Or you can think of it as a game of high stakes chicken.
Once the train is leaving the station,
will even Texas Gov. State Sanctioned Murder Goodhair not sign on?

Sorry to disagree but the votes aren’t there without a compromise like this one. It’s also going to be brutally difficult for the various state GOP’s to actually opt out of it. If you want a policy that gets almost everyone health care in a way that makes the entire topic a snakepit for the GOP then this is how it’s done.

And why would we want to play an unnecessary game of Russian Routlette with the health care of millions of people just to bail Rahm out of the corner he’s painted himself into?

Why would we even think that was a good idea?

I don’t know about other states, but I guarantee you Florida opts out. The wingnut legislature will introduce and pass an opt-out bill the first day of session. And Gov. Crist, to bolster his right-wing credentials against his Senate primary opponent, will sign whatever bill they give him in that regard.

Jane, you and Rikyrah are exactly right.

Great Catch Jane Obama can’t, he just can’t support this idea now.

The black population is not the only folks who would be in states that opt out. This also covers states that want to deny Hispanic citizens coverage as well. Think about Arizona or California.

And is opting out a permanent option? Will it become a political football with states opting in or out as the political leadership changes?

It’s a stall tactic pure and simple. But the discussion postpones for another day (week?) PhRMA unmuzzling Harry and Louise.

It makes no sense. An individual state cannot opt out of Roe v. Wade. Nor can a state opt out of an Authorization to Use Military Force.

Why should there be a way for a state to opt-out of health care for all its citizens?

The votes are there. This has turned into a get-60-votes thing, but you only need 51. There are plenty of ways to prevent a filibuster and essentially force cloture, starting with — as Rachel Maddow reported last night — pulling chairmanships of any Democratic senators who go along with a GOP filibuster.

This can get done, even without 60 votes, and even without compromising the public option (which itself already is a compromise from single-payer) further.

If Obama supports this he could depress the African American vote.

Because the POTUS and most in Congress are desperately trying to convice the American people that they matter when the only thing Congress is interested in is lining their own pockets and protecting their corporate masters.

And what if you’re wrong? A game of political chicken with the GOP outweighs the health care needs of the people in those states?

You beat me to that concept. Except…

The states can actually opt out of under 21 legal drinking age, but they lose their highway funding. The way to poison pill the opt-out bullshit is to tie it to funds somehow. But I doubt that happens.

This sausage making and cruel corporate-y calculations by all the negotiating parties involved in DC just sicken me.

It’s not my first choice (HR676), or my second (a strong, national PO),
but the whole health care debacle has revealed how thoroughly corrupt D.C. is.
If the opt-out plan is passed, my guess is that most states would have the PO within
a few years. If I’m wrong, I would be as unhappy as anybody.

Good point if this passes this gives the idea of States Rights a cause near and dear to the GOP a huge boost. The GOP is playing some 13 Dimensional Chess of their own.

Sorry to disagree, but the reps votes should be along the lines of what the majority of the people they represent actually want. 70% of the country should NEVER be held hostage to the corporate masters.

Wouldn’t the circumstances require an election voting on the opt out by the people of the state? We are talking about a major issue that could be considered a constitutional one of equal representation, and the state government simply not have the right to make such a decision without a mandate from the people. It is a conflict of interest at best, it would be a criminal act if any of them take money from any health industry. I would guess someone will choose to argue this in court.
It is still a piece of shit that starts in 2013 and another million will be dead. Since millions are going to go without insurance with the price rises, anything less than starting tomorrow is revolting and criminally negligent.

I said it before and I’ll say it again: This is the Missouri Compromise of health care and we all know how well that worked out. How many people are the supporters of opt out willing to condemn to death, rather than just continue a fight that we are winning? This is bullshit, specifically designed to divide us BECAUSE we are winning.

I rather doubt you would be as unhappy as people living in states that have opted out or the people who have died because people just threw up their hands and stopped fighting for what we all know is right.

Sorry for the O.T.

Vote for Jane on Huffington Post, Ultimate Game Changer

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

Please,oh,please….let it be a typo…the overlooked snark thing to indicate dry humor.
I’m the WORST at remembering the snark symbol thing. That’s what it is, right Paul?

Confusion, Distraction and Delays. Oh you corporate lobbyists are so clever. You influence peddlers might get plenty of love by the Dee Cee Villagers, but of course you have to pay for it.

Imagine a world where the members of the American League of Lobbyists, and Public Affairs Council had to work for a living. The only thing these lobbyist thugs could do, would be selling meth or crack cocaine.

Open left is reporting Tester will vote for the Schumer PO.

If that’s true that’s huge…

http://www.openleft.com/tag/whip%20count

I haven’t heard the method of opting out defined, but let’s assume that it would be left to state legislatures.

Now stop to consider (as I said below) how cheaply a United States Congressperson can be bought.

How cheap do ya figure a *State* legislator can be bought?

Chump change. Too damned easy, and the only danger is that lobbyists might be overly bored while pulling off this kindergarten-level-lobbying exercise. One day’s worth of national lobbying budget should buy all the State legislators needed.

This is some serious bullshit.

This is a bad road to go down. It will draw race and class lines and divide us even more.

