What are we to make of yesterday's report from the trustees of the Social Security and Medicare trust funds that Social Security will run out of assets in 2037, four years sooner than previously forecast, and Medicare’s hospital fund will be exhausted by 2017, two years earlier than predicted a year ago?

Reports of these two funds' demise are not new. Fifteen years ago, when I was a trustee of the Social Security and the Medicare trust funds (which meant, essentially, that I and a few others met periodically with the official actuary of the funds, received his report, asked a few questions, and signed some papers) both funds were supposedly in trouble. But as I learned, the timing and magnitude of the trouble depended a great deal on what assumptions the actuary used in his models. As I recall, he then assumed that the economy would grow by about 2.6 percent a year over the next seventy-five years. But go back into American history all the way to the Civil War -- including the Great Depression and the severe depressions of the late 19th century -- and the economy's average annual growth is closer to 3 percent. Use a 3 percent assumption and Social Security is flush for the next seventy-five years.

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The only troubling thing about the President's statements today concerning health care reform was what he did not say: that he wanted a any health plan that emerges from Congress to include a public insurance option for Americans who do not want to buy private insurance. But without this option, there will be no pressure on private insurers to adopt all the other reforms to control costs or give all Americans access to affordable care.

Every other reform proposal announced to date -- electronic medical records, comparative effectiveness research, prevention of chronic disease, payments for services rather than for outcomes, and so on -- has been talked about for years. The reason none have been adopted is health providers and insurers can make more money without them. Only with a government plan that competes with private insurers, and offers Americans lower costs if the providers and insurers fail to reform themselves, will the system be genuinely reformed.

Hopefully, the President's failure to mention a public insurance option today was not intended to signal to Congress that the White House is no longer especially interested in it. The Administration should quickly inform policymakers how important this option is as a spur to real change.