Opt-Out Of Spite

by: Chris Bowers

Thu Oct 08, 2009 at 10:30


The latest public option compromise now floating in a trial balloon somewhere over D.C. is an "opt-out" public option that starts nationally but allows individual states to leave the program. The basic idea is that blue states get a public option, while red states don't.

Like most of these "compromises"--namely triggers or co-ops--it has three fatal flaws:

  • First, it is yet another example of compromising with ourselves, even though we have enough votes to pass a national public option through the Senate.

  • Second, only one side, Progressives (as always), are required to give up anything. This "compromise" moves in only one direction--toward a weaker public option.

    The only floated compromise where this was not the case was the "stronger trigger" Pelosi floated last month. In that compromise, Progressives would be allowed to write trigger language, thereby making it a certainty to kick in and also allowing for a much stronger public option than any of the ones currently on the table. Of course, the Maine Republicans saw right through that trick, and the idea was quickly nixed.

    The opt-out "compromise" offers nothing comparable in return, such as a public option that would be available to 100% of all residents in the states that did not opt-out.

  • Third, there is no indication this compromise actually has any votes behind it. In addition to garnering no Republican votes, it is a safe bet is that this would be opposed by a lot of House Progressives, and also opposed by a lot of other House Democrats who are from the red states that would opt-out.

    Given both that we all expect Progressives to fold on anything and that it seems the 60-vote culture of the Senate means the House doesn't matter anymore, it is a common misconception that just because an idea is floated by a Senate Conservadem leader--in this case, Tom Carper--the idea has the votes to pass into law. That just isn't true.

    Yesterday produced a perfect example of why Senate Conservadem ideas are often non-starters. Just before the CBO released the score on Max Baucus's health care bill, a huge, 150 member coalition of House Progressives and Blue Dogs pronounced it DOA. 24% of the funding for the Baucus bill comes from taxing high-cost insurance plans, even though such a proposal apparently has less than 100 total votes in the House. Single-payer has more votes in the House than the Baucus plan to tax high-cost insurance policies.

    The lesson here is that just because a Senate Conservadem likes it doesn't mean the idea can actually pass into law.

On top of all that, this compromise has a problem all its own:

  • It would be a Democratic and Progressive-sanctioned middle finger to the 16,094,055 Obama voters who live in McCain states. This is not even to mention the 4,282,367 Floridians who voted for Obama but whose Republican dominated legislature would opt-out the week after the health care bill passed. There are even a lot of non-voters and Republicans who would use, need and want a public option but who live in red states.
For all of these reasons, the opt-out compromise is not worth supporting. There is, however, one thing that it offers, and which I admit will be very tempting to many Democrats:

  • Spite
A public option opt-out is a good way for blue state Democrats frustrated with Republican obstructionism to both experience the benefits of progressive policies and engage in punitive action against those who oppose them. You don't want to stand up to insurance companies, are fine with having large uninsured populations, and don't mind crippling health care costs? Fine, you go and do that red staters. Enjoy your corporate free for all, while we start living better.

I admit, that can be a pretty tempting viewpoint. The vicious rhetoric against liberals and progressives for decades, not to mention the damage caused by conservative governance and power grabs, increases the desire to just go our separate ways. Just let red America have its corporate free for all, while maybe here in blue America we can regain some control over the system and prove we have better polices.

The opt-out plan still isn't a good idea, and we need to stop talking about supporting it. However, I do at least understand why it is tempting. Spite can be a powerful emotion in politics these days.

Chris Bowers :: Opt-Out Of Spite

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Opt-Out Of Spite | 61 comments
It would also (4.00 / 5)
give the middle finger to McCain voters who live in McCain states, and people in McCain states who didn't vote at all, and Nader voters in McCain states...because believe it or not, even people who didn't vote for O deserve a decent health care system. I've been following the debate on this at Daily Kos, and I find it disgusting how many people are eager to self-righteously subject half the country to an inferior system. That'll show 'em! Plus there's no guarantee that blue states will opt in, once the Insurance lobbies do their thing.

Here's my compromise offer to conservadems: We'll include a robust PO in the bill, you can vote against it as long as you also vote for cloture, and we won't work to defeat your sorry corporate ass in a primary.


No on the primaries (4.00 / 3)
We shouldn't promise that we won't go after them in the primary.  That's too big a stick to give up for one bill, IMO.

Besides, the threat of going after them lives on.  We can do it again and again.  


