Two months ago, I stood on the floor of the U.S. Senate and made a solemn commitment. It’s a commitment I’ve restated almost every day that the Senate has been in session – and I will say it again:

I will not vote for any healthcare reform bill that fails to include a strong public option.

Unfortunately, there has been a great deal of misinformation about what the public option is really about, and what it would mean for ordinary Americans. So let’s cut through the distractions and the scare tactics and talk seriously.

Let’s define exactly what a strong public option means.

We hear people talk about public options, and triggers, and opt-outs, and opt-ins, and all kinds of other proposals.

Some people throw these words around interchangeably. But words are important. This is not some abstract idea.

This is a real set of proposals, and they will affect real people in real ways. So let’s define exactly what we’re talking about:

A strong public option is about three things: competition, lower costs, and accountability.

And that’s why a strong public option is essential to achieve real, meaningful reform.

We can all agree that we need to fix our health care system now, but let’s also agree to fix it the right way.

First and foremost, a strong public option must create true competition in the health insurance market.

The key problem with health coverage is that consumers do not have any options.

In America today, only two industries are not bound by the anti-trust laws that apply to every other business in the country: health insurance and Major League Baseball. When every other private enterprise has to compete in the open market for your business, why does Big Insurance deserve special treatment?

In my opinion, they don’t.

In such a highly concentrated environment, there is no incentive to compete. There is no reason to improve service, expand access, or work with patients and doctors to achieve better health outcomes. In fact, there is every incentive to do just the opposite.

We’ve seen unprecedented consolidation in the insurance market – and that has led to a lack of competition and choice for American consumers.

In the past 13 years, there have been more than 400 corporate mergers involving health insurers. As a result, 94 percent of our nation’s markets are now considered “highly concentrated,” meaning that they are virtual monopolies.

In Illinois, just two companies control 69 percent of our market. And sadly, Illinois is far from alone.

In Alabama, a single company controls almost 90 percent of the market. And in Iowa, Rhode Island, Arkansas, Hawaii, Alaska, Vermont, Wyoming, Maine, and Montana, the two largest health insurance companies control at least 80 percent of the market.

In fact, there are only three states in the entire country where the largest three companies control less than half of the insurance market.

I believe this must end.

We must restore competition and choice to the health insurance industry. It’s time to create a strong public option that will make insurers compete for people’s business, just like any other company in America.

A strong public option would give people a choice for the first time in decades. No one would be forced to change their coverage – but if their current provider isn’t treating them right, they deserve the opportunity to choose something better and more affordable.

Which brings me to my next point:

In order to achieve real reform, our public option must be strong enough to significantly lower costs.

Everyone knows what America pays for insurance. One out of every six dollars we spend in this country goes to pay for healthcare. Health outcomes are down, but somehow insurance company profits are through the roof.

This doesn’t make sense.

Premiums are rising four times faster than wages. In fact, between 2000 and 2007, 10 of the country’s top insurance companies increased their profits by an average of 428 percent.

Now, there’s nothing wrong with making a fair profit. But there is nothing fair about creating a monopoly and then wringing money from the sick Americans who are counting on them in their hour of need.

Not only are there almost 50 million Americans without health insurance – there is also a massive segment of the population who cannot afford what little coverage they have.

The American people deserve the chance to shop around – to compare options and pick the plan that’s right for themselves and their families or small businesses.

If private companies have to compete with a strong public plan, people’s premiums will come down. Companies will bring costs under control, and this will help save money – but it’s not just cost that will improve.

Providers will also improve the quality of coverage. They will start to focus on patient outcomes, rather than profits. As a result, better care would become available to more people.

A strong public option would require some capital to get off the ground, just like any other business – but after that, it would rely on the premiums it collects to remain self-sufficient.

It would operate like a non-profit insurance company, setting affordable rates based on the actual cost of care, not a desire to give giant bonuses to their executives and pay dividends to their shareholders.

The current system is a drain on the American taxpayer, but a strong public option would not be.

It would not be a handout.

It would not force anyone to change their current coverage – but it would drive costs down and give people a real choice for the first time in decades.

A strong public option would provide a cheaper alternative to private companies, and would force those companies to improve their product or risk losing customers.

And that brings me to the third goal we must achieve with real healthcare reform:

Our public option must be strong enough to bring real accountability to the health insurance industry.

For too long, private insurance providers have been running roughshod over the American public.

More often than not, those most in need are the ones who suffer the worst abuse.

There’s a lot of money to be made off of the poor – and insurance companies don’t seem to mind raking in cash at their expense.

Private insurance companies can drop your coverage for almost any reason.

They routinely exploit minor technicalities to avoid paying claims to those who need assistance the most. These companies continue to look for new and innovative ways to deny coverage to sick Americans, because they know these people have nowhere else to turn.

A strong public option, coupled with the rest of our insurance reforms, would change all that.

Our reforms would make it illegal to deny coverage because of a pre-existing condition.

And a strong public option would allow people to shop around if they don’t like the coverage they have, or if they’re paying too much.

As the system exists today, the health insurance corporations are accountable to their shareholders first, and their customers second.

A strong public option would reverse that.

It would prioritize patients over profits, and would give the American people the chance to hold these companies accountable for the first time in many years. That is why I support a strong public option.

That’s what it would mean for America: Competition. Cost savings. Accountability.

And unless we are able to meet these three conditions in the final bill, I will not vote for it.

I believe that a strong public option is the best way to achieve these goals. In fact, my preference is to have a robust public plan that is tied to Medicare.

But whatever form this legislation takes, I will ultimately judge it based upon its ability to bring about real competition, lower costs, and restore accountability.

It is time to make good on the promise first articulated by Teddy Roosevelt almost 100 years go. It is time to make comprehensive healthcare reform a reality.

After a century of debate, we are faced with the opportunity to accomplish something truly historic. If we do this now – if we do this right, we can make a real difference in the lives of millions of Americans

And that’s why I will not stop fighting until this fight has been won.

We must work to make sure every American has access to quality, affordable healthcare – through a system that is competitive, cost effective, and accountable.