What if Lyndon Johnson, to get the Civil Rights bill passed, had said it would be okay to allow individual states to opt out? Just asking.

Aye, and people who call the civil war “the war of northern aggression” would argue that the south should have been able to “opt-out” of freeing the slaves. In any case, I have friends and family in plenty of red states; When it comes to politics I sometimes want to ring some of their necks, but I’m not throwing them under the bus to score a win for the White House.

Jon, It’s only critical IF Texas were to opt out. I think there’s as much chance of Texas opting out of a robust healthcare plan with a p.o as there was that it would “secede”. You’re illustrating a big problem with the Democratic Party. It takes Every little nonsensical comment any Repub makes as, “oh my god, how will we ever survive IF they do that”? It’s about time Dems focus on squeezing every drop into whatever Healthcare Plan it CAN pass and get it done. Personally, I’ve drawn my line in the sand. I’m fed up with the party! The Repubs couldn’t have picked a “friendlier” financial team for ITS constituency. Obama couldn’t have promised “hope” for more process change and run away faster than he has. The Dem. Congress couldn’t have wasted more of the most valuable time an Administration given clear majorities in Congress has.
I’ll say it again: I have been a Dem. supporter, walker, voter, fundraiser for decades. IF the Dems don’t pass a strong Health Care Plan I will NEVER AGAIN walk for, raise money for or vote for another Dem for any office at any level. It’s as easy as that.

Thanks, Jon. I hadn’t considered the fiscal “collateral damage” of this Opt-out thing. Ultimately, as I said in the previous post, this opt-out heads down the road of increasing complexity which plays in to the hands of the healthcare cartel. No good.

Letting the reddest states opt out should therefore make health care reform between roughly $6-$25 billion more expensive. Who is going to pay for that?

The same people who pay for everything else, the middle class. That being said I don’t know how much longer it’s going to take to completely wipe them out.

Jon,

The battle for the public option without this opt-out nonsense is not over!

Let’s hope it doesn’t come to this.

AND THE KILLIN’ GOEZ ON AND ON AND…

Citizen Jon Walker:

The “opt-out” shiny object is like trolls are at FDL: a distraction. Of course the “opt-out” is morally bankrupt, probably unconstitutional and ultimately unworkable for either side in this debate so let’s not slow down here…let’s not snatch defeat from the jaws of victory. Get a fuckin’ strong public option to the floor for a vote with or without a narrow “opt-out”. A vote on real healthcare reform is the only objective, everything else is distraction.

KEEP THE FAITH AND PASS THE AMMUNITION, THE STRUGGLE GOEZ ON AND ON AND…

Letting the reddest states opt out should therefore make health care reform between roughly $6-$25 billion more expensive.

If red states opt out, then that will cut into the amount of savings that would be realized by a full national no opt-out PO.

It will not cost more money, rather will save less.

Far be it for me to get between red staters that want to fuck themselves.

“We should not let Rick Perry force the rest of the nation foot the huge bill…”

But what if he has really “good hair?” Isn’t there some sort of exemption for that?

Opt out, Schmopt out. Feh.

Citizen Bailey2739:

You are a voice of reason in a chorus of shriekin’ Chicken Littles.

There will be no opt out Jon. It is unconstitutional on so many grounds. If they don’t do it right, they are going to have direct blood on their hands. Perhaps a million people in this country have lost people in their families to murder by insurance. Another 10 million have lost their livelihoods. Another 40 million are losing their homes and there aren’t going to be to many days left for them to fix this, or require the military back on the streets in this country to keep order. I don’t think even an American soldier would take such an order.
What comes next after this not so velvet revolution?
They are beginning to understand. Even Wyden says he will vote for a public option, and he’s an insurance company’s best friend.

True. It would not only cut into the amount of savings, it would reduce the impact of a public option in creating competition and holding the private insurance companies accountable.

We need a full national no opt-out PO.

Besides, why is it ok to give the states the choice to opt-out of public health insurance, but to deny greater choice to individual citizens in those states?

Man, it’s as if you have no conception of how insurance works.

Again, we should always keep it in our minds that this whole “debate” began from a compromised position. Single payer (the smart, logical choice) never even got to the table. Hence, no more compromises. Nothing. Nada. Zilch. The Blue Dogs and their ilk can go pound sand on any of their idiot shiny objects.