[ Parent ]
Don't Kid Yourself! (0.00 / 0)
Think some more LIBERAL senator is going to replace Conrad in North Dakota? They can barely elect a right-wing Dem! There are times when I think getting rid of them is addition by subtraction, but look at the natural balance of the country:

Same thing with Blanch Lincoln and Mary Landrieu. They are likely to be replaced by right-wing Republicans. For example, Landrieu and Nelson are about as "liberal" as a politician can be and hope to be elected.

Landrieu's colleague is David Vitter. That's a lot more like what Lousianians are like. The other Florida Senator to Ben Nelson is George LeMieux.

It seems increasingly likely that as the two halves of America get further and further apart, we'll wind up with NO Democratic Red State Senators, and right now, Blue State Republicans have almost totally been wiped out. The only ones left are:

Chuck Grassley (and Iowa isn't wildly blue)
John Ensign (Nevada is ditto, and may even have TWO right-wing Rep senators after 2010)!
Judd Gregg (Dems should win this seat next yea since he's retiring, but the tide is running against them).
George Voinavich (OH is barely Blue and a Republican could win this one)

That means there are ARGUABLY four Senate seats that SHOULD be represented by Democrats but are held by Republicans.
And That means the UPPER-BOUNDARY for Senate Dems is probably 64, and they won't ever get there. They'll be lucky to hold 60 over the next 4 years and probably won't achieve that.

Meanwhile there are a much larger number of Democratic senators from some very RED states:

Mark Begich (AK) -- Any non scandal-plagued year AK would elect the Republican although he might be able to hold onto his seat).
Blanche Lincoln and Mark Pryor (AR) -- Arkansas is now about as right-wing as Mississippi. These senators are both endangered species and one or both should be gone by 2015 when Pryor's term expires.
Evan Bayh is pretty right-wing, but that won't save him from attack in Indiana. This state is the most likely state to flip back to Rep. in the next presidential election.
Mary Landrieu -- (LA) If the election were next year, she'd be gone. In 2014 who knows? Certainly a liberal's not going to win this seat.
Claire McCaskill Ditto. She'll be a big target in 2012 as MO slides further and further right.
Ben Nelson -- Nebraska is RIGHT at the edge of the flat earth. He's probably dead-meat in 2012, regardless of how he votes on health care reform.
Harry Reid -- He's probably a goner. NV should be Democratic but he's not doing well at all.
Kay Hagan -- Has a long time yet to ingratiate herself before 2014, but NC is another state very likely to flip back to Rep. in 2012.
Tim Johnson (SD) His health better stay good, that's all. Because SD isn't a blue state. Not at all.
Robert Byrd -- is already a mummy who's running short on embalming fluid. When he goes, so does this seat. There's just NO chance at all for WV to elect a Dem. It's been moving further and further right, in tandem with KY and TN. They hate them some "niggers" in WV and they darn sure don't want one as no President! Jay Rockyfeller seems to have a secure hold on his seat despite the right-wing nature of WV.

By my count that's 8 Democrats holding seats that would VERY probably go Republican if they were vacant right now.

At best, the natural balance of the Senate is around 52-56 Dems.

Will primaying these right-wingers really help them?

Primaries should be mounted in blue states which have sell out Dems. who could and should be better (Lieberman is a perfect example).  


[ Parent ]
Data support please on this? (4.00 / 2)
Claire McCaskill Ditto. She'll be a big target in 2012 as MO slides further and further right.

I see no data supporting this.  Robin Carnahan, Dem more progressive than McCaskill, leads Roy Blunt for the Senate seat of retiring Kit Bond.

If your info on other states is as bad as on Mo, then it calls into question your entire point.

Obama lost Mo by about 3500 votes out of millions.  

I see no trend "right" in 2009 in Mo.

 


[ Parent ]
I think there's little data... (0.00 / 0)
...to support any of Cugel's analysis above. And no matter how much the current mixed crop of Democrats in Congress and the White House are failing to deliver change that will help to persuade voters to get on board, politics in the country will continue to trend toward progressive goals; slowly, but a complete fail back to Reagan era conservative pluralities isn't going to happen again. Demographics and technology alone make such a reversion impossible.

[ Parent ]
Well, I was being (0.00 / 0)
at least partly facetious, my point being that we shouldn't have to give anything away in exchange for them refusing to join a GOP filibuster.

[ Parent ]
Overly short-term thinking (4.00 / 1)
On the one hand, you have a point in so far as you're saying we have to live with some Democrats that are more conservative than us, even substantially more conservative, especially in more conservative states/districts.

