Editorial Cartoon by David Horsey

As usual, the president said it best:

"Millions of our citizens do not have a full measure of opportunity to achieve and enjoy good health care. Millions do not now have protection or security against the economic effects of sickness. The time has arrived for action to help them attain that opportunity and that protection."

And the president was right. However, that wasn't Barack Obama in 2009. That was Harry S. Truman, addressing a joint session of Congress, in 1945.

Can you believe it? His legislation to provide universal health care failed by only a few votes, and Congress has done nothing about it ever since.

But now's the time.

Almost 50 million Americans today -- working Americans, with good jobs -- have no health insurance at all, because they can't afford it. Another 25 million don't have adequate coverage. Today we spend 16 percent of GDP on health care, more than any other nation in the world, yet the United States ranks last among 19 industrialized nations in preventable deaths. On health care, we are, in short, paying more for less -- in a system that is so complicated, so multilayered that even those who can afford it find it impossible to negotiate. The status quo is no longer acceptable or affordable.

In an ideal world, a single-payer system like they have in Europe or Canada would be the best answer. You can't deliver quality care at the lowest price when so many interests -- insurance companies, pharmaceutical companies, and medical equipment manufacturers -- are in the business simply to make more profit. But the sad reality is, despite the leadership of John Conyers, Dennis Kucinich, and Bernie Sanders, there aren't enough votes in Congress for single-payer legislation. It's too easily shot down as "socialized medicine."

That's why President Obama proposes, instead, a "public plan option." In what he insists must be part of any health care reform legislation, consumers would be offered a choice: to purchase any one of hundreds of competing health care plans already offered by insurance companies or HMO's, or to opt for a new, government-run plan under which, like Medicare, the government pays the bills and private doctors perform the services.

Yet even that modest proposal is under attack: from Republicans in Congress, who have offered no plan of their own; from the American Medical Association, long-time opponent of universal health care; and from insurance companies, afraid of the competition. Fronting for them, the Heritage Foundation, grand-daddy of conservative think tanks, sent out an Open Letter on Health Care, declaring: "The inclusion of a public option is nothing more than a Trojan horse. The architects of the President's proposals, and the sponsors of his proposals on Capitol Hill, know that once a government plan is in place, private insurance companies will be eventually run out of business."

Nonsense.

If required to compete with a public plan, private insurers won't go out of business, but they will be forced to cut costs and offer more affordable products.

The truth is, we already have "socialized medicine" in this country.

It's called Medicare, or Medicaid, or the Veterans Administration. And those programs work for tens of millions of Americans, delivering quality, affordable medical care to those who qualify, either by age, income, or military service.

And they do so without all the expensive overhead of private plans. Take away all those who stand between you and your doctor -- like the Madison Avenue advertisers trying to convince you to buy more expensive drugs, or the insurance green-shades trying to figure out how to deny you coverage -- and you can achieve real savings. According to Families USA, Medicare spends only 3 percent or less on administrative costs, while private insurance companies spend an average 12 percent.

Offering a public plan alone is not the solution.

Total health care reform must also require everyone to buy insurance, offering incentives for staying healthy, and paying doctors according to the results they achieve, not the number of procedures they perform.

But a public option is a necessary part of any health care reform mix, and nothing to fear.

All it does is offer people more choice and more competition.

Just what America's all about. And just what American consumers need.

Obama reiterated his belief in a Tuesday news conference that a public option "made sense" and that private insurers should find ways to compete for clients. But he declined to say whether he would veto legislation that did not include a public plan option.

It's too early in the process to "draw lines in the sand," he said, speaking for himself. Some Republican leaders and insurance companies are drawing lines of their own.

Over in the House, for example, Republican Leader John Boehner of Ohio compared the public option to "the DMV (Department of Motor Vehicles)" and the post office, as if that's a bad thing.

Please. After having gone through telephone hell with my insurance provider a few times, the DMV and post office look remarkably consumer-friendly.

Besides, as several late-night comics have noted, who else will come to your house, pick up your letter to Aunt Nelly and reliably deliver it to her anywhere in the country in two or three days for 44 cents?

The post office argument already is getting old. A recent CBS News/ New York Times poll found a commanding 72 percent of Americans supported a government-administered insurance plan that would compete with private insurers for customers. Yet Americans are realists. While the surveyed folks mostly said they were willing to pay more in taxes for universal coverage, that support dropped when dollar amounts are mentioned. We Americans know what we want, we're just haggling about the price.

The haggling turned to shock on Capitol Hill when the Congressional Budget Office estimated the price tag on the bill working its way out of the Senate Finance Committee could come to $1.6 trillion over ten years. That figure caused such a bad case of "yikes" that Sen. Max Baucus of Montana, the committee's chairman, postponed a drafting session for the bill in his committee. Sen. Charles Grassley of Iowa, the committee's top Republican, suggested on CNN "dialing down some of our expectations" to cut costs when we already have "trillions of dollars of debt."

Piling on more debt, even $1.6 trillion worth, is an important concern, but it need not be crippling. Team Obama argues that new efficiencies in health care can bring those costs down, closer to a less ghastly trillion dollars. Besides, even $1.6 trillion over ten years they point out is less than one percent of the nation's gross domestic product, by their estimates. If so, less than a penny on the dollar doesn't sound like too much to pay for a new health care safety net.

Unfortunately cutting costs has been an unnatural act for our nation's lawmakers and so far, the health care debate has not given them a sudden burst of thrift.

Nor have they shown much interest in offending the insurance industry or big employers.

For example, Senate moderates are pushing health-care "cooperatives" as an alternative to a public option. Trouble is, nobody seems to know exactly what a health care "cooperative" is.

There has been a lot of general talk about some sort of quasi-public/private organization, but few specifics yet.

After a summer of more haggling, I still expect a final health care plan to make its way through a House-Senate conference committee some muscle applied by Obama and his Chief of Staff Rahm Emanuel.

The package should include a Medicare-like public option or some kind of cost-cutting co-op that offers close to the same thing.

Anything short of that won't look like much of a victory.

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