UNLESS the voters get to vote a referendum on it and decide for themselves rather than a governor or legislature making the decisions (while taking millions from the ins. companies on the side).

It sucks and I cannot believe Howard Dean is approving this compromise. And that’s what it is—yet ANOTHER compromise.

I am sick of this.

This stinks. And of course, the states with the most gut-wrenching, overwhelming need won’t get the public option.

Momentum is on our side. Why snatch defeat from victory?

Agreed. Season tickets at the most. State legislators are too cheap. The insurance companies would tolerate this because then their fight becomes much cheaper.

If this plan passes the battle with insurance companies will be waged state by state,
With the current battle underway, media is in seventh heaven. There is a hell of a lot of money being spent on advertising.

For the sake of argument, suppose 2/3 of the uninsured US population becomes covered,
and so the number of annual deaths due to lack of coverage drops from 21,000 to 7,000 ,
or from 45,000 to 15,000, depending on whose figures you believe.
That seems to me like an improvement over the status quo.
How do you weigh that against swinging for the bleachers and possibly missing?

Got that right. State legislators are cheap to buy.

And hell yeh,this is some serious bull.

It’s a non-starter. If they’re stupid enough to pass that law then we’re going to see all kinds of stuff like people moving to pro-health care states in order to live. Can you imagine the political disaster of states making laws forbidding or putting limits on out of staters trying to get health care?

It’s seriously a stupid proposal.

Pffft! I don’t trust voters to make this decision either. They can’t be trusted. Look at all of the retired people screaming about keeping the government the hell out of their medicare.

Why snatch defeat from victory?

Because that’s what Democrats do best?

I don’t know….how do you feel about leaving hundreds of thousands of black people in perpetual slavery in parts of the country, while freeing others? Because that’s what happened in the mid-nineteenth century. This is not a political issue, it’s a civil rights issue.

why do democrats hate america black people?

Please read Digby on this.

You are assuming facts NOT in evidence.

If we want to cover everyone, and control costs there is but one way…. We all know it. I hope anything less dies!

Thinking about this some more, depending on how the funding piece works, there could be a lot of states that would opt out if there was an unfavorable budget position for them.

This thing completely stinks.

You either believe health care is a moral issue, or you don’t. It’s clear to me that most of the DC types just do not get the moral piece. Blergh.

Well I trust governors and legislators even less. At least it’s a bit democratic even though I agree that voters screw up on a regular basis by putting nutjobs in office.

Current Status: Take-no-prisoners blogger

Changing the Game By: Using her web platform to relentlessly hold our leaders’ feet to the fire. One part rapid-fire blogger, one part sharp-elbowed political activist, Hamsher names names, connects the dots, and regularly inspires the progressive community to take action. Since coming together around Plamegate, her group blog, FireDogLake, has been at the forefront of the progressive blogosphere. The site’s live blog of the Libby trial was a blogging milestone, praised by the New York Times as offering “the fullest, fastest public report available.” Her current crusade — ensuring the passage of genuine health care reform – is informed by her own health battles: she is a three-time breast cancer survivor.

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

Nice

….people moving to pro-health care states in order to live.

A diaspora to New England?

YES! I posted the link above as well.

Go vote people!

Just think about it all of america can have a donut hole.

I already voted several times. *g*

As much as I would enjoy reenacting Sherman’s march on Atlanta,
this can only happen through elections and judicial decisions.
And given the current makeup of the Supreme Court, there is no way that Roberts, Scalia & Co.
are going to say that health care is a constitutional right.
No matter that the Constitution says in plain English,

Article 1, Section 8:

“The Congress shall have Power To lay and collect Taxes, Duties, Imposts and Excises, to pay the Debts and provide for the common Defence and general Welfare of the United States; but all Duties, Imposts and Excises shall be uniform throughout the United States.”

It’s actually much worse than that.

” The only danger is that the lobbyists might be overly bored” , I respectfully disagree. I think the lobbyists have a fun board for betting ,like for sports. Whatever it’s called [I’m not a gambling person]. I’m thinking they get their rocks off raising the stakes by adding a prostitute, a vacation/info gathering junket,etc. At what point does your target abandon every moral fiber?
If I were a lobbyist and therefore a gambling sort of person, that’s what I’d do. ” I’ll see your $35,000 and raise you one whore and a junket.”. Obstruct everything that will make your country strong.
The Sibel Edmonds testimony makes it so painfully clear the piddly amounts of money it takes to create traitors.

Vote early and often being dead is no excuse to not vote! :)

Really? As unhappy as a woman in Alabama with breast cancer who can’t get treated because Wellpoint drops her and there’s no alternative?

That unhappy?

Because I’ve seen the traffic breakdown for the blog, and this isn’t a choice most people are making for themselves. It’s someone else who gets to pay the price if they’re wrong.

and all other healthcare states. an interesting factoid.. this is basically the same thing that happened initially after the passage of social security. People would move from low welfare to high welfare states.

The Sibel Edmonds testimony makes it so painfully clear the piddly amounts of money it takes to create traitors.

I think I pretty much said that.

Racism, pure and simple.

Because I’ve seen the traffic breakdown for the blog, and this isn’t a choice most people are making for themselves. It’s someone else who gets to pay the price if they’re wrong.

