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Public Health Insurance Option

President Obama made it clear. He wants health care reform and he wants it now. "We will pass reform that lowers cost, promotes choice and provides coverage that every American can count on, and we will do it this year," Obama said in a news conference Wednesday night.

But, now it looks like reform won't happen until after Congress' August recess. Senate Democratic leader Harry Reid said Thursday that a vote won't happen before the break next month.

The proposed plan in Congress right now would set up a government-run health insurance program to compete with private insurers. Jay Gilbert, President and CEO of Physicians Health Plan (PHP), said using the word 'compete' is misleading. "I don't see how you can compete with the federal government that's not held to the same requirements I am," Gilbert said.

PHP covers around 47,000 people. Physicians started the company 25 years ago. Now Gilbert said operating against a public plan wouldn't be a fair fight.

"The premium revenues I have to compete for, [the government] would get through tax revenues. Other costs I have to negotiate with doctors, hospitals and pharmaceuticals, they would use price controls. That's what governments usually do," Gilbert said. "I have to show profits or break even over a period of years or go out of business. The government can run deficits."

After a few years of that, Gilbert said PHP, and its 100 employees, would likely go out of business. "It's not a fair or competitive playing field between the private sector and the public," Gilbert said. "You'll see more and more people go to the public option, which leaves less market share and the private sector is scrambling over fewer lives."

Gilbert added the current reform plan would penalize businesses that don't provide insurance for its employees with a fee of a few hundred dollars per employee, while it costs thousands of dollars per employee for a company to provide insurance coverage.

"That's a pretty easy decision for an employer. It would ultimately lead to the government providing all coverage," Gilbert said. Gilbert does agree with Obama that some kind of reform of the health care industry should happen.

He suggested insurers take away pre-existing conditions clauses and equaling the cost of coverage to have more people in a plan. "If there was one rate for everyone, that would allow more acess. That's going to have consequences in the price we all pay, but if we got rid of those things we'd have more people in the pool," Gilbert said.

Another idea Gilbert mentioned to help make health insurance more affordable would be to mirror philosophy of some auto insurance plans with incentives for those who are active in wellness activities to say healthy.

"If I take care of myself and run marathons and I eat a healthy diet, can I pay less out of my own pocket versus those who don't," Gilbert posed. "We've got to get patients involved in their own care."

Rising costs of health care are also at the center of the debate. Health care costs have been rising about two to three times faster than the rate of inflation.

"The cost is not something that's going to go down. It never has. What we need to do is change the inflation rate, even just a little, like one to one and a half percent, and we're talking trillions of dollars in savings," Gilbert said. "The reality is health care has a cost. We have to pay doctors, hospitals and pharmaceuticals. My incentive is to compete in the free market. If I don't compete, I lose [the customer.] The government doesn't have to compete."

Gilbert said technology continuing to develop and the population aging is contributing to health care costs. "It's like comparing buying a hamburger 30 years ago to buying a filet mignon today. You can't compare it," he said.

People have mixed opinions. Many said the government has no business in the health care industry. Others, agree with Obama's plan.

"I think a public plan that can compete with the private sector would benefit everybody ... because it will force cost containment," Bruce Stier said. One thing most people agree on is that some reform needs to happen.

"Whatever can help people get better health care, I'm all for it," Tony Gooden said. While lawmakers hash out a reform bill in Washington, change is probably inevitable, but the shape of that change, and when it will come, remains to be seen

"We'll end up with evolution of how we finance health care, probably not a revolution," Gilbert said.

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