Just when Democrats in Congress appear to have an opportunity to pass a substantive public health insurance option as a key pillar of health care reform, the party's weak-kneed faction is backing away -- and pushing for a diluted version that would greatly undermine the potential achievement. We hope the timid faction will put aside their fears. Americans too often are jettisoned or jilted by private insurers when they become seriously ill. The nation needs a fairer insurance system to curb the rampant claim denials and medical bankruptcies that now beleaguer Americans who unwittingly believe that they have comprehensive health insurance.

It is strange, to be sure, that so-called moderate Democrats are so afraid of standing up for the vast majority of ordinary Americans who rely on Congress to secure fair treatment. A strong majority of Americans want a bona fide public option to set a reasonable standard for comprehensive insurance and to keep private insurers honest.

Wide support for public plan

Consider the findings of a national Wall Street Journal/NBC News poll reported last week the day after Senate Majority Leader Harry Reid said he would push for a public option similar to that proposed by the House. Support for a public insurance option varied depending on how the question was phrased. Yet support significantly outpaced opposition under differently phrased questions.

One question asked: In any health care proposal, how important do you feel it is to give people a choice of both a public plan administered by the federal government, and a private plan for their health insurance?

Under that phrasing, 72 percent of respondents said it was "extremely or quite important," while 23 percent said is was "not at all or not very important."

A second question asked: Would you favor or oppose creating a public health care plan administered by the federal government that would compete directly with private health insurance companies?

Under that phrasing, 48 percent of respondents said they "favor" the public option, while 42 percent said they "opposed" it.

Choice requires competition

Both phrasings posed the same circumstance, but the first emphasized consumer choice, a softer wording, while the latter emphasized government competition with the private market, a seemingly more adversarial construct. Either way, a substantial majority favored a public option.

Given the virtual monopoly power of the largest one or two insurance companies that control the health insurance market in most states, it's not surprising that most Americans want more competition among insurers. Absent such competition, insurers frequently deny claims, limit or deny coverage, or cancel insurance policies altogether when customers become seriously ill.

Employer-provided insurance policies are usually subject to a little more state regulation than are private policies. But most state legislatures are in thrall to large insurance company lobbyists. Thus, just a handful of states require so-called "community" rating pools, which require flat rates. Most (like Tennessee) use specific-risk pools for private policies.

Insurance companies strongly favor the latter. Use of tiered risk pools allows them to cherry-pick the healthy and to charge chronically ill patients exorbitant rates, or to exclude pre-existing conditions, or to deny applicants coverage altogether.

Under such lax regulation, insurance companies essentially make money by denying coverage -- the most egregious form of rationing health care ever invented -- or by canceling policies when customers become too ill. They also spend far too much of their revenue (often more than 25 percent) on exorbitant executive compensation packages and high administrative costs, including those for denying claims and justifying denials.

A public plan's advantages

A Medicare-style package for a public insurance option would vastly reduce administrative and total insurance costs, while providing standard guidelines for comprehensive coverage. It also would set a competitive standard for uniformly spreading risks and fairly negotiating rates with providers, whose charges now vary greatly depending on the clout and volume discounts awarded to large insurers. Those rate discrepancies now drive up charges -- often by wildly more expensive extremes -- to privately insured patients and small businesses with few employees.

Small businesses drop plans

The latter reasonably concerns a lot of business owners -- many of whom have been forced to drop coverage altogether -- and their representatives in Congress. In 1993, for example, 68 percent of small businesses offered coverage. Today, just 39 percent do. Their employees are stuck trying to find affordable private insurance. They usually have to struggle with high-deductible, high-cost, low-coverage policies -- and live with the fear of medical bankruptcy if they or a family member become seriously ill.

And increasingly, that is the plight of previously well-insured employees of mid-size to larger employers. Their premium costs and deductibles also keep rising far faster than inflation, and their coverage keeps declining.

Contest GOP propaganda

It is strange enough that weak-kneed Democrats keep running from the anti-reform Republican crowd. It is even more strange that Republicans keep marching in lock-step to label rational reform as an abhorrent step toward socialized care.

Under rational reform and a government administered insurance option, medical care itself would not be socialized. Americans could still chose their doctors, and do so without insurers' "out-of-network" penalties. The government would simply contract with insurance companies to administer a government regulated plan, as is now done with Medicare and with the varied plans offered to all federal employees, including the very same congressional Republicans who love their system but deplore the value of it for ordinary Americans. Go figure.

Americans may be catching on to the sham, hollow arguments of the "Just Say No" Republicans who would deny the benefits of their system to the rest of us. Why moderate Democrats in Congress are afraid to contest the Republican-manufactured propaganda against health care reform remains a mystery. But Democrats clearly need voters encouragement to do the right thing.