As the national debate about healthcare reform intensifies, South Florida stands out as a place that has a lot to gain and a lot to lose, depending on the details hammered out by Congress next month.

A lot to gain because the region has an unusually high percentage of uninsured and people who seek to buy insurance on the individual coverage market, which is often high-priced and unavailable to those with chronic diseases. The reforms are aimed at helping both of these groups get coverage they can afford.

A lot to lose because almost all experts say the only way the country can afford reform is to reduce its healthcare costs. The United States has the highest healthcare costs in the world, and South Florida is among the highest in the nation. Under reform, quite a few of the 218,000 healthcare workers in Miami-Dade and Broward could lose their jobs.

Healthcare leaders like Brian Keeley, chief executive of Baptist Health South Florida, says these two points are closely connected: The higher the costs get, the fewer businesses can afford coverage, which increases the number of uninsured, who often delay treatment until they are extremely sick and go to the emergency room.

There, they run up big bills they can't pay for, and hospitals compensate by hiking rates for private insurance, causing more businesses to drop coverage, which increases the number of uninsured.

``This is a `death spiral,' '' says Keeley.

``The system is totally unsustainable for all parties. Drug companies, insurance companies, the SEIU [Service Employees International Union], you talk about strange bedfellows -- all agree something has to be done.''

With accusations flying in all directions and much confusion about the details in proposals Congress will be considering when it returns from its August recess, here is a quick primer about healthcare, dealing with the misconceptions and the realities: Where the system stands now, how it stacks up to other countries, what is being proposed and what changes mean for South Florida residents.

What we have now

The United States has a public/private mixture. Fifty-three percent get their insurance at work, according to the Kaiser Family Foundation; 27 percent have a government plan (Medicare for seniors, Medicaid for the poor); 5 percent buy on the individual market.

Fifteen percent have no insurance -- 45 million in 2007 and thought by many to have risen to 50 million during the recession.

In South Florida, one million are uninsured. In Miami-Dade, 625,000 have no coverage -- 30.9 percent of the population under 65. In Broward, it's 408,000 -- 27.1 percent of those under 65. This is Census Bureau data for 2006, which was just released. The numbers have likely increased during the recession.

In one sense, the United States already has universal healthcare. Under federal law, everyone in the country -- including immigrants here illegally -- must be treated in hospital emergency rooms.

Those unpaid hospital bills get passed on to people with insurance.

A study by Families USA released this week found that in the past 10 years, family healthcare premiums rose an estimated 3.7 times faster than earnings for Florida workers.

The one group that has a hard time passing on these costs are the public hospitals, because so many of their patients are poor or uninsured.

That's why places like Jackson Health System are in dire financial shape, which is expected to get worse.

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