I might have characterized it better by calling the two pools the higher risk pool and the lower risk pool, but I opted for brevity.

The high risk pool will certainly include many low risk individuals. Some of those who become eligible for the public option may be the "young immortals," but many of them actually do work for employers who will offer benefits under the new legislation, so they will be required to either join the employer-based plan or pay a fine and remain uninsured. The public option will not be available to them. On balance, the composition of the high risk pool will be weighted toward the population that is at higher risk of requiring more health care expenditures.

The low risk pool will also include some high risk individuals, such as the working disabled, folks with well-managed type 2 diabetes, and over-65 individuals who still work. There's a gradient, though. The more one is disabled by age, chronic illness and other incapacitating conditions, the less one is able to work, and over time these individuals tend to lose the ability to hold steady jobs and slip into the high risk pool. On balance, the composition of the low risk pool will be weighted toward the population that is at lower risk of requiring more health care expenditures. If I'm not wrong the low risk pool will be self cleansing in another way. When a covered employee develops an expensive and debilitating disease, she will lose income and may lose her job due to simple inability to work. Pretty quickly she will be shifted either into the exchange or into Medicaid, in other words, into the high risk pool. (It may be that pending legislation has addressed this and I just am unaware.)

The largest employers do have some ability to negotiate for better rates as you note. But not-large employers have almost no leverage and we're going to be requiring them to provide employer-based plans.

I'm glad you note that "For insurers, these [larger employer] subscribers may be "lucrative" (your word) in the sense that there are many of them, but they are not at all lucrative in terms of the lower premiums they pay compared with those paid in the market where the public option would operate."

That reinforces one of my concerns, which is that breaking the market into separate risk pools is inequitable. Why should small companies and unemployed individuals pay more for their insurance plan than the large employers pay, per family or per individual?

By balkanizing the risk pool we are continuing and reinforcing health care inequities. The playing field may be rearranged, but the game continues.

These results suggest that the relatively strong association between income and health can for a large part be interpreted in terms of an interrelationship between employment status, income and health. More specifically, it is largely due to the concentration of the long-term disabled in lower income groups. This indicates the importance of the selection mechanism, as these groups are excluded from paid employment because of their health status, leading to a lowering of income. However, income was still found to be related to perceived general health after controlling for employment status especially among women. This suggests that an explanation in terms of an effect of material factors on health may also be important.

I've also seen studies correlating high risk behaviors, like smoking, drinking, drug use and overeating, with low socio-economic status, but, again, alas, don't have them available to me now.

Also swimming in the exchange pool will be the self-employed, and employees of small companies that do not provide employer-based plans. Being self-employed and associating with many others like me, I can reliably report that some are rich and extraordinarily healthy, while others can just barely drag themselves out of bed in the morning. I'm not saying which part of that pool I swim in.

The exchange pool is a mixed bag, to be sure. A not insignificant sub-group will be quite healthy indeed, but another not insignificant sub-group will be comprised of individuals who cannot currently hold jobs in larger companies due to physical or mental health status, or behavioral issues.

The long answer, from HR3200 (which is not the Senate public option) is detailed in OldenGoldenDecoy's post today: Once Out of the Employer Exchange Plan You May Elect to Remain in the Private Exchange Even Until Medicare Age.

I don't know whether you employer is obligated to contribute to the premium cost of your public option plan at that point or not.

As currently proposed, the health care risk pool is divided into two parts: the high-risk public pool and the low-risk private pool.

The public - through Medicare, Medicaid and now the public option – will cover the elderly, unemployed or underpaid, chonically ill and dying, while the private sector covers the relatively healthy and relatively well-paid. That's a recipe for more gaming, reverse cherry-picking and more skimming by private insurance companies.

The only health care risk pool that makes sense is "everyone." If the public option can't compete with private plans in the low-risk pool, then we have much less chance to improve the quality of health care and bend the cost curve.

The public plans will cover the elderly, unemployed or underpaid, chronically ill and dying, while the private plans cover the relatively healthy and relatively well paid.

The public sector is prohibited from competing for business in the low-risk private pool. The private sector is allowed to compete for a small portion of the high-risk public pool (whee!).

I'm glad the Senate can say "public option," but there is only one risk pool for health care that makes sense, and that is "everyone."

Unless the public option is available to everyone, private plans will continue to game the system and the role of public competition in improving the quality and reducing the costs of health care will be minimal.

That's why Medicare E should be a public option available to everyone.

