Congress has put forward long-awaited proposals for how to revamp the U.S. health care system. The American Medical Association, which represents a minority of doctors, was quick to speak out against the inclusion of a public health insurance option. They also rapidly backpedaled a day after The New York Times made it front-page news, but their opposition to more government involvement in health care is well-known, and their current policy clearly intends to “build upon the key pillars of health care coverage today.” Let’s not forget it was the AMA that hired Ronald Reagan in the 1960s to advocate against Medicare as “socialized medicine.”

What is wrong with the AMA position? What’s wrong is that the “pillars of health care” have failed the American people. We not only have 47 million uninsured Americans, we also have millions more who are underinsured. State and federal governments already pay for the largest portion of health care — by way of Medicare, Medicaid, tax breaks and insuring their own employees. Meanwhile, private insurers are milking the system by denying coverage to the sick and reaping billion-dollar profits.

Conservative pundits (including, recently, Tarren Bradgon in his June 12 OpEd, “Dirigo’s lessons for national health care reform”) tell you that a public health insurance option will lead to out-of-control health care spending, “rationing of care” and loss of “freedom of choice.” Yet right now, we stand at the edge of this abyss, forced there by the current broken system. If we do not change direction now, we will fall, and likely drag what is left of our economy with us.

This year for the first time, Medicare spends more than it is taking in, and funds would be depleted in only a few years if things were allowed to continue as is. Yet Medicare is a saving grace many of my patients wait for to afford them the care they need after losing their insurance (or never having any).

Conservatives — and the AMA — offer the “same old same old.” It seems they are united only in their efforts to preserve the health care industry’s profits, while deductibles and out-of-pocket expenses are continuously on the rise and coverage is declining. Maine doctors, on the other hand, have to live with their patients’ perils every day. Is it surprising that a recent poll showed most of them in favor of a single-payer system?

The bottom line is that all of us must change. Doctors will have to perform fewer unnecessary tests and procedures; some undoubtedly will make less money, especially in regions that are grossly overspending on health care (Maine not being one of them). Patients will have to accept more responsibility for their health, which includes maintaining health insurance. Insurance companies will have to accept fewer profits. All of us will need to be covered.

I am firmly convinced that these goals can be achieved only by an affordable and comprehensive public health insurance option, which will expand choice, level the playing field, make health care affordable and keep the private industry honest.

Benjamin Schaefer is a Bangor cardiologist and member of the board of directors of the National Physicians Alliance.