I agree with Nate Sliver on this one. There is no better way to highlight the effectiveness of the Public Option than to have a comparison. The State Politicians that decide to opt out will really be shooting themselves in the foot by denying their constituents access to the choice of a Public Option. If they do so, and the Public Option lowers rates in the states that have it, the days Republican dominance in the opt-out states will be numbered. I actually think this compromise might be a bigger political win for Democrats than a mandatory Public Option.

those who need it most will be the 17 million left with nothing by hr 3200.

Nate Silver is wrong. This is an epic fail and will tarnish the Public Option when it comes into effect in 2013(swish it were earlier).

Why is the state opt out an epic fail, you ask? Like it or not, our HCR bill whatever comes out of Conference will be judged on a national level. the sickest 10% of the population equal about 2/3rds of medical costs and that percentage is rising and will be neglected as states opt out. Blue states could very well opt out as well, because it will be up to the Governors and state legislatures; all every bit as corrupt and easily bought as the Senate.

Without ensuring access to health care instead of insurance and regulations that don’t work, the sickest population such as in my city of Houston will continue to lack care and go to the emergency room which causes health care costs to explode.

Also people can’t just get up and move to another state. When whatever bill fails to bring down costs it will be a blight on the public option and any government involvement in health care whatsoever on a whole whether some here like it or not; it will not make the state by state point so many are arguing. We don’t have time for this kind of crap.

We need a real public option and we need to thin about lowering the Medicare eligibility to 50 as Dean recently outlined(something we actually should be considering) to have something to show for the mid terms and we should be debating adding more elements that Jacob Hacker originally intended when he wrote the public option.

We know what needs to be done and deciding which compromise to further weaken the public option that already needs work to be amended with further dampen our cause and what we worked for to get to this point.

Believing the state opt out fallacy can work is seriously not looking at reality.

hey Jon,

thanks for this and the last post – my eyeballs are beginning to spin (my fault, not yours:D)

have you seen this ?

Nate Silver says “this is best compromise that has been floated so far. I don’t really see what the problem is.”

I disagree, but I’m one of those pesky “purists”

Well if your goal is not to help everyone I guess you can feel that way. I don’t remember MLK demanding an end segregation only unless the state legislature choose to opt out.

Good post and point, Jon. I live in TX where everything is bigger, including the uninsured as we are number one there. 1800 people showed up for free care at the Reliant center in Houston 10 minutes from where I live.

It will cost the system as a whole too much if people in red states like mine wait and don’t get treated because of a faulty political chess move we don’t have time for because Democrats don’t want to stand for what they campaigned on. The public option is already much weaker than I hoped and this makes things worse.

Notice California is one of the states you mentioned and this score why this idea is an epic fail as well, in detail.

well slap my ass and call me judy -

per Jane’s admonition, looks like a major progressive voice is carrying this rancid water.

Howard Dean tries to have it both ways with some qualifications, but is carrying none the less

gawd, I hope this is just my fried brain

I posted this at the dead end of a previous thread, but I’m still puzzeles, so here it is again:

I guess I’m not understanding something here.

I see the things we seek breaking down into 3 categories:

1) Universal coverage

2) Prohibitions on not covering preexisting conditions and capricious non-payment and cancellation of coverage

3) Cost control

#s 1 and 2 are the issues of moral and ethical import. Live are in the balance.

#3 is about money.

The public option is primarily a means of addressing #3.

Under the opt-out provision, the people in the states that opt out of the public option will still have coverage. #s 1 &2 will be mostly handled, so I don’t see the pressing moral problem.

They will, if the public option works as we think it will, have to pay more. If, instead, it works as the Randians and the politicians elected by the majority of the voters in some states seem to think it will, they will pay less. They will get a chance to show that the market is more efficient. Or to be shown that sometimes it isn’t

I don’t see the problem. Let the economic theories be tested, side-by-side.

If, as seems likely, the opt-out option will result in a stronger public option, crafted by people who believe in it, that is a big gain. The real thing will get a chance to prove itself rather than some crippled version becoming the basis of judgement.

That’s dissaponting. I hope my brain is fried, too.

if your goal is to help everyone, then leaving 17 million behind (not to mention the number of underinsured) doesn’t cut it. i understand that there are good faith differences of opinion on this matter of what policy to advocate for, and i’m not trying to challenge that now. but you can’t claim that a public option as in hr 3200 is universal health care. it’s just not. single payer hr 676 IS universal healthcare: everybody in, nobody out. please don’t sell the public option as something it’s not.

You can’t ignore the state-level politics of this though. First of all, there’s more accountability at the state level. If you think any politician could survive in CA after forcing all it’s residents to pay higher HC costs than other states for purely partisan/idealogical reasons, then you’re no being realistic.

