a multi-million dollar surge in donations from health insurance companies to politicians at the state level

Bang !

I’m surprised by the intensity of your response over this (last minute?) gesture for compromise. All your concerns noted, if the political choice we face is a strong public option with a state opt-out or a weak (or no) public option, guess what? The answer’s CLEAR to me; so clear, I think it’s incontrovertible AND should be OBVIOUS to ALL who are serious about enacting real healthcare reform – now.
If you’re arguing this is a false choice & we must do better, I hope you’ll factor in just how ineffectual our Congress has become over the last 30 years. (This is the one truth Dick Cheney got right.) Personally, I think you’re right on all counts, but so what? I don’t get a vote on this & neither do you. It’s no secret there are MANY who do get to vote who’d love the opportunity to marginalize your efforts. Given the opportunity to rationalize that you’re unable to compromise, I’ve no doubt they’d prefer dismiss your followers as “fringe” and forget any opt-out. Please, stop for a second & breathe. The opt-out may let the weeny pols off the hook, but represents a huge win for those of us who recognize we NEED dramatic healthcare reform – NOW. My call is, your wins on this fight are huge, isn’t this the time to stop fighting for the highly unlikely & take 80% of what was highly unlikely just a short time ago?

What possibly makes you think that is a choice. It will not be a strong PO with an opt out. It will be a weak PO with an opt out.

If it’s a STRONG public option with an opt-out, I’m all for it. The red states, whether or not they’re controlled by Repugs – will eventually have to get on board. The people would eventually realize what they’re missing out on and fight for it.

The effort to reform health care is a slow motion train wreck starring the Democratic Party. The Republicans are just a bunch of extras standing on the sidelines hooting and hollering unintelligibly. It’s the worst horror movie I’ve ever seen. In fact, it’s so bad that it makes Ed Wood’s films look like Academy Award material. Poor old Joe Bob Briggs must be dismayed and driven to drink. I wish I could say, “It’s only a movie,” but I can’t.

And now we have another startling plot twist with Senator Schumer snatching defeat from the jaws of victory by reprising Rose McGowan’s role in Scream when she wandered away from the party revelers in the living room to check out the garage. Who can forget her in that tight sweater slowly opening the door in that tight sweater, and stepping down into the dark garage wearing that tight sweater, and getting munched by the remotely operated garage door wearing that tight sweater? But instead of the lovely Ms. McGowan, we get to watch . . . Chuck Schumer?

Allowing states to opt out of the public option reduces its effectiveness in the states that don’t opt out. We need to garage foo this awful idea.

“Honey, where’s the remote?”

I’m going to go out on limb here…

If a state opts-out (most likely Republican states) doesn’t that mean if the population of that state wants to opt-in once they see how, for lack of a better term, “nice” it is to have the public option, that state’s electorate will have to elect Democrats to get a legislature (or whatever) to OPT-IN? I’m assuming it’s a strong PO based on Medicare rates etc.

Won’t this be good for Democrats in the long run? Or is my thinking demented here?

A message from katymine at 163 on late late night:

larue, I’ve had two good nights, only on oral meds and O2. Elmore can travel without worrying and I get the best back rubs everrrrr

in today’s world of hospice, they do ask that I not seek treatment but now that I have had the morphine and oxygen I feel so much better. when I get stronger, I could go back home and try it. I can say no but youall need to understand the amount of tumors I have, sucks doesn’t it. think of it as assisted living vs hospice

Hear Hear Jon! They are making this so complicated that Occam’s razor won’t cut. It is time they cease this endless talk and give us all Medicare. No compromises.

A related issue: What would be the requirement for a state to opt back in if the state had previously opted out?

I guess the OPT-IN requirement would be:

                                               ELECT DEMOCRATS!

These numbers conform roughly with public support for a public option. Give the people what they want.

AND THE KILLIN’ GOEZ ON AND ON AND…

Citizen Jon Walker and the Firepup Freedom Fighters:

Howard Dean already covered everything you’ve presented here…ulimately, except for it’s constitutionality, the “opt-out” is a distraction, it’s puttin the cart in front of the horse. Get a good bill to the floor of the House before the Senate combines the HELP and Finance Committee proposals and it won’t matter if “opt-out” hasta be used to get the bill to a vote.

“Opt-out” is a distraction…get a good bill to a vote and it doesn’t matter as long as the “opt-out” is narrow and the States required to pick up the problem if they don’t participate.

Don’t waste anymore time on this…dammit!

