Sen. Nelson correctly points out that American families paying more and more each year for health insurance - a 78 percent increase from 2001 to 2007 - is economically unsustainable.

We share Sen. Nelson's belief that reform can enable insured Americans to keep the coverage they have at a cost they can afford, while extending coverage to the more than 45 million uninsured Americans. And we agree with him on the need to control costs by demanding that insurers compete with each other and collect evidence on which medical treatments best serve patient needs.

However, we disagree with Sen. Nelson on one crucial facet of addressing skyrocketing costs and increasing access to health insurance. If Congress and the White House hope to fulfill the promise of making the American health care system fair and equitable to all, reform legislation must include a public health insurance option.

A public health insurance option would offer Nebraskans the choice of buying coverage through private insurance or a public health insurance plan. That choice would increase competition for insurance coverage and make use of the bargaining power of government to restrain double-digit premium increases by big insurance companies. It also would offer Americans a break from the tradition of paying more each year for less coverage.

Real reform would provide affordable access to good-quality health care coverage for millions of Americans, maintain or increase choices for health care consumers and protect Nebraskans' control over their relationship with their medical providers. And it would address the inequities that threaten to foreclose health care access in rural areas by ending the practice of paying rural hospitals and doctors less than their urban counterparts for the same services.

That should be our vision for health care reform.

Nebraska faces steep economic challenges. The skyrocketing cost of health insurance is first and foremost among those challenges. Left unchecked, rapidly rising health care costs will determine the economic success or failure of many of Nebraska's family farmers, ranchers, small- business owners and workers during America's economic recovery.

Over the past few months, we have come to know a young man from Broken Bow. Larry Harbour grew up in Omaha, married and eventually moved to Broken Bow to raise a family. A few years ago, he decided to start up his own small business. He left a job with health care benefits, started his business and has worked hard at it.

When you first meet Larry, it takes only a few minutes to realize that every Nebraska community could use someone like him. He works hard. He is an entrepreneur. He has ideas, hopes and dreams and the courage to act on them. He has done everything that anyone might reasonably ask to stake a claim in his community and help create a better economic future for Broken Bow.

And he is risking everything to do it. At this early stage, his business simply cannot support the $700 or $800 per month he would have to pay for family health insurance coverage. So he currently goes without insurance.

No one should ever say that Sen. Nelson does not understand the importance of this entrepreneurial spirit to Nebraska's economic future. No senator fought harder to support rural entrepreneurial development in the last farm bill than Sen. Nelson. We applaud him for his accomplishments in that arena.

As health insurance premiums and out-of-pocket medical expenses rise, however, more small-business owners in Nebraska will drop unaffordable coverage for themselves and their employees. Economic development efforts will continue to be hampered by the risk that entrepreneurs face in leaving employment with health care benefits to start up their own business.

The strengths of a public health insurance option are what many rural people and small businesses need - stability and affordability - while also providing more affordable health insurance access to vulnerable populations such as low- and moderate-income families and the self-employed.

This is the kind of health care reform that Nebraskans want, need and deserve.