I keep hearing 76% touted as the number of people who want the public option. Well then, let’s put our money where our mouth is. What I’m saying is, if everything we support about the public option is true, then the only epic fail will be for the politicians in the states that do try to opt-out. But, this isn’t taking place in a vacuum. The insurance companies operating in those states are probably going to be less inclined to show what a failure opting out would be. They’ll HAVE to lower their costs in order to avoid a voter initiative to opt back in.

There IS a obstacle created by idealogical purism. I see it here and on other sites. There are people that have checked out of the whole process and are still saying that the vote should be on HR 676. If everyone that really wanted single-payer were a complete purist about it, there would be no HC reform at all. Nothing. It has 0 chance of passing the current legislature. It wouldn’t even need to be filibustered. There would be less than 50 votes. Th point I’m trying to make is that if you are REALLY interested in A) lowering costs and B) giving everyone access to HC, the there has to be some give or there is nothing. I would MUCH rather allow some state politician to screw themselves by letting them opt out of a comprehensive PO, with the likely effect of an expanded PO later, than have a PO that is mandatory in every state but is only available to people within a certain income range.

I do want to say though, that the biggest mistake the Dems can make is to adhere to the 2013 timeline. That is a bad BAD idea.

wow. i’m surprised.

I know this is crass, but the notion of triage comes to mind. If there’s a compromise that has to happen in order to get a public option, this is the most palatable one. It’s also the most likely to yield a positive outcome further down the line. Other compromises — that might produce a weak public option that fails in keeping costs down because it’s only available to those without any alternative, or one that can’t use its size to negotiate pricing, etc — will poison health care reform for decades to come.

If the troglodyte states that refuse to recognize that they’ve got a problem have to be jettisoned allowed to jettison themselves in order that the larger effort prevail, that’s a painful, but in the end, acceptable tradeoff. It saves most patients now, and leaves open the option of saving the others later (or in fact, the states could straighten out their collective power dynamics and opt themselves back in).

Keeping cost down should help to increase coverage.

again, he tried to qualify it. so he’s holding the pom-poms, not waving them yet.

my .02 – they essentially de legitimized him, took credit for his victories,etc.
human nature suggests like most, he’d like to be back on the inside

that makes sense. thanks.

We need to keep our eyes on the long-term goal, which is true Universal Coverage. We need to accept a few things in order to get there:

1. True Universal coverage is not possible in the current political climate. The biggest reason for this, I believe, is that American Citizens have no understanding of a HealthCare system (we don’t have a HealthCare system in the US, it’s basically chaos) and can be manipulated and frightened because of that ignorance.
2. We have to take steps now that will not inhibit progress in the future.

The compromises we should be fighting are the ones that will inhibit progress by making an organized HealthCare system look ineffective. For instance, compromises that are called a “Public Option” yet are crippled by limitations. That sort of a compromise will cause the idea of a “public option” to be a total failure in the public’s eyes and it will be impossible to make the necessary fixes later on.

THIS compromise, however, will be effective where it’s available and can be demonstrated to be a success. The scre tactics will no longer work since people will have been exposed to an actual HealthCare system and will have seen it’s benefits. Those that were excluded, by their elected republican representatives, will also be able to clearly see the cost the “free market”. I think that will change the whole nature of the debate, and single-payer may actuallly have a chance later on.

So why not fix the required level of coverage and let the people in those states that opt out pay more, if in fact, the public option proves more efficient?

If that is the case and the amount is significant, the people in those states will soon demand in.

But we will get past this stage of people arguing their fervently held economic theories and have some empirical evidence.

I rate getting a big enough pool in the exchanges and in the public option to make a difference much higher that getting a limited public option available to a few in each state.

In order of priority, as best I can figure:

1) Robust public option available to all in some states.

2) A Wyden-like exchange that is open to all (except maybe those with great plans won through collective bargaining) , that includes the public option for those in states that haven’t opted out. This is in part to make the public option compete with private plans, especially the very good Mayo-style ones. Just being public doesn’t ensure that it will be efficient.

3) The public option made available in all states.

If giving up #3 for the time being could get us 1 & 2 I’d call that a huge win.

My god, this has to stop! It’s turning into an idealogiocal mob/cult

When Dean agrees with one view, it’s blown up in big letters on the front page and everyone is screaming “Doctor Dean knows what he’s talking about. He’s the genius behind the 2006 & 2008 wins. People need to listen to what he’s saying!”

But then he makes a statement, one that I happen to agree with on the grounds that it’ll help progress later on, and now the same people are yelling “Traitor! Sell out! Burn him!”

