A crowd that filled the Mankato East High School Auditorium to capacity heard nearly three hours of discussion, derision and debate about government health care reform Thursday night at a town hall meeting hosted by Congressman Tim Walz.

With dozens still in line waiting to make comments or ask questions as the forum approached its scheduled two-hour end, the Mankato Democrat extended the meeting for another 40 minutes.

A majority of the audience appeared to be skeptical about Democratic proposals to provide medical coverage for all Americans, attempt to contain skyrocketing costs and restrict insurance companies’ flexibility in denying coverage to people with pre-existing conditions.

Walz responded to the first question, from an insurance agent who thought that malpractice reform was a better approach to lowering costs, the shouts began. “No, No!” some in the audience yelled when Walz said that Texas, with some of the most restrictive laws governing lawsuits against doctors, is seeing above-average increases in health care costs.

It continued with the second question, when Bob Maergerlein of Rochester urged Walz to support a government health coverage option to compete with private insurers. Walz, saying he was undecided on a public option, was unable to finish summarizing the opposing viewpoints on the issue.

When he said that some believe a government option will force private insurers to cut prices, the audience erupted with a battle of cheers — from a smaller but also vocal group of reform supporters — and boos and calls of “No!” from the opponents.

For much of the meeting, it appeared the invocation by a local Lutheran pastor might be the only moment where the audience would be completely silenced.

“Help us listen to one another with a spirit of love and respect,” the Rev. Patrick Patterson prayed near the beginning of the event.

But the crowd — cut off at the fire marshal’s maximum capacity of 743 — became briefly hushed twice again when people told personal stories about loved ones’ struggles under the current health care system.

Bob Idso of St. Peter was initially booed when he began by saying he was “kind of ashamed with all the people who came here to boo tonight.” The reaction changed when Idso, a Vietnam veteran who praised his care under the Veterans Affairs health system, told of his son’s health issues.

The 20-year-old South Central College student has Crohn’s disease, a gastrointestinal disorder, and faces prescription costs topping $60,000 a year.

When he graduates from SCC next spring with an auto-body repair degree, he will no longer be able to rely on his parents’ insurance.

“We don’t know what we’re going to do,” Idso told Walz. “We’re desperate for a solution.”

The crowd hushed again when Rebecca Otterness of St. Peter told of caring for decades for her husband, who has multiple sclerosis and can no longer care for himself in any way.

If she’d allowed her husband to be placed in a nursing home 25 years ago, the costs to the government would have totaled well over $1 million, Otterness said, bringing cheers from cost-conscious members of the audience.

But she said there’s minimal government assistance for the constant and expert care she provides at home.

“We are not taking care of our chronically ill people,” Otterness said. “… Medicare calls that custodial care, and I think I’m better than a janitor.”

More than once, Walz said that he has no doubt that both supporters and opponents of the current health care reform effort have empathy for people suffering under the current system. But for opponents, he urged them to tell what they wanted — not just what they didn’t.

And more than once, he pointed to a graph that showed insurance premiums for average families have risen 74 percent since 2000, while average family income has increased 17 percent.

“It’s not one of those issues we can choose to ignore,” Walz said. “… Not doing anything will have consequences.”

So does a poorly constructed reform bill, said Dr. Philip Araoz, a Mayo Clinic physician. Araoz doubted that Walz will succeed in changing the federal government’s practice of rewarding high-cost states such as California and New York, who are currently reimbursed by Medicare at higher rates compared to low-cost states that have better patient outcomes.

And if the final legislation — expected to be formulated this fall — doesn’t reform the payment system, Araoz advised against supporting it.

“If doing something makes it worse, isn’t it better to do nothing?” he asked.

“I agree,” said Walz, listing reforming the payment system as a key consideration in whether he will support health reform. The other criteria for Walz are that the legislation doesn’t increase the federal deficit, that it prohibit insurance companies from unfairly denying coverage to people, and that people retain choice in who provides their health care.

The forum got further into details of the debate when Bethany Lutheran College student Mary Ramirez spoke. Ramirez said she’s been attempting to read the 1,000-page House legislation this summer and is convinced that it would likely limit some people’s ability to retain their current insurance through tax penalties authorized by a specific section of the bill.

Walz disagreed, saying that the legislation would allow those tax penalties only if an insurer failed to meet minimal standards for coverage and disclosure of costs.

Former Sen. Dave Durenberger, a Republican who has been involved in health care issues and reform efforts for decades, attempted to move to the next question. And opponents of the reform effort reacted with some of the loudest boos of the night, with a few profanities thrown in and one man storming from the meeting.

Ramirez, after the meeting, had a very different reaction.

“I was very impressed with Rep. Walz,” she said, comparing his performance to those by other members of Congress she’s seen at televised town hall meetings. “He knew what we were talking about. … He was very much a representative of the people. He does connect.”

That said, Ramirez — who hopes to go into politics after earning a master’s degree — completely opposes government-centered health care reform.