The four goals of offering the public option as part of health care reform are 1) to reduce administrative costs, 2) to create purchasing power, 3) to force private health insurance to compete with it, and 4) to give the American people a choice of a public or private health plans. The big questions are: who will be eligible? how big will the premium subsidies be? and will it be a national public option with all states participating? If a national public option is offered through a Federal Health Insurance Exchange, it has the potential to transform the US health care system to one that is more efficient, affordable, accessible, equitable and offers meaningful choices to high quality care for the American people.