The public option has become a big factor in health care reform. Democrats will not vote for the health care reform bill without the public option, and the Republicans won’t vote for it if it has a public option, even one with a delay or a trigger that would put a public option in place if the insurance companies do not lower their prices. It’s been discussed almost constantly since February 2007 when John Edwards made it part of his health care plan, with both Barack Obama and Hillary Clinton soon following the same idea. Many people are still confused as to what it is, who would have access to it or why it might be a good idea and work to keep insurance companies in check.

Currently there are a few bills coming out of the house that have the public option included. The very conservative Senate Finance Committee shot down amendments to add the public option offered by Jay Rockefeller (D-W.Va.) and Chuck Schumer (D-N.Y.). The Reform bill encompasses everything we need to do to finally begin controlling our health care costs, expanding access and improving quality.

The bill will do everything from developing new doctors and new nurses, especially in primary care; to giving tax credits to small businesses in order to allow them to afford benefits for their employees; to filling in the Medicare prescription drug program to provide cheaper drugs to seniors; to preventing the most abusive practices of the insurance industry.

For those who don’t have insurance provided by an employer, or for small businesses that want to buy a plan at an affordable rate, the bills would create a health exchange, a one-stop shopping market for health care. Any private insurance company could offer a plan in the exchange, but they’d have to work within a certain standard.

There would be a minimum set of benefits for all plans. No one could be turned down on the basis of pre-existing conditions. There would be guaranteed renewal of policies (no dumping a customer because they got sick). You would not be charged a different price because of gender, health status or type of employment. You would be charged a different rate for age, but it would be more restricted than the current rates today.

If you couldn’t afford the full premium and you made less than 400 percent of the federal poverty line (about $43,000 per year for an individual or $88,000 per year for a family of four), you’d get a subsidy so your premium would be pegged to a fixed percentage of your income. Everyone would have a cap on out-of-pocket expenses. And finally, all of the information and presentation would be transparent—you would be able to compare standard benefits across companies to find the one that works for you.

Any health care reform will be a huge improvement compared to the current system that leaves millions without proper coverage. The solution favored by the President and many others is to introduce the public option. As a government-run insurance plan, it won’t have to make a profit, won’t have to pay a CEO’s salary and will have lower administrative costs. It would have incentives towards quality, presuming you’re a long-term customer because the government will eventually be paying for your Medicare costs. It would have an incentive to use its bargaining power to achieve lower cost, savings it would pass on as lower premiums. And it would force private insurance to compete on those terms or lose customers.

It would only be offered by the Exchange, one option competing with dozens of for-profit insurance plans, each obeying by the exact same rules and regulations and delivering the same benefits. It would not cost more to have an exchange with a public option. In fact, because it brings costs down, it costs more to do reform without it. It's not the totality of health reform. But even this small a change could be the difference between an enabling giveaway to the private insurance industry and an unleashing of competitive forces that would encourage public and private plans to improve.