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The news yesterday was the Harry Reid would include a public option with an opt-out provision in the Senate bill. There has been some reporting Reid might not have the votes for the opt-out and might need to water it down to a public option “opt-in,” state-based public plans, or trigger. A public option opt-in and state-based public plans are two very different proposals that many in the media seems to be falsely equating.
A true public option opt-in would be a national public option that states would need to actively opt in to. The federal government would create a single public option entity, but it would only be able to sell health insurance in states that passed a law to allow the public option in their state. This would be similar to the opt-out proposal where states would need to pass a law preventing the public option from providing health insurance. Probably only a dozen of the very bluest states would pass a law opting in to a national public option. Compared to the opt-out, where the hope is only a dozen of the reddest states would pass a law opting out. Besides denying the public option to most Americans, the other big potential problem with the opt-in is that too few states will opt-in to the public option, and it would be unable to develop the sufficient customer base needed to be viable.
State-based public plans was an idea proposed by Sen. Thomas Carper. States already have the power to create their own public companies to sell insurance right now if they want. “Allowing” states to create their own public plans would in no way be a “compromise,” it is the status quo. Besides the federal government potentially providing states with a large quantity of seed money to help start up these state-based public plans, there really is nothing to this proposal. Given the strong restrictions it would place on potential state-based public plans, Carper’s original proposal would literally be worse than nothing at all.
A public option opt-in would create a single national public option that states would need to opt in to. It would probably be restricted to only a few of the bluer states in the country. A state-based public plan proposal would help states set up public plans if they wanted. They would probably only be established in the same few blue states, but suffer from several additional problems. Many states would probably be too small to properly support a public plan. Having several different state-based public plans would hurt insurance portability and would probably drive up cost since the many different public plans would lack the benefits of scale.
State-based public plans would be a substantially worse idea than a public option opt-in. I suspect the public option opt-in would be able to function (i.e. remain a viable entity that could sell insurance) but its impact would be extremely limited. Since it would operate in only a few states, I can’t see it improving our overall health care system or being big enough to really hold down premiums. Many of the state-based public plans, on the other hand, could easily be too small to even get off the ground or ever function properly. Since the state-based public plans would be limited to the roughly 10% of people on the exchange states like Vermont, Rhode Island, Iowa, West Virginia, Montana, Kansas, etc. would be too small to create a truly viable public plan. While some have confused these two ideas, there is a dramatic and important difference between a public option opt-in and state based public plans.
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The next step is to raise the bar to opting out, perhaps requiring the state to enact a statute to that effect.
After that, to open up the public option to the publc.
And then to reduce the individual mandate to meaninglessness.
And in the long term we’ll all be dead … and/or broke.
And the chance of another national discussion about a newly formed entitlement program (off to a running start in 2013? 14? 15?) will be buried with most small businesses owners (the heart of the economy) and the middle class (the soul of America).
Still, we’ll have the Pyrrhic Option because the peasants feel better about calling nothing –no cost containment, no access to new choices for the public, no universal coverage –something.
And of course it sounds better than ‘shoveling the 9-15M consumers that insurance companies never wanted to touch in the first place into Medicaid II while pumping fresh blood into their monopoly.’ PO is definitely an easier sell, right?
We can still have everything we need right now using current legislation and leveraging an existent program:
-real cost containment through nationwide bargaining
-a priori universal coverage
-unprecedented freedom for individuals and small businesses to pursue new opportunities and take greater risks
Medicare For All / HR 676: the only real option for the American public.
Thanks Jon. There is indeed a huge difference between opt-in and opt-out, mostly having to do with a national vs. state based plan. One is a lot worse than the other.
You really think the opt-in or opt-out will survive the Senate/House conference?
Nothing from nothing leaves nothing.It was a spectacular waste of time.The number of people dying everyday for lack of health insurance,will probably increase.The President’s a gutless bastard!!!All this bullshit was just that BULLSHIT!!! If any of you can glean anything positive from this,then you’re probably Republican.The only real winners in all of this?Health Insurance Industry!!!
It made for some happy talk late PM news on Monday as various American news fountains did the framing that made Congress actually saying a PO was in there sound pretty darn good.
Gosh darn Thank You Congress!
This Opt-Out idea of course seems a pretty easy to do/take off ramp from sticking to a genuine Federal PO plan. Let the states play around with PO. Maybe let the for profits cobble state PO plans together so in essence the for profits get to game in theory any PO plan 50 ways across the United States in each state capitol. Nothing wrong with that idea right?
Heck it is such a brilliant idea maybe do the same thing with Social Security and Medicare then too.
What we saw yesterday was the abdication of responsible and firm Federal legislation to put in place a viable,national PO for American healthcare.
This Opt Out idea is going to be totally gamed and played by the for profits to undermine the unity of a national single PO approach.
Opt Out? Opt In? Opt Around? Opt Maybe/Maybe not?
What we saw yesterday was the shank pushed in hard on a viable,national PO which is only way to give any PO the stature in funding and negotiation standing to take on the big five for profit health insurance houses.
Could we please get past the party favors and see what took place Monday?
This is not a matter of opinion or support. I think an informed debate is critical.
I am really sorry to argue with you Jon, as you spend a huge amount of time on this work. But we are veering off the cliff of distraction with all the explanation for something that still has no framework. I can see that you are resigned to report that insurance is the thing. You always refer to health care with insurance, and the two are not equitable. There is no health care with insurance. There is however rationing of choice, rationing of providers, of provision, and of care. It is trash. It is unadulterated garbage dressed up like a dead pig waiting to become bacon.