I’m not sure what you’re saying. Blue state liberals need not apply?

Back in the 80s and 90s, the LGBT community came together as one and worked hard to pass legislation to give LGBT individuals protection against discrimination in employment, housing, etc. Most states eventually moved to protect gays, lesbians and bis but almost all refused to go the extra step to protect transgendered Americans. The gays and lesbians were all for those compromises and told the transgendered people not to worry, that we’ll do it incrementally. Gays today, everybody tomorrow! Well, years later, transgendered people in most states still don’t have those basic protections, the right to live, work and support themselves. Why? Because so many gay and lesbian Americans moved on to other matters, like same sex marriage. Transgendered people can’t get legislation passed by themselves because they lack the numbers but it doesn’t make them any less deserving. The LGB Americans “got theirs” and threw the transgendered Americans under the bus, just like Frederick Douglass threw the women under the bus when offered the vote for the black man. He never again worked for womens’ sufferage. Tell me, why does anyone imagine this will turn out any differently? One definition of insanity is doing the same thing over and over and expecting a different result.

Where there is racism.. class warfare is blowing up all around.

That’s my Peg! Hi Hun!

There’s not much Alabama (rec.) traffic. So for you to say you’re fine with something, comes at those Alabama people’s expense.

If it’s not a moral issue for you, you should just say so.

The overwhelming majority of people do not choose to be un-insured. They also do not choose to get cancer or chronic disease or just plain sick in general.

I actually think Dean’s words were misinterpreted by those desperate for political cover for a calculating position that puts someone else at tremendous risk if they’re wrong.

A lot of people hid behind Howard Dean’s skirts today because they couldn’t cough up any independent moral justification of their own. It was sad.

Kelly! Woohoo! :-)

Tell me, why does anyone imagine this will turn out any differently?

No argument here Great Historical examples Frederick Douglass I’m sure would be hard for Obama to ignore.

Who is actually Black besides me in this thread?

Look, I live in Southern California (Los Angeles to be exact), not in the ‘hood by the way.

I’ll take my chances playing Russian Roulette with the GOP, here they will lose.

We won’t go with the Public Plan, we’ll have Single Payer for all Californians (SB810). We aren’t spending our time talking about Mexican Immigrants either, if they are resident of the State, they get coverage, if not they don’t, be we won’t turn them away either.

Now if your talking about the Dirty South where the majority of the Black Population is and you have stinkers like Rick Perry for Governor, then you know what, sucks to be you.

If Black People didn’t get the memo that Federal Government largely doesn’t give two shhh about you with Kartina then I don’t know what will make that light turn on in your head.

Obama says he’s the President of the United States and not the President of Black People. That’s okay but when a young Brotha stands up at one of your press conferences and ask you what are you going to do about the double digit unemployment for Black/Brown Males in America and you say some shit like “High Tides Raise All Boats” when the playing field isn’t level to start with, some boats will rise higher than others….

Don’t get all concerned about Black People. They are where they are because they CHOOSE to be. Money has little to do with it. There was a great migration North after Slavery, yet all of them didn’t leave, many of them stayed and where at ground zero for Jim Crow. They are still down there, because THEY CHOOSE to be.

They staunchly defend the South and that’s fine. But when their Governor opts out of Public Health Care you can’t feel sorry for them. Many Blacks have moved down to the ATL just to be around more upwardly mobile Blacks, whatever man, you do that.

I’ll stay in Sunny SoCal and watch my Government ultimately do what’s right and RACE has nothing to do with it – http://www.californiaonecare.org/

“We’ll pick you up later!”

No one ever does.

I keep saying here that this is OUR money that they are using to pay for their own health care but denying it to us to use for our health. I think that should be pounded out every single day. People would understand that, even if they don’t understand the rest of it. This issue is very complicated and I believe that most people would be angry if they were made to understand exactly what is going on.

“Sucks to be you” is even worse than compassionate conservatism.

Your arguments sound like those of the GOPs surprised no one could escape Katrina: “Why didn’t they get the kids into their SUVs and drive upland to a Double-Tree for three nights?”

And if you think the California GOP will let go its minority stranglehold on the legislature long enough to allow single-payer to be passed, you are incorrect.

I didn’t know Alan Keyes lived in LA.

No, I’m saying if you don’t live in a red state, it’s not a very courageous position to take. It’s advocating that someone else take the risk for a political gambit.

I don’t think I saw anyone saying this was a swell idea today who risked anything at all for themselves. California, New York, DC …what have they got to lose if it all goes to shit for poor women in Alabama?

Young African American women are five times as likely to die of breast cancer as white women. If you’re wrong, they’re screwed.

There are better ways to stick it to Rick Perry.

Of course it’s a moral issue,
but what’s going on in Washington now is far more likely
to result in complete crap than partial crap.
It’s easy to play chicken with somebody else’s car (or body).

Is that were I got that great sentence from? Thanks!!!
I’m dehydrating apples as I browse in and out. I always learn best when I have hands working along with study time. But with absorbtion comes ownership. Sorry.
FDL is my education. And it makes me proud. *g*
OT; My husband and I have agreed to buy 6 tickets to the screening of “The Yes Men Fix The World” in 2 weeks. It’s one of our “homeschooling” expenses we alocated to our teens and their friends.

