An ailing U.S. health-care system might improve if U.S. reform legislation passes, but few health-industry executives and doctors gathered at a medical innovation conference believe it will be a lasting cure.

Many attendees at the Cleveland Clinic's annual summit agreed that the latest reform proposals would help expand health-insurance coverage. But they're skeptical that reform, as outlined in legislation seen as having the best chance of passage, will directly lead to more efficient delivery of health care or to controlling soaring costs.

"I'm a little disappointed there's not more to drive the total bill for health care for the country down," said Toby Cosgrove, chief executive of the Cleveland Clinic, the medical center whose cost-containment efforts were singled out by President Barack Obama this summer as a model for the country.

To help make health-care delivery more efficient, Cosgrove believes there should be more integration of hospitals with physician practices and among hospitals. Also, with an "epidemic of obesity" in the U.S., Cosgrove said there should be better incentives for individuals to live healthier lifestyles that would stave off costly disease. The problem of smoking could be tackled by "taxing tobacco out of existence," he suggested.

Without such measures, Cosgrove thinks health-care costs will continue to increase, requiring further action within several years.

The need to encourage healthier lifestyles was a surprisingly common refrain among health-industry executives in the business of selling solutions in the form of a pill or device.

AstraZeneca PLC (AZN, AZN.LN) Chief Executive David Brennan said the current health-care reimbursement system lacks incentives for disease prevention.

Brennan said some health plans won't pay for gym memberships that could help people stay in shape but they would pay for expensive treatments for someone who develops diabetes as the result of an unhealthy lifestyle. "Somehow we've got to get that flipped around so people take more responsibility."

Schering-Plough Corp. (SGP) Chief Executive Fred Hassan echoed that sentiment, arguing in favor of taxes on sugary soft drinks, and even suggested that people engaged in unhealthy living should be required to contribute more to the cost of health care than those with healthier lifestyles.

"I feel if they're adding to the cost of the system, there has to be a level of responsibility," Hassan said.

The pharmaceutical industry, as a whole, backs health-care reform; its trade group reached a deal with the Obama administration to pledge about $80 billion in savings to fund the cost of the reform, including discounts for prescription drugs for seniors in Medicare's drug-benefit plan. The deal is seen as having spared the drug industry from harsher treatment in reform legislation, such as price controls.

Concern exists that current reform proposals don't do enough to address health-care costs stemming from medical-malpractice litigation and so-called "defensive medicine," in which doctors order unnecessary tests and procedures for fear of later being sued.

Novartis AG (NVS, NOVN.VX) Chief Executive Daniel Vasella said spending on malpractice insurance and defensive medicine was "way too much." He argued for caps on medical-malpractice awards, something that hasn't been a priority in current reform proposals.

Drug-company chiefs expect health reform to pass but in a scaled-down form, which is more attractive for the industry than a potentially more partisan approach that may include a government-run health plan.

-By Peter Loftus, Dow Jones Newswires; 215-656-8289; peter.loftus@dowjones.com