If this site is willing to continue to talk about insurance when we should be talking about Medicare health coverage for every god damn one of us, it furthers the distraction and disenfranchises millions of Americans by assumption. This would hardly be productive to the citizens of the country, and would benefit only insurance companies. It is a part of the corruption, and you continue to talk about it as though it will continue and we will have to just deal with it. You are wrong in this respect. I understand you are reporting what you consider fact, but you leave the human equation out of the issue completely.
It is a deal with insurance. I want you to try to understand that you can not deal with insurance and health together. Insurance is to profit from others suffering, or lack thereof if it can be granted by law that the insurance company does not have to payout to the policy holder. It is a selective means for criminal behavior well documented in RICO statutes. They are exempt from such, because they have purchased their exemption from our house of lords and peons.
To assume an unconstitutional provision that disenfranchises some while including others is going to stand even one court test is fundamentally disingenuous. The senate certainly knows this, and the joke is on us for getting our pants in a twist about our lordly gift from the swine that do naught but take rights away from the citizens of this country. They have offered up nothing in this bill. It doesn’t cover everyone, and instead of it being a right, they have figured out how the lowliest of the low will pay for it with the money they would otherwise spend on food.
Further, to assume that any kind of program will work when our government has promised numerous companies involved that their profit will not suffer, is bordering on the psychoactive. Pharma is happy, they get to charge us 8000% more for a pill than they do in Canada or Mexico. It’s built in to the new law, isn’t it?
When will someone stand up and tell these publicly confirmed criminals that we do not accept their giveaways? Will we demand a free, single payer health care system as our fellows in some of the better third world nations get? Will we use our massive buying power to eliminate the cost overrides that cost Medicare alone, 60 to 80 billion a year? Will we cover everyone? Will we never again look at health care and see dollar signs?
Reporting on an unacceptable boondoggle designed to placate idiots and reward campaign contributors needs to be shown for what it is. Will you please create a story about what this “potential, projected, possible, preliminary, plausible, primitive piece of crap doesn’t do? Perhaps we should be looking at this from the bottom up instead of the top down.
HR676 is the only option. As we see the country deteriorate around us, and employment drops again and again due to the collapse of the economy, the people will begin expressing their anger. There is only one way to save this nation from a violent confrontation as families being broken look to those that have caused it and find no reason to understand and cooperate.
Please don’t leave out all that this compromise denies the people of this country.
Makes one wonder why pass a bill, when it gets changed so much.
Stop the opt, I want to get off!
I’m not a cussin’ woman, but agree with most of what you said. I shall keep saying the paraphrase of the former Vietnam vet peace activist, now a US Senator, and former candidate for President: who will be the last person to die before we have single payer – Medicare for All? I think Black Agenda Report has had Pres. Obama’s “number” on health care all along: http://www.blackagendareport.com (Bruce A. Dixon and Glen Ford’s blogs)
That sort of discourse is not allowed up front in first class.
It is critical and thanks for discussing these critical distinctions. But please also don’t narrow the frame to opt-out on the left wing. Yo see where we are we really keep asking the question of whether anything Reid is considering is worth progressive support. I still don’t think it is and make the case here.
Citizen OrganicGeorge:
“Do you really think the opt-in or opt-out will survive the Senate-House conference?”
Short answer: “NO”
What we are lookin for here is how hard One Hung Harry Reid wants to make it on the progressives to get legislation that will create a program that will work. Right now our biggest hope is that Reid will hold on to his dream of re-election, the people of Nevada keep a firm hold of his genitals and the House of Representatives will pass the Medicare Plus package.
As I have been sayin’ for months now, the success or failure of this entire excercise is in the House of Representatives…if Pelosi wants a program that works she will step on Stenny Hoyer’s cape and if she wants Rahm and the fascists to take back the House in 2010, she will let ‘im run a weak bill into conference.
Follow the baseline politics, who gains from a weak bill that won’t make a difference in the economy or the budget within the first year? Answer: no one including the White House benefits from a clusterfuck of a bill like the Clintons tried to bring in 1993-94. Pelosi loses her speakership and the Democrats lose majorities in both houses, Harry loses his leadership, and Obama doesn’t make it beyond 2012.
The stars and the politics line up perfectly, but the only force that can make it happen is out here in the great mass of real folks
A bit off topic, but I just heard mention on MSNBC that the low life Lieberman will join the Republicans in a filibuster unless the PO is removed from the proposed merged Senate bill.
This is not unexpected from this vile worm, but the minimum that we ought to demand is that he be recalled by the people of Connecticut forthwith. Ways to practically accomplish this should be started.
In the meantime under no circumstances should this maggot be left in the Democratic Caucus and he should be stripped of any vestige of chairmanship or influence. Let this prick suffer the consequences.
The Senate Democrats should not withdraw from considering a merged bill with a PO nor be frustrated in this effort by this miscreant sack of shit. If this son of a whore wants to filibuster then fine and let him be relegated to irrelvancy in any measure he proposes. Leave it to the people of Connecticut if they want this shill to be the pariah that represents their state.
In addition the Senate should move ahead with rescinding the anti-trust provision given to insurers and then prosecute it fully so that they are driven out of markets and other comapnies can take their place. Further Medicare and all providers and insurers should be allowed to bargain down prices from drug companies.
The long and short of it is that there is much that can be done in reprisal against this scum and nothing should be spared in doing so.