Real health care reform must come to grips with two fundamental issues. First, with 46 million Americans uninsured, 60 million lacking regular access to a doctor and 45,000 dying every year because of that lack of access, we must join the rest of the industrialized world and guarantee health care to every man, woman and child in our country.

Second, we must address the issue of cost containment. Despite tens of millions of Americans being uninsured and under-insured, we are spending $2.5 trillion a year on health care, almost twice as much per person as any other major country. Health care premiums have doubled in the last nine years and, without real reform, the projection is that they will double again in eight years. This is unsustainable for business, for workers, for government and for our entire economy. Clearly we need health care reform which brings costs under control and we need it now.

Let's be clear. The function of a private insurance company is not to provide health care; it is to make money. We have 1,300 private insurance companies in this country pushing tens of thousands of separate plans — each geared to make as much profit as possible. The result is an enormously complicated and inefficient system which wastes more than $400 billion a year on administrative costs. In other words, we spend about 30 cents of every health care dollar not on doctors, nurses, medicine and hospitals but on insurance bureaucrats, on lavish pay packages for executives, on advertising, billing, sales, and marketing.

In my view, the simplest and most cost-effective solution to our health care crisis would be a single-payer, Medicare-for-all system. Tens of thousands of physicians and millions of Americans want us to move in that direction because it would provide comprehensive care for all through public funding, free choice of doctors and hospitals and simple and cost-effective administration. The political reality, however, is that because of the power of the insurance companies and the drug companies that approach has never really been on the table. While Congress is not prepared to pass a single-payer national health care program, it is my intention to do everything I can to include language in the legislation which will allow individual states to go forward, in a significant way, with a single-payer approach.

The bill recently brought forth in the Senate contains a number of very important and worthwhile provisions. It provides health insurance for 31 million more Americans, bringing coverage up to 98 percent of legal residents. It keeps children on their parents' plans until they are 26 years old and it substantially expands primary care and disease prevention efforts. It also improves the Medicare Part D prescription drug program for seniors by partially filling the gap know as the doughnut hole. This legislation would also end insurance company practices of denying coverage because of pre-existing conditions or throwing people out because they ran up a large bill in the preceding year.

The major weakness in this bill is the lack of strong cost-containment provisions which could begin to control soaring health care costs. If Congress is not prepared to go forward with a single-payer program, which would be the most cost-effective approach, at the very least there should be a widely accessible public option. Millions of Americans do not trust private insurance companies and they should be given the choice to join a premium-based Medicare-type public plan. Further, a strong public option is an important mechanism to keep private insurance companies honest by providing them with real competition. Without that kind of competition from a plan which is national and nonprofit, it's hard for me to see why the insurance companies will not continue to rapidly raise their rates.

Unfortunately, the public option provision in the bill that was passed by the House is weak. The Senate version is even weaker. The relatively few people who would have the public option available to them are those who are uninsured, work at very small businesses, purchase their insurance for themselves or their families, or are self-employed. Excluded from the public option would be workers for companies that offer insurance that provides poor coverage. We have to do better than that. This legislation cannot simply be a huge subsidy to private insurance companies that would get millions of new customers and be able to raise their rates as high as they want.

In my view, we need to expand the public option. It should be available to every American who doesn't have access to affordable, quality coverage. We must open wider the so-called "exchange" or "gateway" – the menu of available public and private insurance plans Americans could choose from. That's an important way to lower health care costs and give people more choices.

In the weeks to come, I intend to do everything I can to make this legislation stronger and more effective for working families and taxpayers in Vermont and America so that we reach the goal of universal health care in a cost-effective way.

Bernard Sanders, I-Vt,. is a U.S. Senator.