Dear Senators,

I commend you for your fortitude in fighting to make quality, affordable health care for all a reality this year.  But I cannot help but express my strong disappointment at the notion that an ill-defined non-profit health co-op is in any way an acceptable substitute for giving Americans the choice of a public health insurance option. We know that public coverage has, on the whole, more ably controlled costs than private, for-profit insurance.  We know that a national public plan will have substantial bargaining clout, low administrative costs, and most important of all, an incentive towards quality that private insurance lacks.  A public plan would force private insurance to compete on cost and quality, not on attracting the healthiest customers and denying care.  In short, it would change the game. You have demonstrated in your options documents that a public plan can be structured in many different ways, and all economic modeling suggests that it would be successful in expanding access, controlling costs and improving quality.  Indeed, the main argument seems to be that it would be too successful.  In contrast, the co-op proposal which has been pushed in the media this past week is not credible as an alternative.  I understand you're still trying to come up with the exact details, but the co-op represents something we already have.  There are any number of not-for-profit insurance plans out there.  They have done nothing to change the game.  As only one example, North Dakota has 475,000 people enrolled in the not-for-profit North Dakota Blue Cross Blue Shield.  They are quite successful in that they represent 69% market share for the state.  However, this has done nothing for affordability, and nothing to keep private insurance's feet to the fire.  Premiums jumped 74% in the past seven years in North Dakota.  As a good rule of thumb, <em><b>if your proposed solution is something that we already have, by definition it hasn't been an adequate solution to our health care crisis</b></em>. I recognize that this is a difficult climate for compromise, but a health co-op is simply not a substitute.  It's a cop-out.  Americans deserve to have the choice of a public health insurance plan.

[Your name here]