It is unconstitutional on so many grounds.

Existing social welfare programs allow states to opt out, which is why the red states have crappy social safety nets and the blue states’ are more robust.

How is an opt-out unconstitutional?

But what if he has really “good hair?” Isn’t there some sort of exemption for that?

Heh. The Goodhair Exemption.

Besides, why is it ok to give the states choice, but to deny greater choice to individual citizens in those states?

It is not okay, but it is acceptable if that is the cost of making a robust public option available to people in states which want it.

let the insurance companies that provide coverage in those states pay in the form of a surtax per capita in the amount of the projected savings lost.

It is not okay, but it is acceptable if that is the cost of making a robust public option available to people in states which want it.

That’s what this so-called compromise is all about? Not acceptable.

Man, it’s as if you have no conception of how insurance works.

Man, it is as if you think that the ponzi scheme that is health insurance in the US has anything to do with pooling risk according to the principles of actuarial science.

They are paying claims from premium dollars and shedding burdens whenever possible.

Health insurance in the US does not pool risk, it pools profit.

that is savings to the FEDERAL government. If the states don’t have a public option the FEDERAL government would need to provide the people in those states with larger tax credits. It would not cost the state it would cost the nation.

That’s what this so-called compromise is all about? Not acceptable.

So you’d rather see an individual mandate with no public option than an individual mandate with an opt-out public option?

that is savings to the FEDERAL government. If the states don’t have a public option the FEDERAL government would need to provide the people in those states with larger tax credits. It would not cost the state it would cost the nation.

Again, given the choice between skyrocketing costs with an individual mandate and no public option, and an opt-in public option, the latter looks good.

It is not a foregone conclusion that red states will opt out.

And if you have more sick than healthy in the public option pool, what then my actuarial wizard?

I’m confused. Do people in the know (like the many here) really think that some states would opt out?

But as marcos points out, having most of the states and about half the population of the country opted out would also diminish the impact of having a public option, which is intended to create competition and get private insurers under control.

The point is to get health care costs under control, and this opt-out nonsense ruins that!

The estimates were 1/4 to 1/2 of people would possibly be opted out under various scenarios. I doubt Florida would opt out.

The point is to get health care costs under control, and this opt-out nonsense ruins that!

I do not accept that cost control is a priority for the Democrat leadership in the Senate and White House because their actions do not support such a conclusion.

Have you been appointed to antagonize me today? NO. I have never said that I want to see an individual mandate with no public option or an individual mandate with an opt-out public option. Honestly, I’m not sure why you insist on seeing things – that are not there – in what I am saying. Does this go back to my suggestion that people donate to The National Association of Free Clinics?

I do not accept that cost control is a priority for the Democrat leadership in the Senate and White House because their actions do not support such a conclusion.

I never said it is a priority for the Democrat leadership in the Senate and White House, though they have stated that it as one of their priorities. I’m saying that it is one of my priorities.

And if you have more sick than healthy in the public option pool, what then my actuarial wizard?

Doesn’t that come part and parcel with the PO as incarnated, that PO participants will likely be somewhat less healthy than the population at large?

Also if the PO pool is large enough, then it can exercise buying power to drive down costs. The 1/3 reduction in worst case opt out scenario should allow the pool to be big enough to exert downward pressure on costs.

I support the opt out provided mandates remain in place for states who opt out. Why? Because state politicians will not opt out if the result is to force their constituents to pay monopolies for insurance while their friends and families in other states enjoy the benefits of competition, lower rates, from the governmet insurance program.

Then all the other services in these states begin to suffer as a result. Folks still will be going to the ER and overloading that system.

Can I still assume a mandate is still on the table even though a red state opts out of a po? Where will the subsidy $ come from then if citizens have to buy from the insurance thieves? Certainly they can’t ask the GUVMINT since they opted OUT of their plan.

I never said it is a priority for the Democrat leadership in the Senate and White House. I’m saying that it is my priority.

