U.S. Rep. Heath Shuler (D-NC) defended his opposition to a public health insurance program during a Tele-Town Hall meeting on healthcare reform Tuesday night.

The &dquo;public option&dquo; was a popular topic during the telephone discussion that lasted more than an hour and included 27 questions for Shuler. Several residents asked Shuler why he is not willing to support the creation of a government health insurance plan that would help cover currently uninsured citizens and compete with private insurance plans.

Even after Shuler said he believes cooperatives or nonprofits could do a better job than the federal government at providing such an alternative plan, citizens continued to question his stance. Shuler said the government would have to provide seed money to help a cooperative or nonprofit get started. Support likely would continue until the cooperative or nonprofit reached a level of membership that would make it competitive enough to drive down costs for all insurers.

Probably close to a half million members would be needed, he said, to adequately spread out members&squo; health risks and lower costs. Once at that level, though, a cooperative or nonprofit is likely to run a program more efficiently and effectively than the government, he said. &bsp;

&dquo;The government would have to be actively involved in the startup … but I think the private sector does a much better job with marketing and communication with consumers,&dquo; said Shuler. &dquo;People would either leave (private) insurance companies to go to co-ops, or (the insurance companies) would have to lower costs to compete because the nonprofits would not have to worry about shareholders or dividends.&dquo;

However, some residents said they don&squo;t believe co-ops or nonprofits would be large enough to compete, especially given the large size of most private insurers.

A woman from Franklin described how she was living in a 2,000-square-foot house and always paid her bills before her family faced health problems. She said she was told she was covered, but then learned she was not covered, and she now lives in an 800-square-foot house. The woman said her sister and husband had been denied care for preexisting conditions and she would like to see a strong public healthcare option.

A Black Mountain woman said nonprofits, like the federal government, are also prone to waste, fraud and abuse, something Shuler said the government must attack in any reform plan. She said she&squo;s not sure how private insurers would be forced to lower rates without a government-related insurance operation.

Another woman questioned why Shuler does not support a government system such as Medicare, Veteran&squo;s care, or the health insurance provided to Congress, and an Asheville man asked if there was any circumstance in which Shuler would back a government system.

&dquo;I don&squo;t want to say, &squo;No, I would never do it.&squo; But in the forms I&squo;ve seen it, the public option, I do not support it,&dquo; said Shuler. &dquo;I truly believe from the co-ops and nonprofits we would be able to get a much better balance of competition.&dquo;

Shuler said House Bill HR 3200, which includes a public insurance option, has no chance of passing in its current form. Fewer than 100 of the 435 House members supported the bill prior to leaving Washington D.C. recently on break, he said.

When Congress resumes work on a healthcare reform plan, Shuler says it must start over with a new direction. Any new plan, he said, must address the waste, fraud and abuse in the current system, promote disease management and healthier lifestyles and provide better access to more affordable healthcare.

Shuler added that insurance must have portability, meaning someone could take a policy with them after leaving a job, and insurance should not be denied to anyone for a preexisting condition. One caller Tuesday said she&squo;s had an incurable disease since 1981. She&squo;s fortunate her husband has a job and insurance, but she&squo;s terrified he will lose his job &dquo;because then I don&squo;t know where to turn,&dquo; she said.

&dquo;Denial of preexisting conditions and people getting dropped is unacceptable in America,&dquo; said Shuler. &dquo;That has to change. That has to be a major part of healthcare reform.

&dquo;It&squo;s unacceptable to have to worry that the insurance company is going to say, &squo;Sorry, you&squo;re no longer covered.&squo; People say that doesn&squo;t happen, but it happens every single day.&dquo;

A retired physician from Arden suggested a phased approach with several smaller bills aimed at healthcare reform, rather than one large bill that is so &dquo;open to attack.&dquo;

Shuler said he believes an incremental approach is needed, and that&squo;s probably the direction it will go.

The Congressman responded to a variety of other questions Tuesday, including one about the lack of Tort reform to cap lawsuit settlements.

Shuler said it&squo;s important to pursue every opportunity to lower healthcare costs, but added that lawsuit settlements on cases not involving gross negligence make up a relatively small portion of the nation&squo;s healthcare costs.

&dquo;It is not the overwhelming part. Waste, fraud and abuse far exceeds it,&dquo; he said.

A retired man from Cashiers who is living on a fixed income said he is worried about the debt that may be created by healthcare reform. He questioned what kind of country proposes a bill that goes against so many traditional values.

Shuler said President Obama has insisted that he won&squo;t sign a bill unless it is deficit neutral. He added that the President has insisted that a plan &dquo;bend the cost curve,&dquo; so that costs for any alternative health insurance plan decline over time. That was not the case with HR 3200, he said.

A Cullowhee man said he&squo;s concerned that expanding access to healthcare will overwhelm the system, and he wants to know what would be done to avoid &dquo;what they have in Canada with long waiting lists.&dquo;

Shuler said the nation already lacks a sufficient number of primary care physicians and specialists in rural areas, and it will have to encourage more people to go to medical school, and help them with the cost.

A couple people raised concerns about getting adequate coverage as a small business owner or self-employed person.&bsp; A Waynesville business owner says many people who have worked for him did not have insurance and were afraid to go to the hospital due to the high cost.

Shuler said he held a Tele-Town Hall meeting Tuesday with small business owners across the district about healthcare reform,&bsp; and the idea was proposed to pool small business employees together to spread out the risk. He added that a disease management program, such as the one used in the Asheville Project, would drive down costs for the group.

A couple people asked whether Shuler will continue pushing for such health and wellness programs as part of a reform bill. Shuler said only about one page out of 1,000 pages in HR 3200 addressed prevention and wellness, which is why he continues to push for its inclusion to lower healthcare costs.

Shuler was also asked about misinformation spread through the media and by top Republican elected officials. A Waynesville woman noted that a Senator said the bill would lead to euthanasia, another said it would outlaw private insurance, and a Republican party committee said the reform was a plot to deny insurance to Republicans, she said.

&dquo;How can you insist on bipartisan support when it&squo;s obvious Republicans are determined to distort the truth?&dquo; she asked.

&dquo;Unfortunately, some members of Congress will always be partisan, and unfortunately, we continue to elect them,&dquo; said Shuler. &dquo;It makes the job very, very difficult. There&squo;s enough bad things in the bill that we don&squo;t have to make things up.&dquo;

He said many members of Congress are working to educate people about healthcare reform plans and refute the false claims of &dquo;death panels and other stuff.&dquo;

&dquo;It&squo;s time for members of Congress to knock down political barriers,&dquo; he said. &dquo;United we stand, divided we will fall.&dquo;