To be eligible for the public option envisioned by the Senate you must:

• Live in a state that does not opt out.
• Not be employed, or
• Not work for anyone who offers an employer-based health plan, or
• Work for such an employer but earn less than a living wage (Walmart employees take note).
• Not be eligible for Medicaid or Medicare or any other health plan.

There are two glaring problems with this:

A) The so-called public option will not be available to the vast majority of the public.
B) The public plan will compete for business in the highest-risk part of the risk pool. What private company in its right mind would not be happy to let the public plan take all that business, while it concentrates its efforts on the profitable, and lower-risk, employee group insurance for larger businesses?

If you didn't catch Sen. Ron Wyden on Rachel Maddow tonight, here's a link to the clip: www.msnbc.msn.com/id/26315908/ . It's brilliant (hey, it's Rachel!) and worth a few minutes of your time.

Liberals and progressives have come a long way on health care this year. Now it's time to ratchet up the pressure.

Watch the clip here: www.msnbc.msn.com/id/26315908/ . It's brilliant, and worth a few minutes of your time.

We've been bandying back and forth the phrase "public option" as though we understand what is actually being proposed. Now it the time to peek inside the black box to see how this particular public option is constructed. One thing's almost certain, the Senate bill will not be as good as HR3200, and HR3200 is not a public option for everyone.

Progressives have done a remarkable job of applying pressure to Democrats in the House, Senate and White House, and helping the public understand what's at stake. Tonight feels good, but the pressure needs to be redoubled in the morning.

...a robust option would be available to anyone that wants it.

Me, I'd rather not wait for the E in everyone. Let's keep up the pressure to do it now, rather than later.

But that's not what Hickey advocates in this post. I wish he would.

[HCAN represents groups that] came together around a plan for reforming the worst practices of the insurance companies, requiring all but the smallest firms to cover their employees, guaranteeing affordable coverage to everyone through an insurance exchange, and offering a public insurance option as one of many choices in the exchange.

In other words, HCAN supports creating a public option that will be available only to those who are unemployed, or whose employer is too small to offer a health plan. Most people will be excluded.

Note: There are some means-tested exceptions that will allow the most underpaid Americans to refuse employer-based coverage and go to the exchange, where the public option is available. If you work for Walmart, for example, you may earn so little that you will qualify for one of the exceptions (unless you are already on Medicaid, as many Walmart employees are).

If you are employed by a company that offers a health insurance plan, and you do not earn little enough to qualify for the exchange, you will have three choices. Here they are:

• You may accept the insurance plan offered by your company, and pay your share of the premium, or
• You may refuse the insurance plan offered by your company, pay an annual fine for doing so and remain uninsured, or
• You may refuse the insurance plan offered by your company and avoid paying the fine if you can find a private insurance company, outside of the exchange, to sell you an individual or family policy, at whatever exorbitant rate they choose to set.

The public plan that HCAN supports is a pitiful thing, available to only a few and operating only in the high-risk, high-cost end of the pool. It will provide absolutely no competition to private insurors in the employer-based insurance market, and, guess what, that's where the action is.

Apparently, this is the plan that HCAN supports. Give the peasants their public option, only make sure few are eligible to chose it. Fix it so that the public option has very little leverage on health care in general, and position it to siphon off the highest risk patients from the pool. Private insurors will quickly develop methods to abet the siphoning process and will soon adapt to the new paradigm. And the public option will be one more way - in addition to Medicaid and Medicare - to saddle taxpayers with the bulk of the costs while channeling the bulk of the premiums to private, for-profit companies.

I'm having a great deal of difficulty seeing this as patient-centered health care reform.

I'm having a great deal of difficulty accepting the claim that such a public option will have a noticable impact on the runaway costs of health care.

Treasury Sec'y Geithner, the failed New York bank regulator who is a protege of Summers and Greenspan.

Summers himself, now chair of the Council of Economic Advisors.

Fed Chair Bernanke, who worked side by side with Greenspan at the Fed from 2002 on, promoting the housing bubble.

The connections go much deeper than just these three. For example here's a link to an interesting article, itself full of links to other sources, that illustrates the extent of the Goldman Sachs intrusion into our government:

http://tinyurl.com/yfc52q7

We're primarily concerned about what's happening in America, of course, but Goldman Sachs has no such parochial point of view. They're citizens of the world, you see, and this might amaze you:

http://tinyurl.com/5n8ygl

We've worn out Einstein's observation that insanity is "doing the same thing over and over again and expecting different results." But we wouldn't have to say it so often if we'd just stop doing it.