KEEP THE FAITH AND PASS THE AMMUNITION, DON’T WASTE YOUR AMMO SHOOTIN AT CLOUDS!!

The issue of “opt out” is a distraction. Everyone discussing it ASSUMES that it comes with a strong public option such as Medicare + 5%. I’ve seen no guarantee of that and I don’t think anyone else has either.

Anyone who thinks it’s “reasonable” to agree to the opt-out issue will most likely find out that “opt-out” comes with a very weak public option.

We MUST support:

- NO opt-out provision
- A strong public option such as Medicate +5%
- A start date in 2010

Progressives should not be negotiating with themselves.

States required to pick up the problem if they don’t participate.

I seriously doubt Red states would do that.

I guess the OPT-IN requirement would be:

ELECT DEMOCRATS!

No, because they would figure out a way to screw it up.

I rather fancy a revolution, actually,

As is so often noted, elections have consequences. I doubt that many states, even red ones, would ultimately opt out. It would be politically harmful. Politicians strive for every vote. Why would they alienate voters that want the PO? After all, this is an “option,” not a requirement that anyone choose the PO. In the end, they will offer the PO, even if they complain about it because to deny someone the option would cost them votes. It is to their political advantage to have something to complain about, rather than have to defend an unpopular position. Any red state (and these are red states) might well see a migration to other states because healthcare access is a huge issue. Who knows, it could even cost them some seats in Congress if they loose enough of the population in their states.

Progressives should not be negotiating with themselves.

That horse is already out of the barn, the frame of this debate has already been determined, and it will take much heavy lifting to change that frame. Progressives have to be able to redefine the terms of the debate in order for what you propose to have legs.

IMHO Given the chance to opt out of a Public Option, any Governor or state legislature that decided to go that route would be dead meat. The people, Blue state, Red state, want a strong Public Option. These polititians don’t speak for the majority of people, only for their sponsors.

You mean like Max Baucus or Arlen Specter? The Democratic party doesn’t equal the progressive movement or progressive goals. The party controls congress and the White House and even that hasn’t delivered a home-run on any policy. Why would it be any different state by state?

Why do we not have a public option right now if politicians would be afraid to vote against it? Your logic is just flawed. If being popular made the public option impossible to vote against it would have 90 votes in the senate.

I know your being facicious, but I REALLY don’t get why in the long run, the OPT-OUT wouldn’t be good for the progressive agenda in the long run. I don’t have any good examples from history because I’m not good a political history but there must be SOME example that analogous where some states passed laws and then, over time, all the other state said “Hmmm, that’s a good idea. We should do that too”.

I guess I’m naive or just demented.

Here are my thoughts:

1) This proposal has the libs’ shorts all in a wad… and we’re talking about a FRIGGING PUBLIC OPTION that will only be available to 5-7% of the population! If states decide to “opt out” this is not going to be a big hit to anyone anywhere anyway.

2) I believe that there won’t actually be many states “opting out” due to the hue and cry from the public on a state by state basis. I actually think it’s a good thing to push this down to the state level (and I decry using the inflammatory “states right” meme to color this proposal) because the people will have much more of a say than at the federal level. The bastards that are supposed to represent us will be called much more to task if it’s on a state by state basis… and the ill-informed populace will probably become more engaged if it’s a state issue.

3) Apparently, according to hill folks, this proposal is not seriously being debated right now anyway because no amendments were put forth with the opt-out clause… if we get to the point were the very weak, nearly lifeless public option causes big problems, imho, the PO opt-out could be a viable solution.

4) IIRC, isn’t this the way Canada initially got healthcare for all? Province by province as people began to see the merits?

The Democratic party doesn’t equal the progressive movement or progressive goals.

Your right (I mean correct). I forgot Baucus was a Democrat. I did mean the progressive agenda. I stand corrected.

I guess the OPT-IN requirement would be:

                                                 ELECT PROGRESSIVES!

Opt-out, Schmopt out. All this crap is a distraction to keep us from remembering that the whole process began as a compromise. Remember that whole “single-payer” thing? And if all this miasma were finally to end up as a state-by-state opt-out, there’s about a 100% chance that Big Insurance will pump untold Bagillions into local advertising to talk the populace into taking whatever position favors Big Insurance the most. And it will work.

No more compromises. Suck it, Rahm…and your Blue Dog sycophants, too.

Allowing Republican majorities in red states to screw the poor AND reducing the effectiveness of the public option in blue states is the moral equivalent of northern states allowing the South to continue slavery.