That has got to be one of the most callous things I’ve heard in this debate so far. “I got mine” isn’t a progressive value.

Hear! Hear! Wish I could be as eloquent. Guess that’s why Jane has a blog and I don’t. ;-)

1993 happened.
And there are plenty of people on both sides of the aisle
who would like it to happen again.
Do we want to be having this same discussion in 2025?

We won’t go with the Public Plan, we’ll have Single Payer for all Californians (SB810).

and you have stinkers like Rick Perry for Governor, then you know what, sucks to be you.

Stop it – your eloquent defense of black and poor people in places other than California is getting me all misty, you selfish bastard.

That was an awfully long comment – let me condense it for you.

“I’ve got mine – fuck the rest of y’all.”

Did I miss anything?

Alan Keyes, that nitwit? N___ Please. I rather have the whole country covered by HR676. What to you propose for a solution then if that can’t get passed?

Some watered down piece of shit? Are you ready to signal victory with only 94% covered and it doesn’t start until 2013?

T.R Reid said that he feels Universal Coverage will happen on a state by state basis, I agree. Too many States vote against their own interest far too often to play Capt Save A Hoe.

I don’t believe you’re black. You speak like a cartoon character, rather like George W Bush trying to sound like a Texan. I could be wrong but I rather doubt it.

Did anybody see the craptastic op ed in the Post by
Doug Elmendorf’s guru, Martin Feldstein?
This is what the elite wants to shove down our throats.
Opt-out is a paradise compared to that.

I will bow out by just saying that I am grateful for what Jane, Eve, Noelle and the rest of you are trying to do, and hope that you succeed.

I think there is still a chance now. And if not, I think the costs will demand it return to the table very very soon.

I do not want to see divide and conquer prevail again. As someone without insurance.. if I have to sellout millions of others in order to get mine, well then I will wait too.

This is the beginning of our success (2006 thru ‘09). Selling out now would do more damage to progressive credibility than anything else I can think of.

It’s not who were are… trading millions of lives like a commodity.

Just like some people would like to see California sink into the Pacific Ocean after a major earthquake, I don’t take that personally. When the Lakers play other teams, what do I hear in the crowd? – Beat LA

I rather have the President stand up and say “Enough is enough and it looks like we’ll have to start from scratch and do Single Payer after-all”

Anything less is a half-arse bill that will be signed into law and Dems will claim victory.

Those concerned about getting left out sure aren’t concerned about not being able to afford the premiums of your newly mandated insurance coverage.

Nobody poo-poo the idea when Dennis Kucinich laid it out in the House bill.

Now all of sudden its a bad idea?

profiles.yahoo.com/dj4monie

The only part of the bill that states will be allowed to opt out of is the public option. The vast majority of uninsured will still be covered and be subject to the same out-of-pocket maximum that everyone else has. The only difference will be that they are covered by a private company under the same rules as everyone else but at a higher cost to taxpayers because the subsidy will be higher. The people paying full ride in the exchanges will also pay at a higher rate without the public option and the states will quickly fall in line to save taxpayer money and wealthier self-employed will see they are getting screwed. Maybe not the best way but far better than no public option for anyone or a watered down version.

I don’t have insurance either.

Rather than opt-in to my companies’ worthless health care plan, I rather wait to see what the outcome of this debate is.

Is this a form of unintentional class warfare?

More than likely, but short of a boycott of the insurance companies nothing seriously progressive will happen at the Federal level. I see that now, this is only the start of the bs slide downhill. Obama said “Change” he just didn’t say it was “Small Change” and that the Status Que is stronger than he first thought.

As folks think through whether this opt-out compromise is acceptable or a deal breaker, I would recommend that they read Nate Silver’s analysis at Five Thirty Eight. Whether it persuades you or not, the points he raises are worth considering.

http://www.fivethirtyeight.com…..urism.html

Well, you are not visiting the wait and see kind of blog, amigo.

And it ain’t small change.. it’s nearly another trillion dollar giveaway to the ******s who got us into this fiasco.

Please explain why we’re in an either/or situation. I just don’t see it.

Allowing states to do single payer is entirely different than allowing states to opt-out of Public Option.

I agree. There’s still a chance. Either way, I’m going down fighting. I have the time to make the calls, we have enough money right now to place $10 here, $5 there, support sites like FDL,Bradblog, Amnesty Int, Aclu on a small stipend every month. I consider it our “Tithe” as patriots. And we have Group Health. My husband’s employer is a small but vibrant company with consistent international prestige. But the world sales are flat. There is no sure tomorrow for people who have insurance today.
We have no choice put to fight for what’s right.

So states with insurance monopolies and monopolistic pricing will continue that way, without a public option and ever-increasing prices, but this time the insurance company profits will be highly subsidized and guaranteed by the taxpayers? What about that works?

… and casteism, which Schumer says does not exist in today’s America …

My position is that I’d rather get 80% of what we want today and be able to fight for the rest tomorrow then get nothing. Rightly or wrongly (well, wrongly), the votes are not there yet. I want universal health care for everyone…but I want it for as many as possible, as soon as possible. And if the insistence is on getting 100% of what we want results in no bill this year then what then? We walk away from getting most of what we want because we couldn’t get all of it?

