SAMARITAN Hospital's new wing shines in the summer sun. The bright entrance seems to beckon to the ill, injured and needy of the Columbia Basin: Enter here, and you will be cured. The cheery welcome comes with an unspoken caveat: It isn't free. You will need to foot the bill. If you cannot, someone will. Someone, like your insurance company. Or Medicare or Medicaid. Or, as a last resort, the hospital itself.

The activity in the intensive care unit at the Moses Lake hospital can be life-determining for those involved, but it is only a small piece of the action going on in hospitals, clinics and doctors offices across the state. What happens in Moses Lake in many ways mirrors events elsewhere in the Washington medical community: a scramble to make sure patients get the health care they need despite the system's shrinking ability to pay for those services.

And behind the doors at Samaritan another crisis looms. The small, 50-bed community hospital and its rural clinic nearby, always in a crunch to pay their own bills, need to add more beds if they are going to keep up with growth in Central Washington. But if they do, they are in danger of losing a key Medicare designation as a rural health clinic and with it a significant chunk of revenue - 10 percent of the bottom line.

"That would be a lot for our organization to absorb," spokesman Scott Campbell says. He adds that Samaritan also needs more doctors "doctors increasingly attracted to urban settings" to maintain its level of service. Samaritan's quandary is reflected at rural hospitals all across Washington and the United States, and is just one more measure of the enormous complexity of the state's health care crisis.

Samaritan may be miles away from other full-service Washington hospitals, but it is not alone in feeling the fallout from the health care crisis in this state and other states across the country. The rising cost of health care has squeezed nearly everyone involved - health care providers, employers, insurers and consumers. And, as the baby-boomer generation moves into the "seniors"? generation, the pressure is only expected to tighten.

A BRIEF RESPITE
The good news is that increases in health care costs may have peaked, for now. A nationwide study by Watson Wyatt Worldwide and the National Business Group on Health finds employers expect health care benefit costs to increase 8 percent this year, down from 14.7 percent in 2002. But that does not change the extent of the problem. The National Coalition on Health Care estimates that total national health expenditures were $1.9 trillion, up 7.9 percent â?" or more than three times the rate of inflation - in 2004, the latest year for which data were available when it released its report last spring.

The other good news is that there are people working on the problem. The federal and state governments, corporations, insurers, health care providers and consumer groups have all begun to establish positions in the complicated debate. However, the bad news is the same: There are people working on the problem. Positions on health care are political - and emotional. The dispute is often heated. After all, the result could determine whether a premature baby lives a normal life, whether a diabetic goes blind. Or dies.

In Washington, much of the focus will be on the state Legislature's 2007 session and the ability of people with diverse opinions to communicate. "That's the big picture and it's not easy,"? says one senior Democratic legislative strategist, who spoke on condition of anonymity.