It’s unconscionable, morally indefensible, and I’d rather see nothing passed than this piece of crap.

Imagine “river cities” and others that straddle a state line, where one state opts out, and the other has a PO.

Seems to me a person could move to keep their health care, but it could change a cities, or regions demographics. This has implications on who your representatives would be.

Is that possible?

IF even only 25% of the population is opted out by their wingnut legislators and governors, that’s still at least 30 people DYING PER DAY, just because they don’t have health coverage. This is the Missouri Compromise of health care. It’s unworkable, unfair and in the end will cause massive social upheaval. Why do so many “progressives” want to throw up their hands and surrender just when momentum is on our side? With friends like some of you, I’ll never lack enemies. Trust me, you throw red state progressives under the bus like this, it will NOT be good for the Democratic Party.

I don’t know whether you are naive or demented either but do you seriously imagine that red state Democrats are going to be HAPPY that the blue state people and the national party threw them under a bus? Would YOU be?

Ah! But in the long run, the North won.

I don’t think there is enough raw energy in the Universe to sway Red States away from abusing their poor. Only over time do things like that change (3 or 4 generations) as the those with anti-common-good ideas go the way of the Dodo.

sure hope you saw this – we were in the same boat yesterday am and I took it as validation :D

The only way the opt-out “option” can work is if there’s a mass exodus of people from red states to blue!

Please click here to see my letter to Reid, which I will be sending today.

So, affordable health care is indeed a privilege, not a right.

Remember: If you get sick, die quickly.

There is no reason for a state, once it’s opted out of allowing its citizens access to a federal public option, ever to opt in. Any plan that eventually passes is sure to contain a mandate that all citizens carry health insurance, that an applicant can’t be turned down because of pre-existing conditions, and insurance companies can’t set a cap on benefits. Those who can’t afford these policies will receive federal subsidies to guarantee the for-profit companies are paid whatever premiums they decide to set.

Since the citizens will be receiving these subsidies, why should they care whether their insurance carrier is public or private as long as they can’t be denied care for pre-existing conditions and there is no lifetime dollar ceiling on their claims? All they know or care about is that their state taxes aren’t going up to pay for the subsidies.

Of course everyone’s federal tax burden will increase in order to fund the profits of the private insurance companies, but people in the red states will be the major recipients of the largesse.

This bs is the Conservdems’ fault! One way to make them wake up is to help bring health care to thousands of uninsured Americans in their states.

Please consider joining Keith Olbermann (who gave $50,000!) in donating to The National Association of Free Clinics, which has already begun to help thousands of fellow Americans, even if only for a day.

Click here to donate to The National Association of Free Clinics (NAFC)!

My belief is that this is why Howard Dean and others are considering the opt-out. It is pure strategy.

The question is, should the Democratic Party compromise the goal of offering affordable healthcare to everyone as if it is a human right just to enhance its electoral strategy?

Actually Jane had a thread up that quoted that very piece last night so I did see it but thanks. :-)

As the current version of the PO will only be open to a small percentage of the population, the insurance companies will have no problem convincing even bluer-than-blue states to opt out. Just get enough of the rural/suburban blue dog Democrats in those legislatures to wobble. How are we going to fight for the PO in every state and keep the fight up when supporters find out they aren’t eligible anyways?

In Washington state where I live, even the urban Seattle delegation is completely owned by the rural conservative builder and road construction lobbies. Health will be easy, just invoke all the hospitals and biotech companies in the city. One of my representatives, in the most liberal and progressive district of the state, “inner city” Seattle, works for a health insurance company when its not in session. Where is he going stand?

and people will move from states that do not have the option. an unintended consequence will be depopulation. An intended consequence will be that intense pressure on the Rs to support public option. the effects are too many to be fully predicted.

Why do so many “progressives” want to throw up their hands and surrender just when momentum is on our side? With friends like some of you, I’ll never lack enemies….state Democrats are going to be HAPPY that the blue state people and the national party threw them under a bus

I hear you. But if it’s OPT-OUT or nothing. What would Progessives everywhere in the future think? I’M SO IN FAVOR OF NOT HAVING OPT-OUT. But we are working with a non-progressive majority in congress. It’s a gamble either way. With OPT-OUT at least the infrastucture is in place and precidence established. The devil will be in the details.. Having OPT-OUT with mandated insurance in Unconscionable

And please, don’t equate me to your enemies, that’s what GWBush did.

