Americans zipped through the first billion of the Cash for Clunkers program and Congress didn’t blink before they quickly added two billion more before recessing--and neither did the public. It’s puzzling that we line up for ‘free’ money, but riot at a program that would allow us to pay for affordable health insurance.

We never question our addiction to cars even though bailing out Detroit goes against all logic for achieving our energy independence, reducing our carbon footprint, and—yes—even factors into meaningful health reform.

We are far from being the healthiest population in the world. Many countries with national health care systems live longer than we do and they are healthier; keep in mind there’s a difference between longevity and health. Sure the US has marvelous and expensive health care for when we are sick—really sick, but little is being done to make us a healthier population, which could ultimately translate into health care savings.

Is it so hard to grasp the significance of how our land development has contributed to a nation where rampant diabetes and obesity devour our health budget. Kids don’t walk to school; parents don’t walk with kids; road projects don’t include bike lanes nor sidewalks; our neighborhoods don’t include safe walking paths and there isn’t adequate public transportation anywhere in Alaska.

Studies have shown that simply having a good public transportation system contributes to better health because people walk more. I wonder if having a dog was part of the study. In Anchorage, many people can’t walk around the block because subdivisions rarely provide safe places to do so. Developers don’t want the added cost and the city’s development codes haven’t promoted walking/biking. The exemplary and rare examples are clearly profitable, but developers say ‘affordable’ housing can’t incorporate these features.

A perfect example of a road project that isn’t likely to contribute to better health of an already poor neighborhood is the Highway-to-Highway project (Glenn to Seward highways). $850 million could go a long ways towards contributing to a healthier populous; instead it may shave mere minutes off driving time—for a few years, at best.

Our shallow Clunker mentality is embarrassing. Why not take some of our huge transportation budget and put it towards re-formatting our cities for better, sustainable health—for everyone.

Aside from the neglected issue of promoting better health first, the debate is rampant with misinformation about how we can afford health insurance. How do we pay now? Except for Medicaid and veterans, we buy it privately—which is almost unaffordable or non-existent due to pre-existing conditions, or we get it through our employment—which is also disappearing for the same reasons. Even Medicare recipients pay premiums. Those without insurance may get treated at hospitals, but the costs are reflected in higher private insurance bills. Affordable insurance premiums can be achieved only by insuring nearly everyone, and only with a public option. Demagoguery is leading reform to failure over this critical component.

Public discussion is being diverted from the one thing that will ensure successful reform. While the term ‘health cooperative’ is rising in the debate, don’t be fooled; cooperatives are few, largely unproven, not likely to have sufficient numbers of enrollees for long term success and offer very limited options for care.

Private insurers cry that a public option will put them out of business. Aren’t they doing that themselves by thinking about their profits first while businesses and individuals drop out in droves? How much do those private insurer supporters, or their employers, pay for their plans? I’d like to ask them if they know anyone, or a small business, who has been dropped from insurance because of a costly illness. Private health insurance doesn’t work for us; that’s why we’re in this crisis.

A level playing field? Private insurers want one and they want to limit the number of enrollees in any public plan because they know it will spell failure. Remember, they answer to their shareholders. A public option should result in affordability for nearly everyone with costs spread widely. In my book, there cannot and should not be a level playing field for a public option because I don’t want the stock market dictating my public health plan details.

Actually private insurers are doing right now what they say a public plan would unfairly do to them: reimburse at lower rates to keep costs down. Do you have a private plan that requires you to go to preferred providers for exams, procedures and tests? Try visiting a non-preferred provider and you will likely end up paying about 50% of the full bill, rather than a 20% co-pay. Private insurers have been negotiating lower rates for a long time—to benefit their shareholders. Doing the same for a public plan would lower premiums/costs and it would benefit the public. Isn’t that our ultimate goal for health reform—to provide more health care for more citizens at affordable rates?