Some see the bill, which must be reconciled with a similar bill adopted earlier by the House of Representatives, as a necessary first step toward broader health care reform. Others, on both ends of the political spectrum, say the bill is so flawed that it should be scrapped.

"It doesn't have everything that anybody wanted it. But it is at least a basis for us to move forward. Nobody is satisfied with this bill," said Walter Kopp of San Anselmo, president of Medical Management Services Inc., which provides services for physician groups, hospitals and health plans.

"It's better than nothing," said Dr. Larry Bedard of Sausalito, chairman of the Marin Healthcare District board and a retired emergency room physician.

Esther Wanning, co-director of Health Care for All-Marin, an advocacy group for a single-payer health system, disagrees with that assessment.

"I think it is too flawed," Wanning said. "I was actually very depressed watching Harry Reid this morning on C-Span acting as if something great had happened, because it is such a gift to the insurance companies. There are no cost controls, and doesn't even begin to solve our real health care problems."

Morgan Kelly of San Rafael, former head of the Marin County Republican Party, said, "While it is a noble thing to want to provide health care for everyone, it is something we just

Jennifer Rienks of Fairfax, a member of the Marin Healthcare District board and a public health researcher employed by the University of California at San Francisco, said she has many concerns about the bill, including that it lacks a public option that would pressure insurance companies to offer more competitive rates.

To those who say the legislation is a good first step, Rienks said, "I'm afraid that people won't want to go farther. We need to go a lot farther than this bill goes if we want to fix our health care system."

On Wednesday, Rep. Lynn Woolsey, D-Petaluma, issued a joint press release together with Rep. Barbara Lee, D-Oakland, emphasizing that she and other progressive Democrats would push hard to keep key provisions in the House bill, particularly an already diluted version of the public option.

"Without competition, without some government plan that brings the premiums down, we are just handing the private insurance industry a huge Christmas present with a big red bow," Woolsey said in an interview.

Woolsey said she would have a "hard time" voting for a final bill that lacked the public option.

Joe Nation of Greenbrae, who introduced his own health care reform proposal when he was serving in the state Assembly in 2005, said, "My biggest concern about both bills is there isn't enough focus on the long-term cost implications. We as a country are going bankrupt. If your house is burning, it doesn't really make sense to add an addition to the house."

Nation said so far, legislators have avoided all the tough questions.

"The tough questions have to do with building the right incentives into the system," Nation said. "We have a system that has all the wrong incentives in it."

Nation said the current fee-for-service payment system that rewards doctors for ordering more tests and performing more operations even when they're not in the best interest of the patient is at the root of the problem.

"Unless you deal with fee-for-service, I don't think you solve the problem," Nation said.

Bedard shares Nation's concerns. "I never had a radiologist complain to me about ordering too many CT scans," Bedard said. But he sees other problems besides fee-for-service.

Bedard said at his urging the California Medical Association adopted a resolution calling for a Congressional hearing on end of life issues once the health care reform bill becomes law.

"Too many people operate under the delusion that death is optional," Bedard said.

Contact Richard Halstead via e-mail at rhalstead@marinij.com