The disappointing debate about “health care” reform in the summer of 2009 is not about reforming “care” at all - it is about reforming reimbursement - by whom and for what services. The media and everyone involved, including President Obama, continue to talk about things that inflame the discussion, not the core problem.

President Obama speaking about surgeons amputating feet and “pulling the plug on Grandma,” former Governor Palin talking about “Death Panels” and all the rhetoric about nationalizing health care is not what this is about.

It is about a public option for non-insured and small business to health insurance.  President Obama’s personal physician advocates making Medicare available at affordable rates to anyone who wants to opt for that plan.   The reimbursement and approval system is in place, physicians, hospitals, therapists and home health providers have billing systems in place to get paid, and like Massachusetts, it could be offered at a fraction of the price of private insurance.

Medicare is far from perfect - especially the oddly crafted prescription drug benefit.  But it works for seniors and the disabled - something they and AARP fight to preserve every time a change is proposed.

The frame of the debate needs to change to a discussion of a public health insurance option for those that want a cheaper, comprehensive plan. The major dogs in the fight would be the health insurance companies, PPOs and HMOs versus the federal government. The health insurance companies, PPOs and HMOs shouldn’t care all that much since they are doing nothing to provide affordable, comprehensive care for the 45 million Americans without health insurance.

The Massachusetts example is a success on many levels - especially the mandatory nature of it and the rates of enrollment. A public health insurance option is do-able and that is what the conversation should be about.