Why not give him the credibility earned and listen to him??

Re me @ 18

I’d renumber the # 3 that is shown as #4 and insert:

3) Get the damn thing started right away. It need to be working and providing visible benefits before 2012 or the Republicans will run against all the scary things they claim it will do and just might win and repeal it before it is even tried.

Why not give him the credibility earned and listen to him??

right back atcha – why isn’t he lending that earned credibility to the efforts of Rep Grijalva ?

How is he not? Dean supports a Public option. His measured support for the compromise doesn’t change that. They aren’t mutually exclusive.

It’s also worth noting that Dean’s credibility has no effect on those opposed to a public option. Those that support it, however, need to remember that he’s been on our side all along and that has not changed.

The biggest problem with the public option opt-out is it doesn’t bring any new senators on board. Unless someone knows something about this that I don’t.

Here is the problem. Under the Baucus bill, which is what this is supposed to be a compromise for, everybody has mandates to have insurance. If a state opts out, citizens who might not agree with their state leadership’s decision will still have to buy overpriced insurance. The insurance companies in those states will be getting the subsidies for folks who can’t afford insurance, but those subsidies will be inflated because there is not competition; therefore, the cost of the plan goes up.

Looks to me like a way to get a “public plan” that costs money instead of saves it.

Not Carper?

If, as seems likely, the opt-out option will result in a stronger public option, crafted by people who believe in it, that is a big gain. The real thing will get a chance to prove itself rather than some crippled version becoming the basis of judgement.

Hmmm. Interesting theory.

I’m so old I can remember when states’ rights was the mantra of the GOP. I’d expect this “states as laboratories” idea from them, not from the Democratic Party in control of Congress and the White House.

I still want to know how many red states opted out of stimulus money, since the opposition to opt-out is based on the assumption that red states will opt out en masse.

Don’t get me wrong — if I could I’d say single payer starting NOW. I don’t like the idea of compromise on an issue this dire. But I’m not willing to totally discount the idea if it leads to a public option for all.

not going to happen. It will be an opt out to the already weak Schumer “level playing field” public option.

re: Opt-Out

Although no one has made clear just *who* in any given state decides whether to opt out, I think that the logical answer is that the choice will be left to state legislatures.

Now when one considers how cheaply a United States Congressperson can be bought, doesn’t one have to conclude that the price of a *State* legislator is pretty much pocket change, relatively speaking?

How would you feel if your neighbors were “opting out” of having fire protection through the fire department? What if some states “opted out” of the federal highway system and the roads just stopped at some borders? What if some states “opted out” of the judicial system? We’re all interconnected. Costly, poor quality health care in one state affects us all. What will we do when our family members need help and they’re in a red state? The fight for health care is about addressing a national crisis, and its a fight for the common good and shared prosperity.

Gawd. Just saw “veteran Democratic strategist” Joe Trippi on Rachel Maddow. What a sludge-brain flat out bore that guy is. No wonder Demo strategy is in such trouble.

I think people would move from one state to another for healthcare if their situation is serious enough. Consequently, those states could have higher costs than they otherwise would have. If it fails, proof that the public option doesn’t work.

I didn’t know anyone was still listening to Trippi. His time has past like so many others – they just won’t leave.

What if states that opt out can opt in at a later date? I suspect the pols responsible for denying their constituents affordable health care available to the rest of the country would take an ass-whupping at election time. Just as the states that passed on stimulus funding are now asking for their share, I think it would just be a matter of time until states that opted out of public insurance want to opt in.

It’s a huge assumption that the states with Republican Govs and legislatures would automatically opt out, but were that the case, residents would be very, very angry and those state legislators would be held accountable. It makes it much more likely we get democratic gains in these states, which is a definite bonus. Plus, even the threat of a public option — a point nate silver makes — would help keep private insurers in check. If states opted out and private insurers in those states acted as the schmucks they are, it’s all the more likely we get public options in those states sooner rather than later.

All in all, IF an opt-out provision helps get us a *robust* public option through the Senate, THEN it should be widely supported. IF it’s a watered down public option, THEN you’re right, it’s not enough. I think the appropriate action for the progressive blogs and grassroots should be to a) accept the opt-out, but b) demand for Wyden’s amendment to be incorporated. THAT would single-handidly increase access and reduce costs than any other measure would aside from the public option itself.

GUYS!! People are making the perfect the enemy of the good… We want a strong public option with a Huge pool of people with medicare (plus x-percent extra) kind of pricing.

The “opt-out” compromise can realize all of that.. but no, some people want it all… medicare was opt-in? why cant this be something similar? stop fighting everything and accept SOME compromise… damn it!! you guys wanna loose everything over making this EXACTLY the way you want.

