In the Washington struggle for universal medical insurance, the House of Representatives has produced a mouse of a "public option" plan that would give insurance companies and hospitals little reason to keep health-care premiums and costs down.

If health-care premiums continue to soar into the stratosphere, they will negate other reform efforts.

The House and Senate bills have many admirable features. Insurance companies would not be allowed to refuse to offer insurance to people who have pre-existing conditions. They would not be able to cancel a paid-up customer's insurance because of sickness. They offer much-needed coverage to millions of middle-class working Americans.

But insurance premiums must be affordable and costs must be controlled. Theoretically, a government-run plan (the "public option") would offer low premiums, which would attract consumers and force commercial plans to keep their own premiums and costs as low as possible, through sheer competition.

In order to do so, the public plan cannot have exorbitant costs itself.

Medicare and Medicaid set the amount they reimburse hospitals and doctors, based on their analysis of actual costs. The House proposal does not allow the public insurance plan to do that. Instead, plan managers must negotiate rates with hospitals and doctors, a process sure to produce higher rates. Hospitals and doctors are not required to accept the public insurance.

To be effective and keep premiums down, public insurance must also have a large pool of policy-holders. The House bill seriously limits the number of people eligible for the public plan to individuals and those who work for companies with 100 or fewer employees after 2014.

With probable higher costs and a seriously limited pool, the public insurance plan - under the House bill - could not offer low premiums that would attract customers and give commercial insurance companies incentive to keep rates low.

If health-care premiums continue to soar into the stratosphere, they will negate other reform efforts.

The House and Senate bills have many admirable features. Insurance companies would not be allowed to refuse to offer insurance to people who have pre-existing conditions. They would not be able to cancel a paid-up customer's insurance because of sickness. They offer much-needed coverage to millions of middle-class working Americans.

But insurance premiums must be affordable and costs must be controlled. Theoretically, a government-run plan (the "public option") would offer low premiums, which would attract consumers and force commercial plans to keep their own premiums and costs as low as possible, through sheer competition.

In order to do so, the public plan cannot have exorbitant costs itself.

Medicare and Medicaid set the amount they reimburse hospitals and doctors, based on their analysis of actual costs. The House proposal does not allow the public insurance plan to do that. Instead, plan managers must negotiate rates with hospitals and doctors, a process sure to produce higher rates. Hospitals and doctors are not required to accept the public insurance.

To be effective and keep premiums down, public insurance must also have a large pool of policy-holders. The House bill seriously limits the number of people eligible for the public plan to individuals and those who work for companies with 100 or fewer employees after 2014.

With probable higher costs and a seriously limited pool, the public insurance plan - under the House bill - could not offer low premiums that would attract customers and give commercial insurance companies incentive to keep rates low.

The Congressional Budget Office projects that, given those limitations, only an estimated 6 million Americans would sign up for the public plan under the House proposal. That's only 2 percent of eligible Americans, hardly enough to hold the feet of the insurance companies to the fire.

The big winner would be the insurance industry. Commercial plans now have 180 million customers. With a wimpy public option, according to CBO numbers, they would probably get tens of millions of additional customers and a relatively free hand to hike their premiums.

Senate Democratic Leader Harry Reid has said the final Senate version will include a public option. What kind of public option? The public has to start asking those questions. Will the managers be able to set rates based on actual cost? How many people would be allowed to join?

The public option must provide effective competition to the commercial insurers if this bold experiment is to work. Reid says individual states will be able to opt out. A state could say, "Our citizens cannot choose the public insurance plan. They must choose from commercial plans only."

If the public plan is effective and robust, states will not want to opt out, any more than they would want to tell their citizens they cannot have Medicare.

The Senate must give us a public plan with some teeth. Then they must fiercely defend it in negotiations with the House. Otherwise, we will all be trapped in the same old cost spiral.