I hope this is just a case of poor reporting. It quotes Eshoo as saying about a Public Plan "Like Medicare, it will not be funded by government subsidies, but solely by premiums it collects, like private plans do."

ALL experts agree that Medicare is going broke because the premiums will NOT cover the cost of care. A public plan based on the current Medicare model is not financially possible - more taxes are needed to pay for it. And common sense (plus Fannie Mae and Freddie Mac) shows that any government subsidized plan will over time drive out private competition - usually after forcing them into crazy business practices and thus harming everyone.

So Rep Eshoo - Lets get honest and practical. What you are really proposing is an eventual single-payer system like Canada or UK.

That is ok. That is probably better than what we have today. But please don't lie to us about an "option", and how that in order to fund that option or any plan means changing both how Medicare will work and how we pay for it.

We need - and deserve - the truth.

Concerned:

I like your message here. Are you saying it's impossible for health care to have a public and private model in direct competition, the way, say, the USPS and FedEx are?

I don't know a lot about the complexities of health care and am asking out of honest curiosity.

Wondering, there's a lot of confusion because the word "insurance" has lost most of its actual meaning in this public debate. The idea behind insurance is that a bunch of people pool their risk, and, if the occurrence of bad outcomes is low enough within that group, the insurance company makes a profit. Or, at least, in the case of a non-profit, doesn't go broke.

Any public plan that signs a lot of people on that we already know are going to have lots of medical expenses (i.e. old people, people with pre-existing conditions) is not really insurance, even if some people call it that. It is really taxpayer-supported health care assistance.

Any private insurance company that really is in the insurance business has to limit the number of high-risk customers it takes on.

So, it doesn't make sense to talk about public and private plans being in competition. They are apples and oranges. Private insurance companies, if allowed to truly exist as insurance companies, are trying to achieve a different goal than public health care.

Now, let's forget that you phrased your question in terms of competition. Could public and private co-exist. Yeah, they could. They could even complement each other if we got the details right. I don't think Obama is getting the details right at all, but that's another conversation.

So, what do I think are the two biggest things we need to fix about our health care system:

* Insurance is tied to employment. We should extend the same level of health insurance purchase tax breaks to individuals that are extended to businesses. We remove barriers to buying insurance across state lines. And we should remove a bunch of stifling regulations and limits related to pre-tax health care savings, so that insurance can be used only for its original purpose of covering big, unexpected expenses.

* People need to be able to save up a significant amount of wealth for old age. To make that possible, we need to shrink government, we need to stop draining wealth out of the economy for foreign wars, corporate bailouts, the war on drugs, etc.

Reforming healthcare is an important effort. It is not up to the Federal government to address it. It is up to the states and the people. The 1,000 page bill currently being proposed in the Congress is not reforming healthcare. It will create an entirely new system. The only competition created by the government, is by the inefficiencies of the public systems, being offset by the efficiencies private systems.

Tort reform would reform healthcare. Changing all healthcare to individual policies would reform healthcare. Eliminating government mandates in insurance policies would reform healthcare.

This is an effort to increase the power of the Federal government.

Steady on you all, this is starting to sound like incoherent right-wing ranting that the editor of this paper dislikes so much!

To the contrary, Steve, this is an excellent conversation.

I don't want to agree with everything people post on Town Square -- far from it. I just want the posts to be rational and civil. This one is great ... carry on!