Well, Senator Knoxville, I don’t know about you, sir, but my opinion don’t count for squat when it comes time for writing these bills. Eyeballing it, it seems we’re going to have an individual mandate no matter what, but the PO is still iffy. Compromises to ensure that some PO with some strength is implemented are going to be required. Two potential ways a PO might see the light of day is a watered down national PO or a more robust opt-out PO. I’d prefer to see the latter, but there must be a PO in the bill if there is to be an individual mandate. And that PO needs to be viable in the political real world.

And, yes, it is quite possible that a poison pill PO is what emerges, one that can make things worse.

I agree cost control is not their priority based on their actions. The opt out lets them pass the buck to their state brethren. It lets them tell their insurance ocmpany sponsors I did what I could to save yoru profits now it is up to the state legislatures.

And state politicians will not have the balls to opt out. Maybe one state at most, then the resulting electoral slaughter will put a quick end to opting out.

Canada achieved universal coverage one province at a time.

I am curious to hear arguments why any opt-out plan would be unconstitutional.

The important issue is whether opt-out states would be able to subsidize a more expensive health care system from other states or federal budget. If they could, it would be a bad idea. If safeguards are can be put in place to prevent (or more realistically delay) subsidies for crummy expensive systems in opt-out states, then I would go with a strong public option with an opt-out. And to me, strong public option means everyone gets to chose public option if they want to. I would sign up for that kind of public option in one NY minute, and I have pretty good health insurance, but at this point, I do not trust it to stay good for any length of time.

Also important is what mechanism is proposed for states to opt-out. It should be something that is responsive to public wishes (say, voters can force state to opt-in through a referendum).

It would be very unfair and unjust at the beginning, but I would bet that with a few years, opting-out would be a brief historical interlude, because a public option would prove far superior than a lightly regulated private insurance system with bogus patchwork health safety nets.

My firm belief is that regardless of public option, whatever health reform can pass now will be so partial and flawed that it will have to be redone anyway within a few years. So my top priority is a law that will move us towards a better system. I have given up any hope that anything that can be passed this year will be a viable or successful reform in the long run. So at this point, I will take anything that will ratchet the country towards a sensible system.

An example of why, is the fact the determination of supply of healthcare professionals, and pricing structure run by very short run federal budget concerns and small closed AMA committees will still be there. The whole issue of a mindlessa and perhaps corrupt approach to determining healthcare professional supply is completely untouched. That is why voucher proposals are BS -with supply side of market a mess, a voucher system will just result in worthless vouchers or increasing costs within a few years.

As I have sad before, many countries with good systems had to settle for halfway houses and partial reforms over a decade before they got a good system. Key is relentless and continuous public pressure, electing more honest progressive Congresspeople, until a good system can be obtained.

I disagree.

The opt out compromise allows for a more robust public option. Those ssenators who are protecting their in state insurers can be told if protectign these monopolies is that important to you, opt out.

IN practice, once a public option is established I doubt any state legislature and Governor would have the walnuts to opt out. I’d even let them opt out of Medicare, perhaps they ought to tie the two, i.e., an opt out applies to Medicare and the new public option.

Well, Senator marcos, I’m sorry you think that your opinion “don’t count for squat when it comes time for writing these bills.” I think the opinions of citizens do count, and I for one am going to speak loudly and get as much as possible in this once-in-a-generation opportunity. Funny that in the end it seems like you’re a whole lot more willing to accept a compromise of a compromise than I am!

I still want a Rockefeller-type strong public option or, at a minimum, a Schumer-type level playing field public option that states can’t opt out of.

I faxed my letter to Reid. Now I’m off to drop it in the mail.

The bloggers and commenters who think an opt-out provision will not be used by red states are conning themselves, and anyone who thinks that it’s tough love for GOP controlled states, or that the disgruntled citizens therein will throw off the chains of the insurance company oppressors after the contradictions are sufficiently heightened are missing a chunk of their brain or their heart.

I don’t want my red-state legislature and my GOP governor to decide that I don’t need affordable health insurance. I don’t want rich carpetbaggers coming in to convince my shall-we-say “easily persuadable” fellow citizens that the public option is socialism and therefore we need to opt out of it.

I saw the same thing happen with the Orwellian “right to work” law and Ward Connerly’s “Civil rights initiative”.

Hell, when it came to Connerly’s ballot proposal, even the corporate centered Lincoln Journal star and the reactionary Omaha World-Herald wrote op-eds against it, and it still passed. So, no more affirmative action for my state.