We get 100% of what we want here (well maybe 95 minus whole country, but we can add up the extra 5% later cause we believe the public option will save people money and those “opt=out” state will have to “opt-in”)

What if states that opt out can opt in at a later date?

Sounds like a budget-buster which would never be allowed.

Therefore, it’s probably on the table.

You’re right, a robust public option would be enormously popular with voters. Governments in red states will be under great pressure to accept it. I am also confident private insurance companies realize this and will be working hard in Washington to ensure that the idea does not gain traction.

residents would be very, very angry and those state legislators would be held accountable. It makes it much more likely we get democratic gains in these states, which is a definite bonus.

That’s got to be why Howard Dean is all over the opt-out idea. It’s got to be the strategist in him.

Just a question – do we know enough yet about the opt-out? I don’t think I do. Is it in writing somewhere in the Congress? Has anyone actually proposed it? I need more info.

The compromise for many was a huge step down from single payer for those supports. The original public option was meant to be a medicare buy in open to all. The House’s “robust” public option is only on the exchange. It pays above Medicare rates and medicare providers can opt out. There have already be several compromises.

Yeah, ’cause the PO is really exactly everything anyone ever wanted in healthcare reform. Whatever.

At this point, if there is a public option (be it for all or just for some) we don’t know what it will look like and if it will even be meaningful. It could be watered down or offered to so few people as to be meaningless. If we get a good one, and I hope we do, and it allows for states to opt out, so be it. Those states that opt out will pay a price. Their legislators will pay at the polls. Enough people may leave for other states to that they loose congressional seats in the House and it will demonstrate the value of the PO across the nation. It is a concrete way to demonstrate the harm the GOP does in more than just language.

details are nowhere close to finalized. Will keep you informed as things happen.

Agree with you completely. I don’t have enough information yet to decide whether this opt-out thingy is a hot idea.

Here is one opinion from TPM.

Their new proposal to devise a national public option in such a way that states could choose not to participate quickly overtook yesterday’s news from the CBO that the Senate Finance Committee bill would save billions of dollars. But is it the long-sought solution to the public option conundrum?

The short answer is: it’s way too early to tell.

ty

When Jane said it on national TV.. I once and for all realized how true it was for me.. a person who is not used to compromising.. it was by far the final line in the sand for me on this issue.

The public option is the compromise.

If it’s not available to the entire public.. it is not public or an option.

I’ll pass.. with a vociferous No.

Last I heard it was down to a couple hundred bucks a year for an individual. Jon has a post up on Schumers latest convoluted opt out proposal.

Schumer Proposes Plan to Improve Individual Mandate

The public option is the compromise.

If it’s not available to the entire public.. it is not public or an option.

hear, hear.

If there was to be a compromise (and lord knows it’s been said before) it was a massive strategical error to not start with single-payer, and *then* compromise downward to PO.

Attaboy, Rahmbo, you dickweed.

Thanks. Read it. All I can say is “yuck”

How is Opt-Out a “compromise” anyway?

Seems like a capitulation to me. I don’t see what the people gain by it, really. The definition of “compromise” is that everyone gives up something. What did the insurance companies give up here? Market share? Monopoly pricing? Exploitative tactics?

Surely not. And yet, American progressives seem willing to give up health care for the least among us, those who need it most, as an appearance of “compromise” when it is no such thing.

Negotiating to defeat against ourselves, backwards away from victory.

That’s what I have been saying for weeks. You never try to move UP – anyone who has ever given it 2 minutes of thought knows that. They were really dumb to try this.

If there was to be a compromise (and lord knows it’s been said before) it was a massive strategical error to not start with single-payer, and *then* compromise downward to PO.

One of the things about Obama that most pisses me off. Everybody knows you start negotiations by asking for more than you are willing to settle for. He gave everything away at the outset.

Trigger of the day!

yep. I thought Rahm was supposed to be so smart politically. If this is his brain child, he has no political savvy at all.

Maybe the Obama Administration is dumb, or perhaps they are just stealth advocates for private insurance companies, who will benefit enormously from an insurance mandate without a competing public option.

For Obama and the conservadems.. that’s a feature, not a bug.

Same as the stimulus. Why ask for tax cuts when you know the GOP will demand them, and then not vote for it at all? I really do not understand the strategy of including “ideas” from opposition that then go on to decry the entire bill (e.g. Grassley).

One effect of the never-ending election cycle is that both parties have completely forgotten how to govern.

O.T.

Go to Huffington Post and vote for Jane as Ultimate Game Changer.

http://www.huffingtonpost.com/…..lide_image

Done.

