We are finally reaching the important stages in Congress for national health care reform. And we need the reform.

Lest you forget we currently pay almost 18 percent of our GDP in healthcare, far more than any other industrialized nation. And for that high cost we purchase less health care than most other nations, with fewer insured and poorer health outcomes.

Further, the annual increases in health care, that far outstrip inflation, are eating up workers raises and lowering our standard of living.

And while we pay more for less, we are also bullied by our insurers, who deny insurance for pre-existing conditions, deny medicines they deem too expensive, deny claims they simply do not want to pay and pay their executives so much that their products are killing our economy.

Yes, while an insurer can deny a justified claim solely to slow down payment or violate its coverage promise, that same company is paying its CEO $20,000 a day whose role is to force those in the industry to fight the claims of the insured. Why? Because the only way to make enough profit to earn $20,000 a day is to reduce expenses and expenses are claims. Insurance for profit is nothing more than wealth for denial … the more coverage denied, the more wealth to spread around the executive offices of the insurers.

So the administrative costs of American insurers hover between 18 percent and 22 percent, while Social Security costs about 3 percent and every other industrialized nation on the planet pay less than 10 percent in administrative costs.

Do we need health care reform? Yes, unless we want a future as a nation dedicated to insuring little more than the executives of insurance companies right to obscene wealth at the expense of all the rest of us.

But will we get meaningful reform without a public option?

A public option means an insurance offering with government employees setting rates and government purchasers providing payments. It means something almost exactly like Medicare.

Without a public option the status quo, insurers setting rates, high administrative costs, huge profits for the denial of care, are all left as they are today … out of control. Nothing really changes. It is simply re-arranging deck chairs on the Titanic.

The public understands this. Over 60 percent of the public have consistently favored the public option. More than 70 percent of doctors favor the public option. Yet it remains highly unlikely the public option will survive the Congressional debate.

Why? Several reasons.

Republicans strongly oppose the public option. Their arguments range from the claim of inefficiency of government to provide any service effectively, to the fear that the public option will lead to the dreaded One Payer plan, where government would administer all health care nationally.

But of course Republicans will not vote for health care reform even if there is no public option, so do their opinions really matter?

Senator Olympia Snowe was the sole Republican Senator to vote for health care reform last week, but her vote came with a promise that she might vote against any final bill.

Then there are the insurance companies, all of whom oppose the public option. You see, lacking a public option, they can continue their present practices of denial and delay, but with more customers forced to buy their products as all of the current plans require more to become insured.

So insurers win big without a public option and may lose big if they are forced to compete.

And make no mistake; they do not like to compete. Have they contributed enough to politicians to win? Looks like it.

Jim Crawford is a contributing columnist for The Tribune and a former educator at Ohio University Southern.