I have one objection in principle and a few related ones in practice.  In principle, this country desperately needs reform in a progressive direction.  IMO, if we don't get it soon, the consequences could be truly dire.  Health care is one piece, all sorts of fundamental economic reforms are others.  If a particular Dem can't support at least some essential things, like universal health care, they're just not good enough, and replacing them with a right-wing Republican doesn't really matter, we're dead anyway.  In the past I would have been less stark about this, but not now.

In practice, your analysis appears to be mostly based on current trends in public opinion.  It's too early to say how even 2010 will go, 2012 is a lifetime away.  The Dems will probably lose seats in 2010 -- I'd give the Republicans control of both houses then for a decent health care bill.  We could easily win them back in 2012.  If you look at history these kinds of shifts are normal.

I think you may be too stuck in assuming that the 50-50 politics of the last ten years or so will persist.  Again look at historical election results.  They're an anomaly, most eras have seen strong dominance by one or the other party.  Most presidential elections involving incumbents are landslides for or against, again 2004 was unusual.  2012 will likely be a referendum on the economy, and a landslide either way.  It wouldn't surprise me to see either Obama winning Texas or losing New Jersey, with Nevada, Ohio, etc., just smoothly going to the winner.  Most voters aren't well informed enough to be ideological, swing voters will vote for anyone who they think has/will make life better, by any means.  Don't forget that Massachusetts voted for Reagan twice, in between McGovern and Dukakis.

In line with this, it is perfectly reasonable to hope for a realignment, with all the 2008 Obama states reliably Dem for a while, and most of the McCain states in play.  I'm neither optimistic nor pessimistic, but I fear for my country if this (or a takeover by a progressive third party) doesn't happen.  For it to happen, Dems need to fix the economy and do something to improve the lives of most ordinary people.  Achieving this is what we need to focus on, not 2010 results.


[ Parent ]
McCaskill will be a big target in 2012 (4.00 / 2)
because she can't decide if she is a Dem or a Republican. Check her voting record on Iraq and FISA and her statements on HCR.

As a hybrid, neither Dem or Republican, she risks pleasing no one.


[ Parent ]
You're overlooking one key thing (4.00 / 1)
and that is: liberal =/= Democratic.

If the goal is to elect more Democratic Senators, then yes, without some paradigm-changing realignment (which is still very much possible) we're probably close to the max.

However, if the goal is to elect more liberal Senators (irrespective of party affiliation) who will, for example, support the public option or Medicare for All, we still have a lot of opportunities.

For example, in my own state of California our Class I Senate seat is currently being occupied by Dianne Feinstein, who isn't anywhere near the maximum liberal potential that this state can elect.

Blue state moderates are - or should be - low-hanging fruit.  In 2012 Joe Lieberman of CT and Tom Carper of DE are up for reelection.  Replace those two with strong liberals and that's two more votes for Medicare for All.

Another example: there are Democratic primaries in IL and MA.  We should only back the candidates who promise to support Medicare for All. (Don't know who that is at the moment)

In other words, we should start keeping track of Senators not be their party affiliation, but by where they stand on the issues.  Ex: Don't say there are 60 Democrats and 40 Republicans in the Senate; say there are ~51 pro-POs and ~49 anti-POs in the Senate, or there are ~4-5 pro-Medicare for Alls and ~95-96 anti-Medicare for Alls in the Senate.


[ Parent ]
Here's my compromise offer to conservadems: (4.00 / 2)
We pass single-payer Medicare-for-All but we allow states to opt out of that comprehensive system and have the HELP Committee plan with a public option instead.

Progressives have already compromised big time. Now it is time for conservadems to vote for it or get a strong primary challenge.


[ Parent ]
How about this compromise: (4.00 / 2)
Individual states can opt out, but everyone else gets the public option immediately rather than having to wait until 2013. That way people in red states can find out by 2011 that their family members in blue states have cheaper better insurance, vote out the assholes who opted them out in 2012, and get the public option for themselves by 2013. In the mean time, people in blue states will not have had to wait four fucking years to get some healthcare relief.

I live in Georgia. I want a public option for myself now, but if I have to wait until 2013 anyway, I would be willing to see this opt-out deal used as leverage to get public option for other states right now.

miasmo.com


[ Parent ]
Florida (4.00 / 4)
Thank you for mentioning Florida here. I initially browsed your post and was going to mention our legislature that doesn't represent Floridians, but you smartly covered that.

