs to be done.''

Individuals who can no longer afford health insurance aren't the only ones punished by the current system. High medical costs are a major reason companies don't come to the region, said Steven Ullmann, professor of healthcare economics at the University of Miami.

What's more, a reform providing universal coverage would by itself lower some costs, said Ullmann, because insured people are more likely to seek treatment when they first get sick -- before illnesses take on expensive complications.

And yet change will be painful and disorienting, especially in South Florida. Federal labor statistics show 218,000 healthcare employees work in Miami-Dade and Broward. They earned $9.8 billion in 2007. Much of that income is supported by Medicare, which paid $9.4 billion in the two counties in 2007. Eliminating some of that Medicare money will mean eliminating existing jobs.

OVERPRICED

Dartmouth researchers, who have been studying Medicare data for years, say many of those dollars come from patients getting unnecessary or overpriced treatment. In Miami, senior citizen lab and diagnostic tests are three times more expensive, per capita, than in Minnesota. A Fort Lauderdale senior's diagnostics cost twice as much.

In the last six months of life, when costs really skyrocket, the average South Florida senior spends at least twice as many days in intensive care as seniors in the rest of the country, and is examined by specialists at least twice as often.

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