Aren’t there only a few insurance companies in the States when you look under their umbrella?
That’s what works about that. Jam up one section, let the pressure release somewhere else. Create fear and upheaval. Kind of like an artificial earthquake. Only different. Keep the rich on the high ground. And fucking buy land at every fucking opportunity.
But that’s not for the likes of us.

I’m not so sure. Consider the history of Medicaid. It was optional for states to join, but all 50 states eventually did. To do otherwise is to give up substantial benefits.

If states can opt out, and the public option is really robust (as in: any small businessperson can by his/her insurance from the public plan if it’s a better deal than private insurance offers, and the public plan doesn’t have to compete with one hand behind its back), then eventually the business lobbies, traditionally Republican supporters, will pressure their states to sign up.

If there is an opt-out, then it shouldn’t be left to governors alone. The legislature should have to pass a bill following its normal procedure (subject to veto by the governor).

Jane @83, who said we were in an either/or situation. I was trying to point out that for most uninsured, their out-of-pocket would be exactly the same because subsidies are based in the bills as a maximum percentage of income. Many commenters here seem to think that states will opt out of the entire health care reform which is not what is on the table. Teddy Partridge is exactly right which is why I am not worried. The wealthy small business owners and self-employed will pay through the nose if they live in a state that opted out and would demand change. There would also be pressure on states because of excess cost to taxpayers for subsidies.

So, black people in Georgia will have subsidized Aetna while black people in Michigan will have subsidized public option until white people in Nebraska demand that Georgia get with the program and stop costing taxpayers an extra 15% or more for the same coverage.

Well, not in that version of America in which he lives. For the rest of us, it damned sure does.

I guess I don’t understand most of the folks replying here.

Early on in this process, most commenters and the majority of bloggers here at Firedog Lake and The Seminal sacrificed the principle of “Everybody In, Nobody Out” — the principle behind Medicare for All in order to pre-compromise on the PO. That is, a majority of you decided, without testing the proposition, that single payer wasn’t feasible. So you advocated for the PO. Congress came out with some bills that included POs. All of these PO bills are very weak and would leave millions of people uncovered. Perhaps 17 million or more by HR 3200, and perhaps 30 million or more by the Senate HELP bill. Yet in spite of this history, I have never seen this kind of moral outrage expressed here on a health care reform issue, except by a few single payer advocates.

Rather the reactions of PO advocates to HR 3200 and Senate HELP have been somewhat favorable or somewhat detached in tone. Some posts have talked about “robust public options.” Others, such as Scarecrows’, have just reported “the facts,” But no one has gotten overly upset about the violation of “Everybody In, Nobody Out” in both of these bills.

So, now comes the opt-out provision applied to the PO, and that may result in some States opting out of a PO choice on the exchange, if State Legislatures have the gall to deny their constituents a Federal benefit. I certainly understand opposition to that. I’m very opposed to it myself because I’m an “Everybody In, Nobody Out” person.

But I don’t understand why I ought to be more opposed to that possibility than to the near certainty that HR 3200, Senate HELP, or some compromise of these with the Baucus bill would exclude from coverage in excess of 20 million people. But from the reaction of most here, I see that many of you are awfully excited about this new compromise with its possibility of excluding people, while you were accepting the exclusions under HR 3200 and Senate HELP with a fair amount of equanimity.

So what’s up with that exactly?

Further, what if the PO advocates were able to get a much stronger PO through if they included an opt-out provision? What, for example, if the progressives were able to get an option for everyone to buy into Medicare, eligibility for everyone to use the exchange including both Medicare and the private companies, subsidies that removed the burden of the mandates from most people in return for that provision, and move-up of the operational date of the reform to July 2010? Wouldn’t that be better health care reform, even with the opt-out possibility, than a compromise HR 3200/Baucus bill with a PO restricted to only to those who can’t get insurance at work?

The point I’m making is that whether a bill that comes out of the present negotiations is a bill worth voting for or not depends on a lot of things, and that an opt-out provision, while a negative, shouldn’t be decisive if your criterion for deciding on whether the bill is worth supporting is whether it really improves the current situation or not.

On the other hand, if your criterion really is that the bill should reflect “Everybody In, Nobody Out”, then I think that the only bills that could accomplish this are enhanced Medicare for All e.g. HR 676, or a very strong PO bill of the type originally sketched out by Jacob Hacker, in which everyone is eligible for the PO and everyone can afford it with the government subsidy. And I guess the problem I have is that I haven’t seen many of you advocating for either of these alternatives in recent months since the House Bills came out of committee.

So, what’s up with that? And, again, in light of this, what’s up with the sudden outrage?

Finally, from my point of view, the present bills on the table are all inadequate and should be defeated by progressives, whatever other Democrats say. Let them eat cake, I say. If an opt-out provision is added to these, then that makes no difference, since they are already unacceptable. On the other hand, if in return for an opt-out provision the blue dogs and Conservadems would agree to:

1)Eligibility for the PO and the national exchange for all individuals in States not opting out of the PO

2) An opt-in for States to extend the right to all of their under 65 citizens to buy into Medicare in place of the PO system

3) Subsidies that remove the burden of the mandates from most people

4) Subsidies for people under a certain income who want to migrate from one State to another to take advantage of either the PO or the Medicare options

5) Move-up of the operational date of the reform to from 2013 to July 2010

6) A guarantee from the blue dogs and any Republicans proposing the compromise that they will vote against cloture and also vote for the final bill;

then I think progressives ought to support that, especially since with a such a good PO, the chances are very good that no States will opt-out, or that if any do they will opt-in again in short order.

