Last night, the so-called "gang of six" -- three Republican and three Democratic senators on the Senate Finance Committee -- met by conference call and, according to Senator Max Baucus, the committee's chair, reaffirmed their commitment "toward a bipartisan health-care reform bill" (read: less coverage and no public insurance option). The Washington Post reports that the senators shared tales from their home states, where some have been besieged by protesters angry about a potential government takeover of the nation's health care system.

It's come down to these six senators. The House has reported a bill as has another Senate committee, but all eyes are fixed on Senate Finance -- and on these three Dems and three Republicans, in particular. But who, exactly, anointed these six to decide the fate of the nation's health care?

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Latest word from the White House is that the President still supports a public option but is also standing by Health and Human Services Secretary Kathleen Sebelius's remark last weekend that a public insurance plan is "not the essential element" of health-care reform. So where, exactly, is the White House on the public option? Just about where it is on the question of whether it agreed with Big Pharma to bar Medicare from using its bargaining clout to get lower drug prices -- or didn't. In other words, we don't know.

Universal health care is President Obama's biggest issue, and he needs strong public support if he's going to overcome the vested money interests in Washington. Which brings us to the question of where the people who voted for Obama stand on all this.

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I would have preferred a single payer system like Medicare, but became convinced earlier this year that a public, Medicare-like optional plan was just about as much as was politically possible. Now the White House is stepping back even from the public option, with the President saying it's "not the entirety of health care reform," the White House spokesman saying the President could be "satisfied" without it, and Health and Human Services Secretary Kathleen Sebelius saying that a public insurance plan is "not the essential element."

Without a public, Medicare-like option, health care reform is a bandaid for a system in critical condition. There's no way to push private insurers to become more efficient and provide better value to Americans without being forced to compete with a public option. And there's no way to get overall health-care costs down without a public option that has the authority and scale to negotiate lower costs with pharmaceutical companies, doctors, hospitals, and other providers -- thereby opening the way for private insurers to do the same.

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