At its heart, insurance is about shared risk. For any group, we can project how many people will get sick, be diabetics, get the flu, give birth, etc., in any given year. Some will need very little medical services, some will need a lot. But in large enough numbers, the cost of covering all the services that any of us will need works out to be quite affordable per person.

Consider the group health insurance rates for a large employer. Those rates are lower than anything you or I can get as individuals. Why? With a large group the cost per person averages out over the group.

Some of us will need medical services but a lot of us won't. With a group composed of everyone in the United States, universal health coverage would work the same way.

Health insurance companies are making money so it is a business that could pay for itself (read: no new taxes). Public insurance could offer a basic health coverage plan with options for greater coverage, at higher prices. Spreading the risk over the largest pool of people available, should result in lower average cost for basic coverage.

The nature of shared risk for insurance does not change with a public option. How should insurance for all of us differ from insurance for some of us? That question sets the stage for an informed debate over health care reform.

Patrick Durusau is a resident of Covington. His columns appear regularly on Fridays