The opt-out "compromise" is a truly terrible idea that bolsters a rather terrifying feeling that I think many of us are feeling these days: the notion that our nation is ungovernable. It also undermines a key progressive belief: that national problems do indeed have national solutions.

http://www.ProgressFlorida.org


Indeed (4.00 / 4)
I'm getting fucked in the ass presently by insurance companies here in Florida, and I don't want to get left out in the cold just because I'm in the wrong state. If I could afford to give up my job and friends and everything else to move to a more progressive locale I would have already done it.

The "opt-out" idea seems motivated by the same "I've got mine" attitude of the tea-baggers. It is not a good idea, it's a spiteful one. I can't imagine progressives would be enthused about an idea to let states opt-out of Roe v. Wade or Social Security or Miranda rights or anything else.

The public option already has an "opt-out" provision. That's what the "option" part comes from. It's at an individual level of granularity, which obviously is better than a state-level one.

Conduct your own interview of Sarah Palin!


[ Parent ]
What if the opt out provision is a negotiating (4.00 / 1)
tactic to get some form of a public option into the Senate bill that has to be reconciled with the House bill that will have a public option?


[ Parent ]
Opt-out states (4.00 / 1)
Want to debunk the notion that the only states opting out are hard-right red states where no one lives. Like Chris said, Florida is one- and Crist is being pushed to the right in a primary. Texas is another, and Perry is in a primary. Those two combined with lots of other smaller red states are a lot.

And on the policy aspects of it, do we even know if this will work? You need a big pool of customers to make the public option work at all.


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Not only is Perry in a primary (4.00 / 1)
but if he doesn't end up opting out, Hutchinson can use the fact that she has voted against the bill as leverage against him in that primary.  Texas would be virtually guaranteed to opt out.

[ Parent ]
you don't think it sets up conservatives for electoral defeat? (4.00 / 2)
if they decide to opt out, and their health care costs are noticeably higher, won't they pay an electoral price?

admittedly it sets up health care reform as a long-term game. in a few years the blue states get it, and the red states are pushed into it only by waiting a few more years.

it's not ideal. i think we can still push for a national public option that's available everywhere. but this is actually the first conservadem idea that I could hold my nose and accept. the debate has moved into reasonable territory.


Of course they won't (0.00 / 0)
Why would they?

Conservatives have been pushing for less government and in particular less government spending for quite a long time. They have not only failed to be punished by voters in many states, they continue to get elected and govern states by espousing such a politics.

We've seen stark differences between the amount of government programs available between red and blue states for some time now. The fact that California (until now) had more generous health care and welfare policies didn't lead Texans to flock here, and didn't cause a voter revolt against Bush or Perry. You haven't seen Alabama Republicans tossed out of office because Massachusetts created a "universal" system.

The "pay an electoral price" notion only makes sense in profound ignorance of how state politics actually works. Republicans in red states and in many blue states will succeed in pushing an opt-out and will suffer little if any electoral penalty for it.

Especially since those states will still enjoy the other fruits of health care reform, from an end to rescission to coverage of preexisting conditions.

The only reason people are willing to "hold their nose and accept it" is they live in blue states where they are convinced they'll get a public option, and are willing to throw people who live in red states overboard to get it. That undermines our messaging and organizing strategy.

And it will come back to haunt folks who will realize, when their state opts out too, that living in a "blue state" didn't provide the protections against Republicanism they thought it did. Welcome to my world.


[ Parent ]
here the results of health care reform would be brutally obvious. (4.00 / 1)
- states with a public option who saw costs decrease

- states who opted out who saw costs increase

other policies are just less visible.


[ Parent ]
That is completely dependent on a lot of things (4.00 / 2)
and using it politically would depend on broadcasting this to the public, and broadcasting accurate political information has proven difficult, at best on other issues (and especially so on this one thus far)

[ Parent ]
This "compromise" gives more money/power to our opponents to work against us (0.00 / 0)
The most important thing that a federal public option does is challenge the insurance companies and reduce the amount of money they collect. If we let states opt out, then they are likely to collect a lot more money and that money will be used to bribe and lobby state legislators to maintain the monopoly system that enriches the insurance companies.

We have to quit passing legislation that makes our opponents stronger and richer and think that by doing so we are somehow winning something. We only win this game when we can get bribery and corruption out of the system. The more money we give to insurance companies, the more bribery and corruption there will be. That would be a loss, not a gain.


[ Parent ]
That won't matter (0.00 / 0)
It just won't. If you think state legislative battles can be won by pointing to inconvenient things like facts, especially in the face of a massive amount of insurance industry money, then I have to conclude you are too unfamiliar with state legislative battles to offer a credible opinion on this topic.