Here’s another way to handle this to make it even more palatable. Give a State an opt-out option to be exercised in the following way: the Governor can propose the opt-out, but the opt-out has to be confirmed by a sample survey performed by HHS civil servants (i.e. no private companies or contractors allowed) in which more than 50% of a stratified random sample gave support to the Governor’s proposal. Thereafter, HHS would perform such surveys annually, and a State would be considered to have “opted-in” when a majority of its people as indcated by the results of the survey were again in favor of the PO.

The Dixiecrats’ real agenda is to get their black populations to migrate to blue states for access to better medical care.

Very true however -

In another post from last night spelled out how sticky it could be to start Single Payer at the State level. Dennis’ spells it out – http://www.youtube.com/watch?v=pWXRwrYa4oU

Is it a bad idea to let Red State morons to “Control The Dice”? Yes it is

Is it one way to let Single Payer get done properly? Yes

KO think Shaming them will work, I personally don’t think you can shame the unshamable.

If you don’t live here you might not know but we passed two versions of the same bill twice in both houses only for The Governator not to sign it. What GOP? They don’t control the California House in Sacramento Dems do!

Senator Mark Leno (See his website.) introduced the new single payer bill, SB 810, The California Universal Healthcare Act on March 11. The bill passed through the Senate Health Committee and will next be heard by the Senate Appropriations Committee in 2010. State budget problems have caused this delay.

Two years ago California’s Governor Arnold Schwarzenegger vetoed a prior version of this single payer bill stating, “I must veto SB 840 because I cannot support a government-run health care system.”

He’s the only GOP’er and the most important one standing in the way and this is his last TERM – Ya!

So the rest of you in 49 State land might have to deal with Mark Stanford or Bobby Jindal types where they will Opt Out of the Public Option defending your State from Federal Law.

I’m not saying its the right way, but what other options do we have?

We shouldn’t consider it unless we’re guaranteed of getting two big handfuls of senate votes. But, if it gets us there and the alternative is iffy…

Agreed!

Whether momentum truly is on our side is hard to judge from outside the Senate. I would assume those folks have a better head count than any of us.

2) An opt-in for States to extend the right to all of their under 65 citizens to buy into Medicare in place of the PO system

If this was agreed to, progressives in every state would be leading the fight to opt out.

the double digit unemployment for Black/Brown Males in America and you say some shit like “High Tides Raise All Boats” when the playing field isn’t level to start with, some boats will rise higher than others….

Two things: 1) a rising tide does raise all boats and fixing the entire system to create a rising tide is a good start; 2) trying to put healthcare reform in place with union cardcheck and universal savings accounts and starting the Green Revolution are aimed at assisting all working folk to have good paying jobs which really improve America.

If you didn’t hear candidate Obama’s speeches you missed that stuff. OTOH, now that he’s in office there’s this thing called Congress which works at it’s own pace and doesn’t do anything overnight (unless it’s in their personal interest). Yell and scream at them. It’s the Republicans primarily who are opposing reforms.

I’ll stay in Sunny SoCal and watch my Government ultimately do what’s right

Is California going to go broke while you bask in the sun. Maybe you would do better to work towards fixing it’s problems. Start with single-payer if you like.

I don’t see racism in any of this healthcare reform discussion. All I see is people trying their best to convince more people to support it and vote it into effect. It’s messy. That’s life. Wear a helmet.

Why would we subsidize in states which opt-out of the PO? I thought we were against mandates without a PO. Heck, I’m against mandates entirely.

No, this opt-out plan cannot allow opt-out states to still get the subsidies. That encourages insurers to take and take and take with no downward pressures on prices.

Mandates, subsidies and the public option have to be a package I think.

6) A guarantee from the blue dogs and any Republicans proposing the compromise that they will vote against cloture and also vote for the final bill;

“against cloture”? Maybe you mean “for cloture”.

Let’s get it done!

Thanks Mark, That is what I meant.

Now that the government is getting involved, will it be acceptable for States to use Federal money in ways that prevent people from moving from one State to another to engage in commerce and other activities. It is also worth noting that the blue states subsidize the red states by paying more in taxes than they get back.

If the racial disparity between deaths due to lack of healthcare becomes even greater because Red States opt out, is that just how the cookie crumbles? Is that the kind of Country we want to be?

THIS IS NOT JUST ABOUT RACE. THIS IS ABOUT MONEY AND BREAKING UNIONS, TOO. RACE PROVIDES A NICE SWEETENER FOR THE CRYPTO-RACISTS (and the not-so-cryptos, too) AMONG THE BLUE DOGS TO VOTE FOR THIS, BUT IT’S NOT THE PRIMARY MOTIVATION.

