The administration made an important speech to the AMA recently about the health care reform debate. I'd like to take the arguments presented in it one at a time. I think one of the major points of the plan being presented is the public insurance option. Obama says that we need a public option for more choice in health insurance. It's not too difficult to see why that argument resonates. Most of us have little choice in which plan we have. Our employer picks our options, and in many cases has only 2 or 3 plans to choose from. Most of the options are from the same 2 companies. In my area, 2 insurance companies have 80% of the insureds. So clearly a lot of us feel we need more choices. But why is our choice so limited? First, why should my employer have any say in the insurance I have? That was born of a previous period of salary caps when "benefits" was the only way to raise pay for workers you needed as a company. It's way past time to change the tax laws so that there is no reason for employers to be involved in insurance decisions. But that still leaves me with only 3 plans to choose from. Why is that? There are over a thousand companies offering insurance in this country. State laws keep me from shopping for insurance across state lines. State laws also mandate what "must" be included in a policy. The effect is to limit my choices. Why not open up competition by eliminating these restrictions? There is no reason for me to buy a policy that covers chiropractic for example, because I'll never use it. But it's been placed in many state requirements. Let the companies and the states involved offer policies tailored to choice. How about a low-tort option like the car insurances offer? I'd sign on for that. Just limiting pain and suffering to $250000 makes a huge difference in malpractice premiums, so let me choose that option to lower my premiums. How about an option to lower premiums by refusing second opinions? Not sure I would sign that, but it should be an option. I don't need insurance that covers maternity anymore. THAT should lower premiums a lot. How much am I willing to pay in co-pays to lower my premium? That would increase more responsible use of services. How about discounts for exercising regularly? I'd sign that one! Nothing like my pocket book to encourage good behavior. This would be real choice. The public option would be a false choice that would end up by limiting all our options. Who would it really benefit?