actually Knoxville, I see it as Schumer’s fault – Carper never would have got much ink on this if ol Chuck wasn’t motivated by covering the asses of his colleagues instead of you know, providing relief for millions of american families

the “who” of who makes the opt out decision is the most important aspect. dems should concentrate on establishing a process that only allows voters to decide to opt out.
it could be set up so that a governor or legislative body could make a preliminary decision, but that decision must be subject to voter approval or disapproval.
if that kind of process is established, this could actually be a huge and effective political weapon for dems.
protecting medicare and social security has always been golden. so much so that republicans are trying to steal that play from the dems playbook.
protecting a public option – or making certain that a state does not opt out – could be just as effective.
and while there are no guarantees that a public option will be a robust one, yet, the fact that states could opt out, should provide lots of weight to an argument for a very robust option.
look, i hate rahm’s approach to politics – and obama’s acquiescence to it – as much as anyone. and i’d love to see him knocked on his figurative kiester on this issue.
but this compromise is one of those rare opportunities where everyone may actually get what they need and it may actually work out for average citizens as a result.
dems need to look at this dispassionately and try to set up the process, via tight legislative language, so that they will ultimately benefit.

So, you’re saying that freeing some slaves but not others would have been something you could have supported, since it meant that SOME free people are better than NO free people? Because this is exactly the same thing. “I got mine” isn’t a pregressive value.

You must live in a state with out initiatives and referendums ;)

Schumer must be thinking what I wrote @ 30: That the opt-out “option” will cause a mass exodus of people from red states to blue, creating a domino effect that will lead to the public option becoming available in all states.

Still, Schumer wouldn’t have to be worrying about covering the asses among his colleagues if there weren’t Conservadem asses among them.

Again, we need to make them wake up, and one way to do it is to help bring health care to thousands of uninsured Americans in their states.

Please consider joining Keith Olbermann (who gave $50,000!) in donating to The National Association of Free Clinics, which has already begun to help thousands of fellow Americans, even if only for a day.

Click here to donate to The National Association of Free Clinics (NAFC)!

And please, don’t equate me to your enemies, that’s what GWBush did.

Our comparative advantage is that we have lots of smart and informed folks who have their eyes and brains on these complicated policy and political problems. That is a feature, not a bug, and should not scare anyone.

“And please, don’t equate me to your enemies, that’s what GWBush did”

I said “some of you”, which was not directed at you specifically, nor in the context of a reply to a comment made by you yet then you equated ME specifically with Bush, while asking me not to equate you with my enemies, apparently without irony. At this point, I guess all I can say is, if the shoe fits…I didn’t equate you with my enemies, YOU did.

Again, we need to make them wake up, and one way to do it is to help bring health care to thousands of uninsured Americans in their states.

They’re already awake and conscious. What they need is a political offer that they cannot refuse, backed up by the power to make good on threats.

Speaking the truth to power tells them nothing they don’t already know.

to the contrary. i live in oregon, which has a very active and energetic history of voter initiatives.
i’ve certainly seen lots of f@#ked up things get passed.
on the other hand, there have been lots of sane issues ushered in by voters that would never have happened if the issue had been left to a governor or lawmakers – medical marijuana and physician-assisted suicide to name two.
why do people believe that voters, even brain-dead red staters would not like a public option?
as i posted in an earlier comment on one of jane’s posts, how many red staters do you see giving up their medicare?
this is a great issue for dems. being able to keep it alive and have voters energized by it is a great thing.
what is so hard to recognize about that?
some folks act as though they are afraid to allow voters to have a say on this issue.

I guess I’m naive or just demented.

You’re neither. Don’t be so hard on yourself. Rethink it and ask yourself what happens to the poor in states that opt out? Then consider its effect on the ability of the public option to make a difference in states that have it when its overall size nationally is diminished reducing, if not eliminating, its ability to use economies of scale to reduce costs. Republicans will say, “We told you it wouldn’t work,” and the states without it will remain that way probably putting off any meaningful chance for reform for another 20+ years and hundreds of thousands of people, if not millions, will keep on dying because they can’t afford basic health care.

This is a lose-lose proposal that only our Nobel Peace Prize winning President and the Democrats in Congress could love and call a victory.

BTW, I wonder if the health insurance companies and Big PhRMA bought it for him?

some folks act as though they are afraid to allow voters to have a say on this issue.

One of the main problems that liberals have is that they do not trust people with whom they disagree to participate in democratic processes because liberals fear that others will not make the correct decisions.