While it’s true the so-called Federalist option – allowing states to opt-out of public opton for health care – would disproportionately wind up landing on states with the largest African-American populations, in so many words repeating an injustice which bedeveiled A-A workers in those states when the same thing was done with Social Security to get it past the predecessors (also Democrats) of today’s Blue Dogs. And which took decades to redress.

What I would remind you is that such an opt-out would also replicate the “right-to-work” or “open shop” provisions of the Taft Hartley Act of 1947. State by state regulation of whether unionization was supported wound up, in thsee same Old Confederacy and border states, resulting in anti-unionism in those very states. That both undercut union organizing in those states AND facilitated the movement of union jobs from unionized Northeastern and Midwestern states to the “right to work” states, phenomena which we are still dealing with today. In so many words, it created an incentive to arbitrage labor inside the US by threatening to move the plant to the land of crackers, where saying Union could and would get you fired. This provision will merely replicate, refresh, and continue the “Rust Belt to Sun Belt” migration of jobs to the downmarket South which has been a feature of American life for the last 30 years or more.

I can see the same thing happening, particularly if there is an employer mandate in the bill – jobs will move to the states where you get crap insurance (if any) and if you want to be in a public option state, go ahead, try finding a job there.

This proposal was seriously, deeply thought-through by someone who does not have voters’ best interests at heart. It’s also the kind of thing which will garner warm bipartisan support from people like, say, Senator Corker – who I suspect could easily see his way clear to supporting a plan wihch will encourage bringing the equivalent of a new, non-healthcare, non-union Saturn plant to his state.

Big Bidness mnust be seriously pleased with the sudden approval this stupidity is gaining. (That sudden embrace, BTW, is an indicator that the liberals have no stomach for a fight.)

BTW, that Taft Hartley act was passed in 1947, and is still on the books.

I agree – absolutely insane. The Republican legistlature jumped the gun on this one, trying to get a bill passed to opt-out. I understand the pressure of failing state revenues, but if this program is not federal in scope, it’s already a failure.

To echo the points made above by letsgetitdone (and to crib from comments of mine elsewhere)….

All the hyperventilation around here about the impending holocaust that a state public-option opt-out would trigger merely amplifies the ludicrous exaggerations about what the best public option plans in current bills could possibly achieve.

Let’s not forget that giving states the right to opt out of the PO does not mean a state, even one with raving wingnut leaders, will actually do it when the time comes. Witness the bluster vs the reality of the governors swearing to refuse stimulus money.

More importantly, if a blood-red state does opt out of the PO but remains subject to the other provisions of ObRahmacare, that will merely bring it into line functionally with … Massachusetts! Not ideal, but still progress.

As a single-payer advocate who’s had to endure accusations here of being a DFH purity troll out to kill people’s babies, I know what it’s like to be told to pipe down and swallow an unsatisfactorily incremental plan. Sauce. Goose. Gander.

Moreover, and crucially, as I’ve pointed out in this diary, if the PO opt-out plan does survive, it creates an opportunity to strongly pressure Congressional leaders not to deep-six the Kucinich amendment, which would allow states to opt out of ObRahmacare altogether and institute their own state-level single-payer systems.

At present, the fate of the Kucinich amendment rests primarily in the slippery fingers of Pelosi and Hoyer. It deserves support regardless of the outcome of the PO opt-out proposals. But as long as the PO opt-out proposal survives, it provides an opportunity to exert extra pressure on the Leaders, through an insistence on consistency:

If states deserve the right to opt for something weaker than the PO, they also deserve the right to opt for something stronger.

This is an approach which certainly alarms those liberals who would impose their views on others. But it does reflect the federated nature of American democracy.

One would think that, if 2/3 of Americans support some sort of government managed health care finance, that any legislators and governors in any state which opted out would likely face the wrath of a significant number of voters at election time.

We live in a divided nation, and the impulse to impose one-size fits-all solutions is noble, yet impractical and is the source of our gridlock. The solution to that is decentralized, grassroots democracy, not top-down authoritarianism. We can extend our hand in aid but can’t force everyone to shake it to achieve peace.

I, for one, think that the Civil War should have never been fought and Jesusland been allowed to secede. Thinking further, had the Revolutionary War not been fought, we’d still be attached to the UK and would benefit from the NHS.

Jane, you must remind people and stress on your blog that in an opt out america the insurance companies will be able to make a huge amount of money off of the government “subsidies” for people on the individual market in the states that opt out. This will allow them to soak the government for more and more cash and become even more powerful than they are. Our tax dollars! To those criminals! The reason this opt out will be okay with the blue dogs and Conrad/Baucus/Nelson etc.. is that it will allow their insurance company friends to collect lots of tax money in opt out states.

Please get the word out! The moral case for a national public option is strong, but there are also strong political reasons that progressives in the house and senate CANNOT support this giveaway of tax money to interests that are uniquely hostile to progressives and their goals.

Thanks for all the good work you do.

White America – 1
Non-White America – 0

See box score for complete details…

Goodnight everybody! Thanks for coming out tonight; drive home safely.

I think this is really a false fear. I can see States not opting to move to Medicare for All, single-payer if that is an option. But I really can’t see them opting out of the PO. I know some of these Governors are ideological assholes, but can they really gain more votes from their fellow assholes than they will lose by not giving people the choice of a PO? Sure I can see them screwing black people in these red states without blinking an eye, especially given party-related voting behavior, but they’ll be hurting a lot of their white constituents too. What for?

