Yes, there is a great deal of confusion regarding a single-payer plan and the public option, but let's be clear. One is a winner. The other is fatally flawed.

In the single-payer plan, a governmental or quasi-governmental agency becomes the administrator of a national health insurance, a pooled fund obtained by progressive taxes to pay for the health care needs of a single risk pool of all Americans. The original concept of insurance would be revived: using contributions from a very large risk pool to cover the medical costs of the few who are unlucky enough to get sick or injured. Everybody in. Nobody out.

Currently we have 1,100 "private" insurance companies competing for profits primarily by limiting their risk pools to only healthy patients. This process results in small risk pools of people who will not cost insurance companies money. Those people who are excluded from insurance are relegated to haphazard and delayed health care. The result is often personal disaster and bankruptcy after a neglected illness becomes advanced and difficult to treat. Those who are able to buy insurance pay a hidden premium tax of 10 percent to cover the health care costs of those who are excluded from private insurance. The societal costs of our current for-profit non-system are staggering in terms of human suffering, financial hardship, and poor health for the populace and the work force.

What is the "public option"? The public plan option refers to a publicly owned and managed health insurance plan that would compete with private plans through an insurance exchange mechanism.

An insurance exchange is intended to serve as an insurance shopping mall for policies and allow citizens to choose among many plans. The public option uses tax dollars and graduated subsidized premiums to pay for the health care needs of those Americans who are without insurance or are dissatisfied with their employer-based or individual insurance plans.

Theoretically, a public plan would have no need for profits or advertising and would have such economies of buying power that its overhead would be very low. The public plan should therefore be able to out-compete the private plans and provide better service at lower cost.

But unfortunately, the public option will be swimming in shark-infested waters. The private health insurance companies are adept at avoiding risk. They stay in business by excluding customers who might cost them money and by denying services. They over-market the healthy and under-market the sick. They vigorously recruit the healthier clients found in employee groups and assiduously avoid the unemployed, poor, sick, and older Americans who then gravitate to the public plan. Furthermore the public plan will not have the advantages of a single-payer plan because it will remain part of a very fragmented health care system with its associated inefficiencies and administrative costs of 30percent. The public plan will therefore become more costly than the private plans, will struggle, and in a few years fail. Opponents will then say, "See, your public plan failed and so will a single-payer plan!"

Members of Congress and the public are beginning to recognize that anything short of single-payer is fiscally irresponsible, unaffordable, and a bailout for the private health insurance industry. The Congressional Budget Office two weeks ago said that Congress's current proposal for healthcare reform HR 3200 will cost $1.3 trillion and leave millions of Americans uninsured. It may be for this reason that Speaker of the House Nancy Pelosi last week agreed to allow Representative Weiner, D-N.Y., to introduce an amendment to HR 3200 (http://pubrecord.org/politics/3105/pelosi-allow-floor-single-payer/) which would basically replace the text of that bill with HR 676, the single-payer bill, which for several years has been sponsored by Rep. Conyers of Michigan. Just allowing that debate on the floor of the House would constitute a major victory for truth and the public, regardless of outcome.

All of us should call and e-mail our representatives, senators and president daily to encourage them to proceed with the debate of single-payer health care in both houses of Congress.

Be well. To be otherwise is very expensive.

Mike Huntington, M.D., Norm Castillo, D.O., and Paul Hochfeld, M.D., Corvallis