Governing seems to be nuisance theatre at best.

mwaah ratty !

it’s Masters of the Electoral Universe, all the time. even before I had the benefit of Jon’s, Jane’s, and other wonks take on this I was against it – which sounds rockheaded, but it wasn’t something they did with an eye to providing relief – it was something to cover the Nelson’s, Lincoln’s, Landireu’s, asses period. same with the much discussed WH approach – it was all about 2010 and 2012 not about relieving the suffering and the dying that’s going on everywhere

To bad we won’t all op-out of voting. To think that what these assholes in the congress will give us, is what we get is enough to make one sick.
We all forget that the Congress of years past set up the insurance based healthcare system that we enjoy. They promoted it, defend it, and even supplied it us. Now like the banks were to big to fail, the insurance industry is to important to be hurt. They won’t do anything that will in any way roll back the insurance industry. You see it is more important than us. Rich or poor makes no difference, we all are less important than the insurance companies. We can’t see that everything is more important than people or country. The Banks, Wall Street, Automakers, Insurance companies, Oil companies and Oil Supplying Nations, Corporations, Military and the Idustrial Complex, Wars, Global Economy, Global Trade, are some of a few things more important than us. Even our economy is put second in the context to the world economy. They right after the economic crisis beset us, did they meet to worry about how we would fare. No! they met with the worlds leaders to talk about how to save ethe world. They bailed out the banks, but have let our people lose houses, jobs, savings, and net worth doing little to even stem the tide. It is not a Government of the people by the people and for the people. It is a Governemnt for everything except the people. Who’s to blame? The people because they voted for, supported, and worked for the people they elected. Those people who now view them as less important.

The only reason I would go for the opt-out is to get it passed, to get it started sooner and to get a big enough support for it that it can continue a long long time (as long as it’s needed).

It would be a compromise for sure, not something a purist would think of.
ymmv

While the highway system was being built there were some states which remained all but cut off from the world for a while. Here in WV the mountains made the time to build horrendous and expensive. We were back-woods a long time. Now we probably have as many miles of roads as the much larger Texas. We’re still a sparsely populated state compared to many and we don’t have as many interstate highways as many, but there are enough roads to escape…and return after we find the rest of the world is just as screwed up.

I think it’s hard to make these equivalencies: health insurance is different than highways or civil rights. That doesn’t make it trivial and we have to work on it until everyone has what they need — care when they need it at an affordable price that doesn’t break them or the country.

I would guess so too, unless the PO failed badly in all the other opt-in states in it’s first few years. But I think you’re absolutely right that it has to be clear in the legislative language that an opt-out isn’t permanent and irrevocable.

Yes, Wyden’s amendment seems very promising.

I think people would move from one state to another for healthcare if their situation is serious enough. Consequently, those states could have higher costs than they otherwise would have. If it fails, proof that the public option doesn’t work.

I don’t think so. I’m not calling you one, but some Republicans made that same argument on Katrina. If they just moved to their Summer homes that wouldn’t of happened or to a better state. People can’t move just because they want to all the time, especially in this economy.

It’s not just the states with those costs, it’s the system as a whole as a small percentage of the sickest people(10% = 2/rd of all Medical costs in this country) reside in the states that will opt out and will be the most expensive everyone pays for; not to mention the state lobbyists buying the legislatures even in blue states to opt out. The same problems in Washington are just as bad at the state level.

This will not be a true public option but it will be perceived as the public option failing as I outlined above with detail. then any effort for a foothole for real reform with a true public option mechanism however weak to build on later(like with SS) will not be possible like it is now.

If this is all that can pass then we should pass it, and I say this as a low income Texas resident. We should still try to push for universal coverage, but if this is the only way then I don’t mind making the sacrifice in the hopes that we will get a public option in the future.

Of course, I can’t speak for everyone else who will have to suffer the consequences along side me. However, in the words of Thomas Paine, “Time changes more minds than reason.” And I can only hope that the prosperity enjoyed by the other states will inspire Texas residents to demand the same.

If 9 of these 10 states are run by republicans, then it would appear Grayson was absolutely correct in his assessment of the republican health care plan.

It seems that much of the fighting is within our constituencies. Nobody thinks the opt-out provision is universal healthcare, but if it can be implemented within a short period of time it can provide the foundation for a future single payer. The key is that it needs to be passed and implemented FAST, before we lose our perceived advantages in Congress.

This is way into EPU Land, but I want to note:
Barack Obama : “There are no red states or blue states, there are only the United States of America.”

Pledge of Allegiance: “one nation, under God.” – if I remember correctly.

We can’t just leave some of our citizens behind.