I’d prefer to cut out the corporate middle people and let voters hash out conflicts democratically, accepting that the cards will fall where they may.

Jane has a fresh cross-post already in progress: “Veal Pen “Opt-Out” Gaining Steam? Where?”

Some of the Southern states have recently become very nearly to or just barely blue states. If they get sold out by Democrats this quickly, these states may go back. That’s not because the Republicans would be better, but because people who have recently gotten involved may feel that even when they get Democrats elected they still get sold out. They may stay home instead of working to help Democrats win.

If we’re arguing that the Conservadems who imitate Republicans are intellectually and morally bankrupt, then helping to bring health care to uninsured Americans anywhere, but especially in Conservadems’ states, even if only for a day, is a moral victory, however small, and makes a statement, yes, speaking the truth to power, though it may not be anything they don’t already know.

I guess, aside from doing something that morally right, I’m not sure what better ideas you have.

You don’t think speaking truth to them will help.

You don’t think that acting morally will show others the moral bankruptcy of the Conservadems, either.

What’s left?

Again, please consider donating to The National Association of Free Clinics, which has already begun to help thousands of fellow Americans, even if only for a day.

Click here to donate to The National Association of Free Clinics (NAFC)!

sorry Knox, but Schumer aint thinkin’ anything but cover at all costs – sadly this is just one more ploy in the oft discussed Incumbency Protection Racket

Jon. Reasonable, but if the opt-out is the plan’s major weakness, I ask which states are really likely to opt-out & what % of our population do they amount to? It’s not a very strong argument to suggest the “possibles” instead of the “probables” at this point of the fight. Everyone knows when it comes down to it, how few of our net-taking states actually refuse Gov’t. perks. And, the end-game is near.
While I agree COMPLETELY with Jane that this proposal is a “perfect example of what is wrong with the Democratic party”, so what? That’s the world we live in. I take it for granted how ineffectual our Congress (including Democrats) has become over the last 30 years, why don’t you? (This is the one truth Dick Cheney got right!)
Nothing happens in Washington without compromise. Obama could care less about ideology, he’s argued over and over for compromise. He’s THE pragmatist of our day. Further, it’s abuntantly clear the Senate is the true “decider” on this Bill and it will enact as little change as it can get away with. Historically, without STRONG White House leadership, this is what the Senate does.
So, the only relevent question is, how far can the Senate be pushed? I might be missing something here, but a strong p.o. with an “opt-out” seems like a tremendous win FOR MOST OF US. NO, it’s NOT perfect, not even close. It obviously won’t make you happy. But, it offers significant change & that in itself would be MONUMENTAL. Think not? What else has EITHER Party done in the last generation to help the great majority of our families?

As I posted earlier I’m from Washington. As often noted Oregon, Washington, and California are very active with initiatives and referendums. For every “good” initiative on a (relatively marginal) issue like medical marijuana or treatment of farm animals, we have to fight off ten that revoke basic rights or gut the budgets or shift the tax burden in favor of corporations. And often we fail. WA has two scary, scary ones on gay rights(VOTE YES ON 71!) and budget limits(VOTE NO ON 1033!) this year, both on the bubble. We’ll see.

If there were reforms that changed the funding of voter intiatives and campaigns great, but it will never happen until all three states opt out of the public option.

You think Schumer’s been angling for this “opt-out” nonsense from the beginning?

I think not.

He’s getting what he can get now and hoping to turn it into more when he can, maybe when they merge it with a House bill.

If the choice is between creating a robust public option that my neighbors here in California can use at the cost of allowing Jesusland to opt out and forcing my neighbors to patronize an insurance company or go without, then the choice is clear to me.

I find it immoral to deny health care to people for whom it is within our political grasp to help.

This “everything for everyone” trumps “something for some” is a prescription for perpetual failure. The problem arises when the incremental becomes excremental. And never, ever challenge Americans’ divine right to be stupid.

I think you’re 100% right. It is immoral to deny health care to a single American. But we live in an imperfect representative democracy.

I find it immoral to deny health care to people for whom it is within our political grasp to help.

What if it’s not within our political grasp because of Conservadem and Republican assholes who are blocking it?

How do we tip the political tables? That’s what I meant by asking if you have any better ideas?

Sorry, but again, please consider donating to The National Association of Free Clinics, which has already begun to help thousands of fellow Americans, even if only for a day.

