When the notion of health care reform was first tossed around, the precepts were simple: everyone in this country should have access to affordable health care. The mechanics of how that was going to be accomplished were the subject of considerable disagreement, but it seemed that everyone agreed on the goals. Some people pushed for "socialized medicine", and some pushed for a "single-payer" system. What Congress went for instead is a system of more tightly regulated private insurance. The big question: does the system they're trying to create meet the simple goal of affordable health care for everyone?

Initially, it might have. The idea was to force insurance companies to compete in a marketplace, with a public option included in the market place to prevent "back door deals" and price fixing. The public option was also there for the "uninsurable", those that the insurance companies wouldn't insure at any price. The legislation was also put in place to prevent insurance companies from dropping customers or raising their rates when they got sick.

The regulations and market place seem to still be on the table... for now. The embattled public option, however, seems to be on life support. It has the unenviable position of being ground-zero for a political ideological battle. Those on the left claim it's essential. Those on the right claim it's "socialism" or the first step toward it. With all the smoke in the air, everyone seems to be losing focus of what that public option was supposed to accomplish.

There's been talk of a deal in Senate committees of replacing the public option with Medicare. On the surface, that's not a bad idea. My original idea for health care reform was to provide Medicare to EVERYONE for free, with an option for a tax credit if you "opt out" to buy private health insurance. But still - instead of creating a new government program for providing health insurance, why not use the one that's already there? It's actually kind of brilliant...

Except... the plan isn't to use it exactly as a replacement for the public option. It will only be available to those 55 and older. Supposedly, that's a large segment of those in need of this type of coverage - the older unemployed with age-related medical conditions. Unfortunately, it does nothing to help those between college and age 55 that are uninsurable. Once again - a great idea, poorly executed.

There are claims from Harry Reid that the public option is not dead. I have my doubts. Too many people are digging their toes in the sand on ideological grounds to be able to compromise for the good of the American people. The contributions from insurance companies aren't helping.

Personally, I am both ideological and pragmatic. I would love a socialized medicine system like they have in England. I would have been very happy with a single-payer system like they have in Canada. I would have been happy enough with any system that ensures that all Americans have access to affordable health care and don't have to stop and do the math before deciding whether they can afford to go to the doctor or the hospital.

Will the system we end up with meet that goal? I doubt it. From a pragmatic standpoint, I understand that sometimes it takes several steps to reach a goal. I would've preferred, however, that the first step be a bit larger than it seems we are going to be making.