With a health care system in crisis, it is up to us to understand the issues and what is at stake: The 47 million uninsured, the minimum 20 million underinsured, our rank of 37th in the world in overall quality of care while we spend 82 percent more than other industrialized nations, businesses crumbling under the weight of providing health benefits, disparities in quality and cost, medical bankruptcies. All are driving a commitment to reform.

And yet, the usual forces are lining up in opposition. The insurance companies, which don't want to compete against a public plan, have conceded that they can forego preexisting condition qualifiers and premium penalties for health conditions. But they agreed to this in 1993, and now, 16 years later, we see no change. They clearly have a vested interest in swarming the halls of Congress with lobbyists to make sure that they're not threatened with serious change or competition.

The American Medical Association, which represents barely one-fourth of physicians and is heavily weighted to specialists, has long expressed opposition to a public plan. However, a year ago, the Annals of Internal Medicine reported Aaron Carroll's study that found that 59 percent of doctors said they support a national health insurance program.

Co-author Dr. Ronald Ackerman states, "As doctors we find that our patients suffer because of increasing deductibles, co-payments and restrictions on patient care."

Last week a New York Times /CBS poll found that 72 percent of the public support a government-administered insurance plan that would compete for customers with private insurance. On the brink of making decisions about "real change," we must define why a public plan matters.

First, a public plan will provide coverage for the 47 million uninsured people in America. The cost burden of paying for charity care in place of being reimbursed for the uninsured will be eliminated by a public plan.

Second, with the other federal plans in place, there will be enough bargaining clout to significantly impact pharmaceutical as well as other costs.

Third, a public plan with adequate size and influence could implement recommendations from the newly established Comparative Effectiveness Board to improve quality and cost.

We know from research out of Dartmouth that high cost does not equal high quality. Practices vary across the country, with some areas provide better quality for lower cost. This kind of disparity represents opportunities for cost savings by reproducing the best care provided.

Fourth, perhaps the most vital function that a public plan could have would be as a platform to reform the way that doctors get paid. The fee-for-service model in which doctors get paid more for doing more drives up cost and lowers quality.

The payment system needs to be structured to pay for quality health care, not quantity. Until payment reform is accomplished there will not be a sustainable, coherent system.

While President Obama is advocating for a plan that protects choice and fosters competition, let's not fall prey to the fear tactics of Harry and Louise and those who try to scare us into believing that this is the road to socialism.

We, the people, elected Obama to deliver us from the crushing weight of our broken health care system. The people want it fixed. Doctors want it fixed. Now is the time for us to stand up and refuse to let power politics deliver plans that amount to putting Band-Aids on a hemorrhaging, fractured system.

Julie Day is a practicing primary care physician with the University of Utah Community Clinics and serves as the medical director of quality improvement for the clinics.