The Government Insurance Option is inevitable, not because we do it now, but because when you take away the ability of private insurers to exclude patients or punitively charge them based on experience or perceived risk, you will find that consolidation will occur, with some companies winning and many going broke and requiring bailouts. As insurance companies strive for profitability, they will also strive to shed their sickest clients. A Government Insurance Plan will allow them to do that. The uninsured 25 year old is not the challenge here. Companies will write that person a very cheap policy because, more than likely, he or she will not become seriously ill for 20 to 30 years (which is why many 25 year olds who don't get it automatically go without insurance). A 45 year old, obese man with a pre-existing condition - someone strangely like me - will be avoided at all costs, even and especially for high deductible plans. The problem is not, as some intimate, the overuse of option coverages, drugs or doctor visits, but the prospect of some catastrophic event which will result in hospitalization and costs in excess of $100,0000 (or more). Most insurers would rather not care for these folks under any circumstances, because they will lose money doing it. They certainly won't make money - and in this environment they want to make as much money as possible from this line of business. Health care reform won't let them do that - unless they can shed these people to a public insurance fund. It may be that some in the industry have not yet figured out that a public fund will let them shed the high risk cases. Perhaps it needs to be more explicit in the law - or maybe there are ideologues in the lobbying arm who need to do a better job of doing their homework. By the time the debate is over, I am sure the insurers will be quite comfortable with the public fund,even though it is the the camel's nose to single payer. A public fund is like crack cocaine. Once insurers are in the habit of dumping risky cases onto it, they will find it harder and harder to stop as profit targets rise (as they always do in capitalism).