The rock and the hard place is not so much between various policy choices, but between framing the issue in terms of politics and framing it in terms of policies. The MSM has endlessly repeated the trope that the public option cannot pass because there aren't the votes, instead of examining what are the strengths and weaknesses of the various choices.

For example, several posters here have suggested that all we need to do is allow health insurance companies to compete across state lines and tort reform. Well, okay, what are the implications of that?

Allowing health insurance companies to compete across state lines means that the state with the crappiest regulations 'wins,' and the rest of us are stuck with insurance that isn't worth a damn.

Tort reform sounds better, because there is evidence that defensive medicine drives up health care costs and the present system injects an adversarial component to the doctor/patient relationship. However, that slogan avoids the question of how we compensate those who have suffered medical injury. What recourse is available to those who have been harmed by medical practioners?

Of all the proposals wending there ways through Congress, I would say the more robust a public option is passed, the better the politics.

Why?

Because, if uninsured folks are either going to have to purchase health insurance or a pay a fine, delivering them to the tender mercies of private health care insurance will be suicidal. How do you spell g-o-u-g-e-d? When the uninsured get the bill, they will be furious and rightly blame those who put them in this untenable financial bind (some estimates have a middle-class family making $66 could end up spending 20% of their income on health insurance). Screwing the middle class has never been a great electoral strategy.

So, there has to be some mechanism to keep this affordable for the middle class. Only a robust public option with huge subsidies can do this.