The truth is that big money and loud megaphones almost always trump the needs of a disinterested and uninformed or misinformed populace.

I don’t want a goddamn opt-out, I want healthcare!

IN practice, once a public option is established I doubt any state legislature and Governor would have the walnuts to opt out.

But you only disagree because you’ve convinced yourself that leaving the opt-out in won’t lead to nearly half the country not having a public option, because you’ve convinced yourself that all the states will opt-in.

That is a very bad bet.

Jindal and his cronies are already planning for Louisiana to opt out. I am hoping this puts the nail in his coffin but I am concerned about the citizens of Louisiana who will die because of this.

I found this link after checking my email updates about healthcare:

http://www.statehousecall.org/…..lan-for-us

So they are going to use this issue as a political tool. Nice.

If the so-called liberal Democrats just sit there and allow putting opt-out into bill withouht demanding something in return, that would be sad. I would demand concessions for opt-out, which would be:
1) strong public option in sense that anyone could enroll in public option,
2) require a popular method to by-pass opt-in opt-out decision (this is people’s lives and health at stake, what excuse is there for leaving it up to corrupt governors and legislatures,
3) specific safeguards to prevent opt-out states from subsidizing their crummy systems with funds from other states or federal budget.

I we had that, I would go with public option plus opt-out. As I said, I think opt-out would not last long with those conditions.

That is a very bad bet.

Worse than betting on a universal PO that might not materalize where we’re still stuck with an individual mandate?

So you’d rather see an individual mandate with no public option than an individual mandate with an opt-out public option?

This is a false choice. As has been pointed out repeatedly, democrats have the votes to pass a stronger PO on a simple up or down vote. No democratic senator – not Nelson, or Lieberman, or Blanche Lincoln – has come out and said that they will join the GOP on a filibuster.

This opt-out gimmick is just that, a gimmick. It’s a trick to divide and conquer those who advocate REAL healthcare reform. And as we see by the many comments here, it’s an effective tactic.

But let me reiterate. I live in a red state where easily persuadable citizens vote against their own best interests again and again, as a result of well funded propaganda campaigns. Well screw that.

I don’t want a goddamn opt-out, I want a public option!

I think the opinions of citizens do count, and I for one am going to speak loudly and get as much as possible in this once-in-a-generation opportunity.

If the opinions of citizens did count, this country would look a lot different than it does.

Funny that in the end it seems like you’re a whole lot more willing to accept a compromise of a compromise than I am!

If you’re going to shoot for the moon, at least have enough oxygen, fuel and navigational expertise to get there and back. Do you have the political equivalents of those requirements in place to achieve a robust public option nationwide, and if not, can you get them and if so, from where are you going to get them?

I still want a Rockefeller-type strong public option or, at a minimum, a Schumer-type level playing field public option that states can’t opt out of.

We agree.

I faxed my letter to Reid. Now I’m off to drop it in the mail.

That and $3 will buy you a latte at Starbucks.

I don’t want a goddamn opt-out, I want a public option!

I want a pile of fucking gold bricks delivered to my doorstep too, damnit!

I like the way marcos uses “Democrat leadership.” Now where have I heard/seen that before?

I’m not really likin anything about the guy.

I like the way marcos uses “Democrat leadership.” Now where have I heard/seen that before?

I use that phrase because it really pisses off Kool Aid drinkers like you and many others here in CD-8, Pelosi’s district, who assign guilt by linguistic association to anyone who strays from the reservation.

I’m one of those Greens who didn’t vote Democrat after Clinton in 1992 until Obama, so my criticisms of the Democrat Party come from a position of sanity (not Hannity) rather than right wingnut land.

marcos,

you still haven’t made the argument that the opt-out compromise is necessary. It’s not.

We have the votes for a public option (see post at top of FDL homepage right now) no senator has ever gone against their party to sustain a filibuster (see the post right below top of homepage, right now).

You have no argument, all you have is “worries that we may have a mandate w/o a PO”.

That’s a false choice. You have yet to make a case WHY it’s necessary to have an opt-out that we don’t need.

Let’s hear it.

Bullshit

You’re gonna have to do a lot more than that to piss me off, sonny.