Click here to donate to The National Association of Free Clinics (NAFC)!

we are both obviously conjecturing concerning any probable result via a voter referendum.
and while many issues are often swayed by the amount of money spent, it is not necessarily the case.
btw, i don’t regard medical marijuana and assisted suicide as “relatively marginal”. it’s amazing that anyone would attempt to characterize either in that light.
anyway, i would predict that few, if any, states would actually opt out, if voters had their say. unlike many issues that come up via an initiative where voters may not know much about the issue or may have limited knowledge or little or no involvement, each and every citizen deals with this issue on a very intimate basis.
while some idealogues will hold the line and some plain idiots may be swayed by a huge amount of money flowing into a state, i’m confident that most people clearly understand that they are better if they do not have to deal with private insurers.
i’d trust voters with that choice any day.
besides, if a state’s voters choose that way, so be it.
i’ve lived from one coast to the other, in the north, east, midwest and now the west. each state is very different. you can cross a state line and you’ll notice a very different attitude based on where people choose to live.
when i cross the bridge into vancouver washington, i notice a very different mentality, as many people choose to live in washington – as opposed to oregon – because they don’t want to pay certain kinds of taxes. that is their choice.
if most voters in texas do not want a public option for health care, well they are welcome to that choice. that is democracy.

It is within political grasp to provide a public option of some configuration to those in states which do not opt out under this proposal.

It is not within political grasp to provide a public option of any significance to those in states which would out out.

One should support an opt-out bill if one finds the above two propositions to be true and delivery of health care financed by the government to the most people possible is the goal.

Back to basics: Any state that opts out may well satisfy their own teabagger population, but does that necessarily and invariably refer to a significant majority of its voters? I have my doubts. I lived in Arizona, for example, for more than forty years and while for the most part it was run by a Republican majority, there were more than enough Dems, progressives, independents, and yes, Hispanics, to elect Democrats to the state house, the Congress, and the governorship. My gut says that while it’s true that Republicans feel they can stomp on some of the people some of the time and some of the people all of the time, they should consider the fact that it’s grossly unlikely they can stomp on all of the people all of the time. I say go for the opt-out option and let the people’s voice be heard, state by state. A robust public option will benefit everyone everywhere; if a state’s local officialdom chooses to play the game and opt out, they may well have imposed term limits upon themselves, and if the people throw them out and demand opting back in, so much the better for all concerned. Save for the political fascisti, of course.

Did I miss the part where Republicans promise a strong public option if they get the right to opt-out? Is this just another concession with nothing promised in return? We say it will be budget neutral unlike just about everything else. We take single payer off the table when that would save a huge amount of money. We give up cost control measures. We give up the right to negotiate for the best price on medicine. We delay when the program will start. We limit who will be eligible. What do we get for all these concessions? We do not even get the promise of one Republican vote. The most we can hope for is one, and she is about to branded as a traitor and primaried by her own party.

I completely agree with you. I do not support an opt-out bill at all, though I am trying to understand some recent statements by Schumer and Dean.

As for my suggestion to donate to The National Association of Free Clinics, my point is only that we need to use a variety of methods to achieve the goal of pressuring/shaming Blue Dogs into not blocking an up-or-down vote for the public option on the Senate floor.

I’m not sure how to say it clearer. I think that this is a step in advancing a larger goal.

This is just hyperbole. First of all, it would take a pretty poorly conceived political calculation on any of those states’ parts to opt-out. If the public otion truely works to reduce costs, the political future of their party would be doomed. Second of all, Republican governers of blue states would not dare to opt-out even if it were solely in their power to do so. Seriously, you think Vermont and California are going to opt-out? Connecticut? Rhode Island? Hawaii?? Are you joking? They’d be tarred and feathered! This is just a way of inflating the numbers. Cut out the scare tactics.

I keep hearing the “I thought we were in it to help everyone” line. Well, I heard the opposite line of attack during the stimulus fight: “Ok, Republicans, vote against it. But your states can go without the money.” I was all for that, and I’m all for this. Let the Republicans dig their own grave. Let them go without the benefits. That will do more to ensure a progressive majority in the future.

Then progressives ought to stop fooling around and just vote against the bill, because of the likely inadequacy of any PO in it. They ought to let the President and the blue dogs stew about it for a few months and then come back next year when the blue dogs are facing re-election. See what they do when their seats are on the line.

I really have questions about your claims about the numbers. According to the eligibility restrictions in HR 3200, when the PO begins in 2013 only those who can’t get insurance at work will be eligible. How many are in this category about 60 million altogether? If 50% of these are vulnerable in your worst case scenario, then that’s 30 million rather than the 154 million you cite above. Also, the devil is in the details on this one. What are the specifics of the opt-out and any later opt-in? We don’t know yet.

