Few current social or political topics stir the emotions quite as much as health care reform.  Whether you believe that the Patient Protection and Affordable Care Act (PPACA) is a sign of imminent and apocalyptic American socialism or an important step towards ensuring that all Americans have access to basic health care, nothing can ruin a tranquil Sunday dinner at Grandma’s house quicker than prodding Uncle Charlie into a debate about whether Uncle Sam is taking over our health care system.  But politics aside, if anyone was naïve enough to hope that the health care debate ended when President Obama signed the bill into law in March, 2010, they are facing the reality that 18 months later there still seem to be many more questions than answers when it comes to the future of health insurance in America.  And in Pennsylvania, while state government officials are busy deciphering how their citizens can get the most out of the PPACA, they are also distracted with having to deal with another potentially critical health care problem in the western half of the state - where an impasse between the area’s largest hospital system and the dominant health insurance company threatens access to doctors and hospitals for millions of patients who already have good insurance.