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Your question is excellent and indeed poignant and fundmental to the argument.
A few points to consider.
1) As is in the Senate Bill (No verion of the slaughter fix up yet,no?)- all people will be required to buy a “GOVERNMENT APPROVED HEALTHCARE INSURANCE PLAN.”
“GOVERNMENT APPROVED” is puporsely left undefined in the bill, stating that definition is left to be determined by the Secretary of DSHS. So A government approved plan can theoretically be private or public. There is nothing eliminating a public option. As we know they have kicked araound expanding the enrollemnt criteron to Medicare / Medicaid.
Their staretgy is to make private insurance companies non-viable first. They are the direct barrier to single payer. Private insruance must be destroyed for govermnet to be the ultimate insurer.
So, how to do this?
Lets look at the banks: Hello Mr Banks. You must make bad loans because we said so - and here is an incentive to do so, and nything that goes under - dont worry, we’ll hide it in Freddie and Fannie.

Today: Hello Mr insurance companies. You must write bad policies. - youo no longer can underwrite your patients. ie your business model must die. Bad loans = Bad insurance policies. Eventually they fail.
Or make the analogy to auto insurance. Pre-existing conditions = 3 DUIS, 9 speeding tickets and 5 accidents.
In this bill, the analogous health insurance company is forced to say yes. Underwriting risk - the life blood of the fundamental concept of insurance is stripped.
And like Fannie and Fae there to sweep up the pieces; so too will the clause of “gov approved health cae plans to be determined in the future by Secretart of DSHS - be the dumping grounds for these failures. Think about it.
When current private heath insurance business show systemic failures, there is nothing in the Senate bill preventing the DSHS secretary deeming a series of new government programs the new “approved health care plans”; or in such a crises - DHSH secretary deeming the expension to new enrolees to both Medicare and Medicaid. It was not long ago that the expansion to Medicare to an age of 50 was kicked around. And that that was just tailgaiting. Do we believe for one minute that once insurance co’s show failures, that the rationale to resurrect, expand create and ‘deem’ gov backed plans to be the fall back position?
Of course it will.
The only other alternatives would be:
1) Hey, we’re breaking private insrance companies - damn that could lead to single payer gov system - lets lay off and pass legislation to get these guys back ontheir feet. Something tells me thats a very cold day in hell.
2) Well, we did say vaguely, “no public option”. Of course the wording is here to allow it to occur; but we have to stick to our word and we’ll let the private sector develop a new creative way of insuring people and we’ll just stand aside while the private system figues it out.

Call me a pessimist - but that is just not gonna happen. They have clearly shown that their fundamental intentions are to assume and absorb the private sector into their public and governmental bureaucracies. Nd this is there most prozed posession.

So yes jackmercer, you are correct in that as is there is no obvous public options clearly constructed. But the language is there to create it, and the war is being fully waged against the private insurers. Public option is inevitable. It will will be over-run with all the patients dropped by the businesses willing to take the penalty over the tax; over-run by the patients dropped from a failed private insurance plan.

This goverment insurance policy migration is inevitable,and will be exponentially faster and more massive than anyone will predict, and the subsequent lethal business effects on the private healthcare delivery systems will be swift and thourough.

Thank you everyone so far with you kind and supportive comments.
This is the real tragedy. insuance companies are the life blood to the healthcare system.
Kill the life blood, you kill the system.

Thanks for taking the time to expand on the issue. So it is as I suspected, this is a backdoor route to single payer based on possible future laws, not current ones.

They did kick around expanding Medicare to age 55 just a few months ago but that didn’t last more than two days. Which kind of begs the question. If we have the most liberal house, senate and president that we have seen, IMO, in probably 70 years and they can’t pass a public option, how can government run insurance be expanded after this current group inevitably loses power in possibly 2010 and most definitely by 2012? Is your argument that the public will be so decimated by this that they will force even a Republican administration to expand government insurance? I’m not ruling that out, Johnson did the same with Medicare and Medicaid and it has become one of the third rails even with even conservative politicians, evidenced by Gingrinch’s results in 1995.

My hunch is that we will end up like Germany who has a system quite similar to the current proposals, a mix of a government subsidized private market and a public pool (roughly 50% of the market) which is similar to our 50% public that consists of medicare, medicaid, VA, SCHIP, etc. It hasn’t crashed their system yet and doctors aren’t fleeing Germany but I will grant you they have the highest health care costs as a percentage of GDP in Europe and some of the lowest health outcomes in Europe comparatively (though they still beat us in outcomes and cost as a % of GDP).

But we are a larger and more diverse country with a totally different social and societal dynamic so perhaps it will all come crashing down and force a UK or Canadian style system of actual socialized medicine. Or at least like most Eoropean countries with actual 100% socialized insurance. Once that occurs, then I agree, the United States as we know it will have been lost.