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.

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.

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.

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.

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.

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.

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.

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.