[Anne Underwood:] President Obama hopes to increase the number of Americans with insurance and to rein in costs. Do you believe any of the plans under consideration by Congress will accomplish those goals? [Dr. Marcia Angell:] They won't, and that's the essential problem. If you keep health care in the hands of for-profit companies, you can do one or the other - increase coverage by putting more money into the system, or control costs by decreasing coverage. But you cannot do both unless you change the basic structure of the system. Q. Segments of the health care industry - pharmaceutical companies, for instance - are promising to cut costs. A. It's not going to happen. These are investor-owned companies. Their fiduciary responsibility is to maximize profits. If they behaved like charities, heads would roll in the executive suites. Q. But what about market mechanisms for reducing costs? Wouldn't the public option, for instance, provide competition for the insurance companies? A. Theoretically it would, but I doubt the public plan will pass. Industry is lobbying against it, and the president has not said this is a must." Even if it does pass, I'm afraid the private insurance industry will use their clout in Congress - and they have enormous clout in Congress - to hobble the public option and use it as a dumping ground for the sickest while they cream off the young and healthy for themselves. Q. How? Won't insurance companies have to cover all applicants regardless of health status? A. It's hard to regulate an enormous industry without setting up a bureaucracy to oversee it. That's very expensive and creates a whole new set of problems.