We can also put a civil rights hedge into the bill, a rule that States can’t opt-out of the PO if lack of employee-based insurance is too highly correlated to race or ethnic group. I think existing Census data can be used to figure this out.

If the choice is for residents of all states to be compelled to patronize vampire insurers or for some states to opt out and their residents made to be insurance company captives through their states’ democratic processes so that others can have a public option, I’ll take the latter, thanks.

I think you’re assuming that every bill allowing State choice will result in a race to the bottom. But does this one do that. If it did I’d be very much opposed to this. However, no one’s talking about exempting the businesses in States that opt-out of the PO from any business taxes for funding the PO, and no one’s talking about exempting people in the affected States from Fedeal taxes that would be used to support the PO. Also, no one’s exempting individuals in these States from insurance mandates. So, every effect of allowing this choice is negative for the States involved. They’re just foregoing the advantage of taking the PO, but they’re getting all the costs of it. I think State Governments are very unlikely to cut off their noses to spite their faces.

Take a look at the example you gave. There’s a reason for Saturn to move to a non-union state (btw, I’m very pro-union in my views, and think that Taft-Heartley is terrible law) if they want to be non-union, but with the PO unavailable in a State, they’d be paying more for employer-based health insurance than would otherwise be the case. Of course, they could always decide not to pay for health insurance, but then they’d be subject to mandate fines, so where’s the advantage to them relative to the consitions in a PO State.

I think State Governments are very unlikely to cut off their noses to spite their faces.

Don’t misunderestimate the ability of the true believer to stand on the railroad tracks as the train comes barreling down at them repeating “this is not happening, this is not happening.”

Why are we dancing around the central issue like Tom Delay on two bad feet. The existing Medicare system is the easiest, most cost efficient path to take to provide medical access to all Americans.

Insurance coverage and medical access are deliberately conflated to postpone spending money on the poor.

Everything else is political gymnastics and mental masturbation.

The PO in such a program would be Federal in nature, and uniform in all States that did not opt-out. As I understand it, the States opting out get no advantage from doing so. They just get to pay employer-mandated taxes and individual mandated fees and give up an individual choice for every one of their citizens. They win nothing, they lose something. Opting out is a symbolic gesture having no benefits for one’s State.

Finally, put in the fail-safe I talked about above. Give States an opt-out to be exercised in the following way: the Governor can propose the opt-out, but the opt-out has to be confirmed by a sample survey performed by HHS civil servants (i.e. no private companies or contractors allowed) in which more than 50% of a stratified random sample gave support to the Governor’s proposal. Thereafter, HHS would perform such surveys annually, and a State would be considered to have “opted-in” when a majority of its people as indicated by the results of the survey were again in favor of the PO.

Or in my own variation of this proposal, give a State the right for its under 65 citizens to opt-in to the actual National Medicare program. That should finish any possible race to the bottom.

The present POs on the table are real giveaways to the insurance companies, because their POs are too weak to survive. If we can get a much stronger PO in return for an opt-out provision, let’s do it, so long as we also have an opt-in provision for Medicare for the under 65, and some of the other safeguards I’ve specified above.

I think it all comes down to what the Red State Senators are willing to pay for getting the opt-out. If they’re willing to pay nothing except voting for the final weak bills we have now, I say let’s defeat those bad bills, and come back next year when their jobs are on the line. If they’re willing to sweeten the pot so that the PO in it is a Jacob Hacker type of PO, along with a Medicare option for States so-inclined, I’d give ‘em their opt-out

I don’t. This is a time when the crazies are in the ascendant. But turning down the PO while continuing to pay for it, is so profoundly stupid that I really think these yahoos will do it. Symbolic protest is one thing. Denying your citizens something concrete like choice in order make such a protest is not something that too many Governors or legislatures will do. But again, we can put in a fail safe requiring confirmation that 50% of the population agrees the Governor or legislature.

TPAZ, if you know a way to stop dancing around the central issue and bring Medicare for All, HR 676 to the fore so that it really gets fully debated nationally instead of getting dismissed with some slogans and marginalized I’m all for it. But when even Jane, NYCEve, and Marcy Wheeler, not to mention the President and the Congress and the major well-funded “progressive” voluntary associations continue to take it off the table, then Medicare for All Advocates such as ralphbon and I occasionally have to do some dancing around to try to get it back on.

Excellent post, Jane. It is a civil rights issue.

Before the true progressives in congress let a bad bill becomes law, they should kill it with the understanding that it will be the litmus test for the 2010 elections. Also, in 2010, the progressives introduce legislation to reinstitute the draft. If congress will not defund the war, then have every American vote on both issues. I’m willing to bet the draft will lose and healthcare will win at the polls. We trade healthcare for war. The only other option is to organize national strikes for healthcare. The President will weigh which battle will cost him less political capital. It’s hardball, to be sure, but that is where we are.

Give us real healthcare reform in 2009 or face radicalize voters reacting to conscription or war defunding in 2010.

I’m for defeating all the bills on the table right now. They are travesties. Giveaways to the companies.