It’s vaguely familiar. :)

willf, if the votes are there to stop the filibuster and to pass a robust nationwide public option then wonderful.

If either of those tests fail, then what?

A green that wants democrats to compromise a hugely popular position with corporatists because he comes “from a position of sanity”?

Truly a rara avis.

Weren’t you the one touting the advantages of anarchy yesterday or day before?

The position is not hugely popular within the Democrat caucus in the Senate, otherwise, we’d have seen a different outcome at the Finance Committee.

Remember that you’re entrusting Harry Reid with the power of putting forth the bill, which would require more hurdles to amend on the floor if the PO is anemic or absent.

Again, I’d love to be proven wrong, but I’m not seeing much contingency planning going on here.

Anarchy is a political philosophy that animates people like Noam Chomsky.

Well, see, it’s not our responsibility to prove you wrong. It’s your responsibility to prove you’re right.

I also like the way you dance around questions.

There is no proving right or wrong until the votes are cast and the bill is signed.

Options should be kept on the table as long as possible to ensure that worst case scenarios can be mitigated, not dismissed for not being pure enough for a polluted bill.

Back to the cesspool.

Namaste

Not strictly on-topic, but related, and outrageous. Red-state Oklahoma is now going to post info on-line about women who receive abortions.

If you’re going to shoot for the moon, at least have enough oxygen, fuel and navigational expertise to get there and back. Do you have the political equivalents of those requirements in place to achieve a robust public option nationwide, and if not, can you get them and if so, from where are you going to get them?

You shoot for the moon and, yes, accept compromises along the way. But you don’t start whining about each point you’re willing to compromise on before each battle is over.

That [sending a letter to Reid] and $3 will buy you a latte at Starbucks.

If the opinions of citizens did count, this country would look a lot different than it does.

If you really believe that your voice has NO power in our representative democracy at all, then why are you here distracting those of us who do believe that our voices count?

I don’t expect my one voice to decide an issue one way or another, but I do expect to have some influence, however small.

You do understand that we have a representative democracy with hundreds of millions of citizens, right?

I don’t ask to be mean, but hopefully to make you think about what you’re trying to accomplish.

You shoot for the moon and accept compromise along the way.

Unfortunately, the President compromised with himself at the outset and that has severely constrained the options which are viable now.

If you really believe that your voice has NO power in our representative democracy at all, then why are you here distracting those of us who do believe that our voices count?

Voices count only when they’re organized and presented in a way that counters our opponents. I’m unemployed, but gave $10 to http://www.freeclinics.us/ because that is organizing people in a way that will matter. Other than that, organized labor is the only liberal/progressive formation that has the capacity to organize, but they’re too busy fighting one another.

We’ve got to be thinking about eventualities two and three moves further along in the process should we not get what we want that maximizes the product under very adverse circumstances.

So, if the Finance Committee is any bellwether, it is going to be an uphill fight to get any sort of PO in the Senate Bill, and if Harry Reid is the one who makes the calls on its character, then the Senate PO is going to be very weak.

Do you anticipate the Conference Committee reporting a bill that looks more like a Senate public option or a House public option?

Against this backdrop, with little capacity to effectively leverage broad public support into effective political pressure, I think it is counterproductive to knee jerk react against opt-out, which might be a viable compromise, just because it is not what you want.

Glad I wasn’t the only one who felt like marcos was deliberately not understanding me!

marcos @ 63

Voices count only when they’re organized

Sorry, marcos, but you seem more interested in creating phony controversies among us today than in contributing toward common goals, and I wonder how you expect the opinions of citizens to count when you’re here creating confusion with people whose goals are so similar to yours?

Marcos is having a wonderful time arguing. That’s it.

Just another troll.

S
C
R
O
O
L

Look this whole debate is funny…

Your talking about a GOP that still rooted in its racist ideology. They see the Obama Admin and Democrat controlled Congress as evil and the devil. The likelihood of Texas seceding was slim and none, Perry knows that. But as somebody else said, many state opt out of government programs. Look how many states had to fight their Governor to get Stimulus money or money for extended Unemployment Benefits?

What makes you think they won’t try that same shit with Health Care Reform?

