A week before the federal healthcare reform law is set to be argued before the U.S. Supreme Court, the Affordable Care Act took center stage at a North Carolina forum to discuss the healthcare system.

A hospital system executive supported the law’s goals of increasing patient access and improving quality. A budget hawk argued that healthcare is the nation’s biggest fiscal challenge. And a business advocate warned that a government health insurance mandate burdens small businesses and threatens jobs.

GlaxoSmithKline‘s (NYSE:GSK) Research Triangle Park campus hosted the forum that was coordinated by statewide public affairs television program NC SPIN. The forum was called “What the Health: Can We Survive Our Healthcare System?” Affordable Care Act arguments before the Supreme Court are scheduled to start on March 26. But on Tuesday, debate about the healthcare system was flying fast and furious.

Duke University Health System CEO Victor Dzau said that the U.S. system is characterized by certain contradictions. While the United States tops other countries in breast cancer survival, by other measures such as infant mortality or chronic conditions, the country ranks low. What Americans want from their healthcare system is convenience, choice, the very best care up until the end of life, all while not paying much for it, if at all. Dzau said that the ideal healthcare reform ideal increases access to more patients, improves healthcare quality and controls costs.

“Believe it or not, this is what the Affordable Care Act tries to do,” Dzau said.

Erskine Bowles, former University of North Carolina Systems president and chief of staff to President Clinton, gave his remarks by video. He said that while the United States spends twice as much as any other developed country on healthcare, the country ranks low in outcomes such as infant mortality and life expectancy. Bowles argued that uninsured Americans cost the overall healthcare system because costs of their care are shifted to other payers in the form of higher insurance costs and higher taxes. In order to control those costs, Bowles said, everyone needs to have skin in the game.

Skin in the game would come from the ACA’s mandate that everyone have health insurance, a requirement that has come under fire by opponents. Results of an NC SPIN healthcare survey showed that just 43 percent of North Carolinians believe that the health insurance mandate is “necessary and needed”; 20 percent responded that the mandate is unconstitutional. Respondents did not readily take responsibility for their role in healthcare costs. Just 15 percent attributed rising costs to poor lifestyle habits; 29 percent said those costs were due to doctors and hospitals and 32 percent linked those costs to health insurance.

Gregg Thompson, North Carolina director for the National Federation of Independent Businesses, said that healthcare, specifically rising health costs, ranks as the top concern among small businesses. The NFIB does not oppose healthcare reform. But he argued that a health insurance mandate would add more costs to businesses that cannot shoulder the financial burden.

Physicians speaking on the panels offered support for an insurance mandate. Dr. West Lawson, chief medical officer at WakeMed Health & Hospitals in Raleigh, said that insurance works by pooling risks. Those who have lower healthcare risks need to be part of this pool in order for the risks to be shared. Some presenters argued that healthcare is not a good whose value is easily understood or appreciated by consumers the way they would value a consumer item. Healthcare needs can arise suddenly and unexpectedly in circumstances where cost is not the foremost concern. Allen Verhey, a professor of Christian ethics at Duke University’s divinity school, likened healthcare to the basics of protection offered by government, such as policing.

“It’s more like fire protection and police than Oreos and automobiles,” he said. “It’s hard to anticipate what you need when you need it and then make rational choices.”

While the forum did not settle the healthcare reform debate, it did shine a light on the need for individuals to take more responsibility for their health. To that end, NC SPIN closed the forum by announcing a new statewide effort called “A Healthier NC.” The initiative will push North Carolinians to be aware of their vital health statistics and encourage people to be part of a medical home to coordinate patient care. Additional details on the effort will be released in coming months