However, there are worse problems with the position you’re taking than I’ve currently indicated. I posted the remarks below in replies to Posts by Jane and later Teddy Partridge.They’re also relevant to your post, so I’ll repeat them here

“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 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 indicated by the results of the survey were again in favor of the PO.

This feature would get by the problem of Republican Governors or legislatures trying to deny the PO benefit to their citizens out of ideology or spite.

Just to highlight something I perhaps didn’t sufficiently highlight in my original comment in reply to Jane. An opt-out provision has been proposed, I assume its of value to the Republicans, Conservadems, or blue dogs. If that’s true don’t give it away for nothing, or pre-compromise it, as some did here with Medicare for All. Make them pay dearly for it, or defeat the present bills and come back next year when they’re up for re-election and in a panic because they have no health care reform.

Jon, you closed by saying:

“This opt-out “compromise” is a perfect example of what is wrong with the Democratic party–they are too willing to compromise their ideals. When did the noble cause of “universal health care,” become the goal of some insurance reform which will help some people? The Democrats completely control Washington. There is no need or excuse for compromising their principles.”

I entirely agree, and above I made the point that “Everybody In, Nobody Out” is a principle that has already been compromised before this opt-out. Most of you are currently calling on everyone to fight like hell for HR 3200 or a similar bill. But, the truth is that such a bill makes “the noble cause of “universal health care . . . the goal of some insurance reform which will help some people.” It is already a sell-out. It will leave 17 million people uncovered by CBO estimates. That number is likely to be much larger by 2013 as well, since that bill contains no way to bend the cost curve and prevent the insurance companies from driving up prices 40% between now and then. At that point, even more people will prefer to ignore the mandate and go without coverage.

The only alternatives to a bill that won’t cover everyone are Medicare for All bills like HR 676 and Jacob Hacker-type PO bills. Neither of these types of bills are on the table now. To get one or both on the table we have to defeat the bills that the legislative process has so far brought forth. If we work for anything else right now, we are working for a bill that “will only help some people.” We are selling out. Just as surely as the folks who are willing to allow a State opt-out.

The question posed by the author of this blog is not the relevant question. That’s why the numeric values provided are equally irrelevant to the larger issue that needs to be addressed. This issue is how do we cover the 47 million people who are currently uninsured, and not how many people, both those with and without insurance, have access to the PO.

Of the numbers given for all people that would be denied the PO, should their states opt out, what we are interested in is how many of them would actually be eligible for the PO by virtue of being currently uninsured. The answer given would of course be less than 47 million.

For the PO to be viable it must include a sufficient numbers of enrollees in order to spread risk and thereby keep premiums affordable, supplementing subsidies for this purpose as needed. Also the premiums must be less than that of private insures and government subsidies would be adjusted accordingly.

So say that a quarter of those currently uninsured were opted out from not having the PO available to them, 12 million or so, the PO for the rest of the currently uninsured would still remain viable. It would be dealing then with insuring 36 rather than 47 million, enough enrollees to remain viable presumably.

The real question then becomes why would any state deny the small fraction of their uninsured population the chance to receive it from the government at no cost to the state? The only reason, aside from crass indifference, is that they can’t abide the government intrusion. They can’t be driven by their free market idolatry and prostration to insurance giants by attempting to render the PO null and void. We have seen that the effect of opting out on the PO’s viability is marginal at best.

I guess that since Carper from Delaware apparently introduced this gambit the motives may include simple graft. The task of keeping people relentlessly bent on destroying this nation at bay seems endless. This asshole should be voted out and an equally relentless campaign against him should unleashed throwing everything at this fuck.

The strategy you are calling for would be a total folly. During election years the legislature is extremely timid. It’ll be much more difficult to pass any reform, let alone an even MORE progressive reform if we push the whole thing to next year. If we do that, then the Dems and Obama will have a huge defeat looming over them and lose seats to Republicans next year. If that happens, you can kiss reform, ANY reform, goodbye.

As I’ve said a million times now, 676 has absolutely 0 chance. I’ll repeat it again. It won’t happen. It would not pass an up or down vote in the senate even IF it were by some miracle able to get around a filibuster.

Working our butts off to defeat something that has a chance under the outlandish notion that the House and Senate are spontaneously going to become more liberal next year, an ELECTION year, AFTER being defeated on a more moderate bill, would be like turning down a free car because maybe tomorrow the car you already own might suddenly become an hover car.