What other solutions do you have for Red States? These places have small levels of Blue usually in Urban Areas (not sure you would call Tulsa an “Urban Area”)

I wish some FDL’s would stop saying we have a Republican Governor, when Arnold has been “moderate” though he vetoed twice measures that would have give the State of California Single Payer Health Care, calling it “Socialized Medicine”.

He is in the last months of his term, when it comes back to his desk in mid 2010, he’ll either sign it or the next Governor will, I can wait…

Why not wait? The current bills won’t start until 2013, I’ll be forced to wait and like how many others feel, Americans will die in the meantime.

You can want, want, want until your face turns blue, the reality on the ground says -

We’ll get a watered down shitty bill

It will have a federal mandate

States will be allowed to Opt In/Out

It will only cover 94% of the population even if everybody accepted it

There are no real cost containment measures in it

Its not true reform or Universal Coverage

America lives in a Microwave Society… In Canada Universal Coverage didn’t happen overnight. I know many believe the United States is a great country, its not its a dysfunctional country.

Any country that constantly plays hypocritical football with its constituency is dysfunctional. Truth and Righteousness is trumped by Ideology and Religious Oppression.

Just look at what happens around you? You largely don’t have these same social problems in Western Europe. In countries like France, the French Government is scared of the people, they march, they strike, they throw molotov cocktails at the police…

Here we have Northcom, we know if get out of line, the media won’t cover it and the Army will be put into an uncomfortable position of protecting the State/Federal Government from its Citizens and all you pro War types like unflinching soldiers. Well they won’t flinch when it comes to defended the Republic from one our outburst, they’ll shoot first and ask questions much later if at all.

So as I said before, if you live in a State where its controlled by wingnuts from top to bottom; you two choices -

Leave or Make Them Do What You Want

As a progressive in Texas, thank you, Jon.

There is only one argument you need to know when it comes to the ‘opt-out’ BS. Here it is:

BUSINESSES WILL LEAVE STATES THAT DON’T HAVE A PUBLIC OPTION.

If they set up the public option so that all states have to take the public option and use it for say 3 years. Now, in that 3 years let’s say the public option is working fine. Then, let’s say at the end of the 3rd year, a red state wants to opt out. Fine, but the nationl rates will continue to be calculated as though all the states are still using it. In other word, the public option rates will always be based on all 50 states. As for the people in states who’s legislators want to opt out, it will be up to the citizens to stop them whether it’s through large protest or just getting someone to run against them who will vow to restor it. Since I live in New Jersey, I don’t really care what happens to these people. This is what happens when you VOTE FOR A REPUBLICAN WHO CALLS HIMSELF A CONSERVATIVE DEMOCRAT! IT’S BASICALLY AN OXYMORON!

For further discussion of how far some progressives are willing to bend over in support of the proposal for states to opt out of the public option see the Huffington Post: “AMERICA-STAN: The Progressive Movement Neuters Itself by Supporting ‘States Rights” to Opt out of the Public Option”

http://www.huffingtonpost.com/…..16030.html

The article also discusses how the Public Option has been turned into the “Public Option in Name Only.

An aspect of the current debate pertaining to the PO , the single payer scheme and the private insurance scheme should be established. This is that if the PO is to function at all it will ultimately lead directly to a single payer scheme, and ultimately necessarily to supplant the private insurers. There is but one condition that the PO needs to satisfy, that it offer lower premiums than the private insurers.

The polemic between those that argue for a PO plan now or a single payer scheme now becomes mute. The real polemic is between the private insurers and those aspiring to make the PO viable, because the two can not coexist.

The argument is simple. For the PO to succeed it must offer premiums that are continually lower than private firms, As long as this holds there is no need for private insurance firm to exist and once this ceases to hold there is no need for the PO to exist. Stated differently, the PO exists if and only if the private insurers do not exist. .

A friend of my on disability here in Texas just received a letter today saying that Texas has opted out of Medicare, that his future checks will be cut $400 this month, and $200 forevermore.

He was making a little over a $1,000 a month before and barely making it. Now it will be something like $879 or something like that. How can people survive is my question? He was a NY City cop for years as well as a paramedic, in the military as a helicopter pilot, a professional photographer, and journalist, and NOW he’s “useless” to Texas after a massive heart attack made him have to retire so he gets the shaft????

Yes, apparently.