Islanders have long been acutely aware of the problems of health care access. Cut off from the larger medical community by Nantucket Sound, Vineyarders are twice as likely as other Massachusetts residents to be uninsured. On Friday afternoon Martha’s Vineyard Community Services held a panel discussion about the recent national health care bill, and how it would improve access as well as hit home.

The panel included industry luminaries such as the president emeritus of the American Association of Medical Colleges, Dr. Jordan J. Cohen, Amy Whitcomb Slemmer, the executive director of Health Care for All, a nonprofit instrumental in the push for universal health care in Massachusetts, and local health care advocate Sarah Kuh, executive director of the Vineyard Health Care Access Program.

For the most part the discussion centered on the accomplishments of the recent federal law, as well as how far the country still must go to untangle itself from the financial morass rising health care costs ominously forebode. According to World Health Organization statistics cited by moderator Victor Cappocia, a senior scientist at the University of Wisconsin and former director of Community Health Services in Boston, the United States health care system ranks 37th in overall performance despite costing more than twice as much per capita as any other country. According to the CIA World Factbook, the United States ranks 46th in lowest rate of infant mortality, below Cuba and Portugal, and 50th in life expectancy. In addition, the majority of personal bankruptcies in the United States are caused by medical costs (even though the majority of these bankrupt citizens had health insurance).

Despite all this, health insurance and broader health care reform has been remarkably difficult to pass since the Roosevelt administration. Dr. Cohen had an explanation.

“For one thing it’s extraordinarily complicated, which means that it was so easy to characterize what was being put forward in ways that were completely disassociated from reality,” he said. “Now I’m obviously revealing my bias here, but nevertheless I think it’s fair to say that the distortions that were implanted in people’s minds were very poisonous.”

Despite the sometimes rancorous legislative process, Dr. Cohen said what finally emerged from congress was “a very meaningful bill that should be celebrated.” He said while the gap in insurance coverage would finally be addressed, the long and much more complicated battle over more effective delivery of health care had just begun.

Ms. Slemmer agreed, priding herself on Massachusetts’s 97 per cent insurance coverage rate, a product of the reform she helped bring about in 2006 and which bears a strong resemblance to the national bill. But as coverage has risen, so too have premiums, and although most Bay Staters are happy with their reformed care, the state is on an unsustainable path. If Massachusetts was the vanguard in insurance reform, Ms. Slemmer argued, it would have also to be the vanguard of delivery reform.

“We’re ready to take the next step,” she said. “We should move away from the fee-for-service system into something that looks at and provides incentives for really taking care of patients’ overall health.”

She said there are currently incentives in the medical system that reward doctors for volume of care rather than quality of care, such as expensive tests that may even be detrimental to a patient’s health in the long term, and that more energy should be put into implementing policies that look at a patient’s overall health.

“Now if you thought that coverage was complicated, reforming the delivery system is complicated times one hundred,” she said.

Every member of the panel agreed that reforming health care delivery is a necessity, however complex. Mr. Jordan highlighted passages in the national bill that provide significant financial support to pilot programs; Ms. Kuh and several members of the audience said the Vineyard is a perfectly isolated laboratory for improved delivery.

Ms. Kuh, whose organization has been assisting Islanders gain access to health care since its founding in 1999, sees the problem as a challenge.

“I think we have a wonderfully exciting opportunity here on the Vineyard,” she said. “If you have lots of members of the community and you have a broad group of stakeholders I think we can accomplish a tremendous amount. Plus there are going to be federal funds that are going to be made available for these kinds of innovative partnerships that can make a difference in a community’s overall health.”

Mr. Cappocia said Americans will have to curb their appetite for instant gratification and endless medical procedures, but he rejected concerns that the new changes in the law would result in the bogeyman of “rationed care.”

“We have rationed care right now,” he said, “only now those who can least afford it have their health care rationed the most.”