The health care debate and accompanying legislative sausage-making fest (minds out of the gutter, please) is in full swing, and there is uncertainty about how it is going to end.

A smattering of groups are amped up about this, so it’s a good thing Mark Sanford wasn’t in Argentina getting better medical care or a rogue kidney transplant.

A week ago Wednesday evening, with all the trimmings of an infomercial and trappings of Oprah guised in an ABC News special, the President discussed his take on the issue with that sweet old man Charlie Gibson.  He harped on compromise as a key theme towards achieving an equitable outcome.

In the glowing aura of the soft mood lighting, Obama did not cede any ground on a public insurance option.  He boiled the harsh hesitance towards a new framework down to the platitude it just may be, saying people are worried because they think, “The devil they know, they think may be better than the devil they don’t.”

(The President held a forum this week on the same topic, and there was concern among the press that the attendees’ questions were hand-picked.  Seems like the Administration was caught.  Still better than having the town halls rehearsed back in the Bush days.)

In any event, the AMA has formally registered its opposition to a public option with Congress.  Some of its members even booed Obama in person.  Oh, and two weeks ago, the two largest insurance associations rebuked a public option, saying it would kill employer-based coverage.  Ruh-roh.

Let’s unpack this issue a bit.  In order to resuscitate (pun intended, zing!) the citizenry’s confidence in American care and the ability to have some kind of insurance, something must change.  Everyone but Larry Kudlow seems to agree on that.

Those in power or those taking the biggest cut of cash are always reluctant to give it away.

Prominent thinkers and columnists are of course invested in this debate too.  David Brooks wrote an interesting mock meta-piece on the process recently, but hopefully the outcome will be a little more robust then he predicts.  And Paul Krugman calls out centrist Democrats as Obama’s frenemies who may hold out and thus kill the bill.

It should also be noted that with almost ¾ of the country (including half of Republicans) favoring having a public insurance choice, if an adequate option does not come out of this high-stakes scrum, it would be a major failure for Obama.

But how can Chicago Hope fail?  (Yes, I am referring to Obama and not the underrated ‘90s medical drama featuring the unflappable Hector Elizonado in a tour-de-force performance.  What else can you say, he never flapped.  Okay, digression complete.)

Now, nobody wants to ruin the economy further but is it really a tragedy if the massive, complex apparatus of private and employer-based insurance takes a hit?  Some of the jobs lost there can be rehired into a new public option and we can see what wins out.

Is the argument that a public option might be so favorable to the masses that it would hurt the untenable choices many people have now?  If we thought that things should never change because messing with the existing system would result in some people losing their jobs, then I would probably still have a job.  And I’m not bitter.

As someone who is out of work for the moment and COBRA-ing on a PPO plan he’s never felt was reasonable, I’d be curious to see if the government option would be worth my while.  It may not be, but the goal here is to help the most people possible financially and medically.  As the illustrious, yet somehow fictitious Andrew Shepherd cleanly states in The American President, “Government is choosing, government is prioritizing.”  We would all do well to refresh ourselves with that thought when debating this issue.

I am not saying public health care is necessarily the best choice, but why not let it be a choice?

The proposal on the table won’t outlaw private insurance, but merely allow for a public option.  This option can start small or as a pilot program with adjustments made as needed.  And more often than not, the free market decides and champions the best option, as subscribers to a conservative economic model will attest.

Lo and behold, when I want to ship a package I have the choice to hit up the US Postal Service or a private carrier.  Guess what, 90% of the time I go for DHL or FedEx.  The truck with that rascally “Home Delivery” dog with a package in its snout always gets me.

Or if transportation wets your whistle, take black livery cars.  They have found their niche and held their own against taxis in New York City.  And the organization that licenses and regulates cabs, the Taxi & Limousine Commission, is a government agency. Sacré bleu!  Wait, that’s French, I take it back.  Don’t want to be associated with those wimpy pinkos.  Anyway, I almost always take cabs over black cars.  Scratch that, I take the subway and bus almost all the time.  Whenever I ride in a cab these days, it feels luxurious.

A new product or service (if successful) always alters the landscape and inevitably displaces or shrinks an existing one if it is deemed superior.  The iPhone stomped on other 3G devices, but we haven’t seen angry detractors in Congress lamenting the erosion of LG smartphones.

The rub here is that the public nature of this potential health plan gets into tax issues.  Still, if you are currently paying for health insurance outright or having it deducted from your paycheck each period, what is the difference in having that disappear and paying a similar amount (we hope) in taxes instead?  A dollar is a dollar is a dollar.  So, here’s to a clean bill for health.