But in recent weeks the noise has challenged the issues, widening the distance between Washington, D.C., and the town halls and putting words like "mobs" and "death panels" in the same conversation as "pre-existing conditions" and a "public plan option."

Confusion about the health reform proposals is understandable. Health care is complicated, emotional and historically intractable. It involves life, death and money. And details of the legislative proposals are not necessarily clear because the bills are in various states of readiness and flux.

A 1,100-page bill passed by three House committees last month is awaiting debate and a floor vote. In addition, there are two key bills in the Senate - one that has made it through its respective committees and another that has yet to be approved by its committee. The dueling Senate proposals eventually will need to be reconciled before going to the full Senate for a vote.

The House bill, or HR3200, is getting the most scrutiny - and the most heat - because it is further along than its Senate counterparts. The bill would set up "exchanges" through which consumers and employers could buy coverage; require employers above a certain payroll level to provide insurance to their workers; expand and modify existing government programs; impose a tax surcharge on high-income earners; and create a new public insurance option - although White House officials today voiced a willingness to jettison this idea.

While no legislative action can take place before Congress returns from its summer recess, plenty of time exists for people of all political persuasions to debate, understand and misunderstand key elements of the proposals. The following are some of the key questions at the core of the debate:

Q: Will I be able to keep my current coverage?

A: That's the plan. President Obama has repeatedly said that if you like your insurance, you'll be able to keep your insurance.

But critics say a "public plan," or an option administered by the government, would push private insurance companies out of business as employers, expecting to save money, dump their plans and force their workers into the public plan.

"The thing that gets so lost in the hullabaloo over the public option is that the public plan is being proposed as one competing option for small businesses and individuals to choose," said Peter V. Lee, executive director for national health policy for the Pacific Business Group on Health. "The current proposals don't provide for large employers to go into to the public plan."

Robert Zirkelbach, spokesman for American's Health Insurance Plans, countered that after two years, the legislation allows a designated health official to open the public option to employers.

Today, Health and Human Services Secretary Kathleen Sebelius said a public option was "not the essential element" of comprehensive reform. And White House press secretary Robert Gibbs said the president "will be satisfied" if the private insurance market has "choice and competition."

Q: Isn't a government-administered plan a form of socialism?

A: No. Under socialism, goods and services are owned and controlled by the government rather than by private enterprise. The health reform proposals do not advocate government ownership of hospitals or require doctors and nurses to work for the government. Instead, they allow the private delivery system and private insurance to remain but offer a public plan as an option.

"If somebody is going to say the public plan option is socialism, then that person is the same person who would think Medicare is socialism," said Melissa Rodgers, associate director of the Berkeley Center on Health, Economic & Family Security, explaining that Medicare retains the same hybrid of a plan administered by the government but delivered by private enterprise as the public option.

Q: Will everyone who is uninsured get covered?

A: None of the proposals would cover absolutely everyone, but they are expected to significantly reduce the ranks of the estimated 47 million people in the United States, or about 18 percent of the population under age 65, who do not have health insurance.

The House and Senate bills require people to have health insurance and provide subsidies for low-income people who meet income-eligibility requirements. But that doesn't mean everyone will buy insurance nor that no one will slip through the cracks.

Q: Will my taxes go to pay for coverage for illegal immigrants?

A: None of the plans would change the way the federal government handles health coverage for illegal immigrants. The federal government does not provide coverage for illegal immigrants, although states and counties are allowed to use state and local funds to cover undocumented adults and children. In California, for example, the state provides people who are not here legally with limited Medi-Cal services in cases of emergency and pregnancy, and some counties offer coverage for undocumented children.

Currently, federal law requires hospital emergency rooms to treat all patients regardless of immigration status, but the law is limited to treatment rather than payment issues.

Q: What about coverage for abortion?

A: A comment last month from Minority Leader John Boehner, R-Ohio, that the House bill would "require (Americans) to subsidize abortions with their hard-earned tax dollars" is incorrect.

Coverage for abortion services would remain unchanged under the proposals. Currently, federal dollars cover abortion only under restrictive circumstances - rape, incest and to protect the mother's life.

An amendment to the House bill by Rep. Lois Capps, D-Santa Barbara, explicitly preserves the status quo on federal funding for abortion services. Capps' amendment also stated that abortion services do not have to be part of the minimum benefits that every plan must cover.

Q: Will I be forced to go through end-of-life counseling and will that affect my treatment options?

A: No. The House bill simply would allow Medicare to pay doctors for their time in counseling patients about end-of-life issues, whether that means treatment options, hospice, pain management, advanced directives or other concerns. Patients would not be required to go through counseling.

Lawmakers debating the Senate Finance Committee's version have decided to drop the end-of-life provision from their bill.

The controversy over the end-of-life provisions stems from the fear that sick and elderly people would be counseled into accepting no treatments or minimal care to save the system money.

David Magnus, director of the Stanford Center for Biomedical Ethics, said the concern ignores that the current system pays doctors and hospitals more money for providing more, rather than less, care at the end of life.

Sebelius said on Sunday-morning talk shows that the end-of-life proposals were likely to be dropped from the final bill.

Q: Would the proposed cuts to Medicare limit access to care and services for seniors?

A: Seniors have been vocal in expressing concern over the impact of the overhaul on their benefits. The fear comes from the fact that as part of the reform, the government intends to cut billions from Medicare.

Obama has stressed repeatedly that the cuts don't translate into reduced benefits for Medicare recipients, but America's Health Insurance Plans, the industry's trade group, disagrees.

"Cuts of that magnitude are going to have a significant impact on seniors," Zirkelbach said. "Seniors are going to pay higher premiums, lose benefits, and in some parts of the country lose access to Medicare Advantage."

The House bill has proposed some $380 billion in cuts over 10 years, with about $150 billion to come out of the pocket of Medicare Advantage plans. These are private plans that offer full Medicare medical coverage.

Critics have argued the federal government has for too long over-subsidized these policies, reimbursing them by as much as 14 percent more for the same services that traditional Medicare provides as a way to encourage seniors to pick a private option.

Another big chunk of the cuts are expected to come from reduced reimbursements for hospitals, nursing homes, home health agencies and imaging services. Reductions in benefits or payments to physicians are not on the table; in fact, the bill would give physicians more money.

Q: How are we going to pay for health reform?

A: That's the trillion-dollar question.

Neither of the bills covers their costs. According to the Congressional Budget Office, enacting the House bill would increase the federal budget deficit by $239 billion over the next 10 years. That takes into account the spending changes and revenue increases that would save about $219 billion and bring in $583 billion in new revenue over the same period. The total cost of the bill over 10 years is estimated at $1.04 trillion, and the bill intends to pay for the provisions with spending cuts and a new tax on the wealthy.

The Senate bill approved by the Health, Education, Labor and Pensions Committee is less close to covering its costs. According to the CBO, the bill would increase the federal budget by $597 billion in the 2010-19 period, offset by a net savings of $48 billion. Details on the reform bill from the Senate Finance Committee were not available, but it may not include a public plan option and could impose taxes on employer-sponsored coverage.

While the bills make a number of financing proposals, some health experts argue they don't go far enough to reign in costs over the long term.

"There are no substantial proposals to change the system," said Victor Fuchs, Stanford University professor emeritus of economics, health research and policy. "You cannot increase coverage and reduce costs without making substantial changes to the way we finance care and organize the delivery system."

E-mail Victoria Colliver at vcolliver@sfchronicle.com.

This article appeared on page A - 1 of the San Francisco Chronicle