Hi MosquitoFleet, Thanks for your comment.

You claimed:

“The strategy you are calling for would be a total folly. During election years the legislature is extremely timid. It’ll be much more difficult to pass any reform, let alone an even MORE progressive reform if we push the whole thing to next year. If we do that, then the Dems and Obama will have a huge defeat looming over them and lose seats to Republicans next year. If that happens, you can kiss reform, ANY reform, goodbye.”

I know this point of view, sometimes things work that way, but I think only at medium levels of fear. If the President and the blue dogs end up with no reform, the blue dogs will be facing sure defeat, a blood bath of the kind they experienced in 1994. They’ll absolutely need a real health care reform bill that looks like it will work. They’ll be scared “shitless.” And they’ll be willing to agree to any bill, even one that provides for a Jacob Hacker-type PO.

If progressives, most of whom come from safe districts stand firm, the blue dogs will have to cave. When was the last time the progressives played chicken and lost? Answer never, because they never play chicken. That’s why they always get rolled. Well, I think it’s time for progressives to stand up and roll the blue dogs. We can do it because they need a bill politically more than we do.

You know there’s one thing about a tough negotiation, if you’re not prepared to give up a deal you can’t get the deal you need. You PO people haven’t been prepared to leave the table and tank a bad bill. So what you have been getting are bad bills, even with 60-75% support of the public for the PO, depending on the poll you look at. You’ll keep getting bad bills until you have the guts to recognize and say no to crap providing giveaways to the insurance industry.

Next you say:

“As I’ve said a million times now, 676 has absolutely 0 chance. I’ll repeat it again. It won’t happen. It would not pass an up or down vote in the senate even IF it were by some miracle able to get around a filibuster.”

Did I say that HR 676 has a chance to pass? The strategy I want progressives to follow is here. It doesn’t assume that HR 676 has a chance to pass. It only assumes that progressives have the votes to tank anything else if they want to. That power gives them a good possibility of getting at least a very good PO of the kind discussed in the above link. It’s not a Jacob Hacker-type of PO. It’s better.

Regarding the filibuster, progressives shouldn’t worry about it. They should assume that something good can be passed through reconciliation or getting rid of the filibuster altogether. I’ve discussed reconciliation in the piece linked to above also. Here and here are two other posts that talk about getting rid of the filibuster altogether. It’s not hard and I won’t accept any more BS about how Democrats are limited by the filibuster, because that’s just a lie. It only limits them because they want it to limit them, so they can have an excuse for selling out. Progressives need to remove that excuse from Democratic politics.

You end with another very questionable notion:

“Working our butts off to defeat something that has a chance under the outlandish notion that the House and Senate are spontaneously going to become more liberal next year, an ELECTION year, AFTER being defeated on a more moderate bill, would be like turning down a free car because maybe tomorrow the car you already own might suddenly become an hover car.”

1) I wouldn’t advocate for the defeat of something that has a chance if it were worth anything. But HR 3200 or an even weaker compromise bill that is likely to come out of some attempt to merge the bills “on the table” has negative value. It creates a PO that won’t work and will only prove to be people that the Republicans are right about Government. These bills are dangerous to progressives. A merged version of them will set us back a generation. It will have little in common with Jacob Hacker’s original proposal except the use of the term PO.

2) I never said the House or Senate would be more liberal next year. What I’ve said, or at least implied, is that they will be more frightened. It is their increased fear that will cause them to accede to a more liberal bill, not their increased liberality, which as you say, won’t exist.

3) Your car analogy is completely inappropriate and unpersuasive. The upcoming bill is not a free car, it is a car that has a high price for progressives and blue dogs, and that has negative value the minute it leaves the showroom. It will defeat us in 2010, unless by some miracle the Administration can persuade people that it is solving the jobs problem. Unfortunately, the President’s own timidity and the blue dogs foolish market-oriented balanced budget ideology are likely to make that impossible.

This “Public Option” is newspeak for a government option. A public option would be a real referendum for the people to vote on.

If this were a democracy, these issues that affect us all would be left up to each state to hold a referendum and let the people vote.

As is, we are being held hostage by “representatives” that fail to represent. We cannot recall them. We can vote them out only every two years.

I can change insurance companies without a revolution.

I do not my medications delivered by the government that sends me the mail addressed to others.

OPT IN with a referendum is constitutional. OPT OUT assumes a power
not in the Constitution for Congress.