In a March 26 press conference, House Speaker Nancy Pelosi said that health care reform "should have a public option in it for it to really be substantial." This statement puts her more strongly behind creating a new government health insurance program than President Obama, who proposed such a program during the campaign but mostly avoided discussing it and has lately been cagey about how hard he'll fight for it. Five Senate Republicans, including Minority Leader Mitch McConnell and Charles Grassley, ranking member of the Senate finance committee, have put Obama on notice that they will oppose any health care reform that includes a public option because, they fear, private health insurers will not be able to compete with a government health insurance program. They're probably right about that. It might be worth losing sleep over if private health insurers were today doing a halfway decent job of keeping costs down and/or providing an acceptable level of coverage to policyholders. But they aren't. Even as Republicans scream their heads off about government bailouts for Wall Street banks and Detroit automakers, they're maneuvering to shore up the severely dysfunctional market for private health insurance.