[ Parent ]
Texas Health Care (0.00 / 0)
With this Opt-Out provision the citizens of Texas may score both with lower insurance premimums and better coverage.  They also have restrictive political policies on medical law suits which lowers medical costs again.


Conservative......CNN news:Nopenhagen: US PRES 2 WKS LATE ATTEND 1 DAY, GORE JOURNEY BY TRAIN.

[ Parent ]
That law got enacted six to eight years ago (4.00 / 3)
And Texas remains one of the most expensive health care states in the country.

[ Parent ]
WRONG! (4.00 / 3)
"They also have restrictive political policies on medical law suits which lowers medical costs again."

Sorry, wrong! You FAIL! In fact "tort reform" has no appreciable effect on health care costs at all as has been shown by studies. That's another That's just another right-wing talking point designed to confuse the issue.

Nobody but a Ditto-head would believe that kind of mush!

Are "frivolous lawsuits" the real cause of high health care costs? The short answer is no. Malpractice costs represent less than half of 1% (0.46 percent of total health care expenditures) and malpractice settlements have grown modestly with inflation. In fact, in states that have adopted caps on jury awards, doctors are prescribing too many aggressive and intensive treatments that increase costs, but don't improve outcomes.

When Texas capped non economic medical malpractice damages to $250,000 in 2003, most conservatives argued that the reform would free doctors from having to prescribe unnecessary treatment. It didn't happen. According to the Dartmouth research on disparities in health care spending, many Texan doctors are still prescribing aggressive treatments that don't improve outcomes. In fact, as of 2006, Texas was still at the top of the list of high-spending states.

Thanks for stopping by!  


[ Parent ]
Do people really track state-by-state health care costs? (4.00 / 2)
because that would be what would be required for there to be electoral consequences.  Also, there would have to be a Democratic party strong enough to capitalize on the issue in the state in question.

[ Parent ]
absolutely. oh, you mean the Republicans (4.00 / 1)
no no.

people will blame "Washington" for their shitty health care and their huge mandated-by-law insurance premiums. it won't be [your state here] making them buy that insurance, no sir. it was them Democrats.

this opt-out idea is a gift to Republicans.

not everything worth doing is profitable. not everything profitable is worth doing.


[ Parent ]
you can do this... (0.00 / 0)
"the first conservadem idea that I could hold my nose and accept" while millions in red or opt out states die? Really? That's all it would take for you to send these people to their death for lack of insurance? How you could even sleep at night is beyond me! This is the most detached, callous analogy of what you're proposing I've heard! It's disgusting.

[ Parent ]
I think I'm going to call it (4.00 / 5)
The "spite option."

As I argued over at Daily Kos, people who think "blue states would definitely refuse the opt-out aren't really familiar with how state politics works. Under a tsunami of insurance money, including ads claiming that the opt-out would save money, protect jobs, etc, you can bet that a lot of legislatures would take the opt-out.

The notion floated by some that this would somehow spark a counterrevolution against GOP politicians is absurd - organizing in the states is not so easy, and backers of the opt-out would still have other reasons they can and will use to convince voters to back them anyway.

One can see this having played out in California in 2004. In the waning days of the Gray Davis Administration, the legislature passed and Davis signed a bill mandating employers provide their workers with health insurance or pay into a state fund to provide it to those workers.

Big business and some insurers funded an effort to put that law on the ballot as a referendum, which succeeded. Prop 72 went on the November 2004 ballot, and in an election where 55% of voters supported John Kerry, only 49.2% of voters supported keeping the law.

I could envision a similar battle taking place here in California, where numerous other proposition fights have shown that voters here are susceptible to well-funded anti-progressive lies.

I could also envision someone like Arnold Schwarzenegger or Meg Whitman pushing through an opt-out, since Arnold has already pushed through cuts to Medi-Cal and Healthy Families that resulted in the loss of millions in federal funding.

So this whole thing is just ridiculous. It's a sign of progressives who are dispirited, defeatist, and angry. They feel a need to take a few victories here and punish everyone they feel has stood in the way of victory, even if by doing so they not only pass up an opportunity to build the Democratic and progressive base, but do active damage to the gains we have made in the process.


Yes (4.00 / 3)
And we shouldn't lose sight of Chris's first point:

it is yet another example of compromising with ourselves, even though we have enough votes to pass a national public option through the Senate.

Why isn't all progressive energy going into getting all Democratic Senators voting for cloture. I was just over at TPM, where Josh Marshall is praising this compromise, not knowing, or not caring to point out that We Don't Need to Compromise.

(Or, if you prefer, we already did, when single-payer was somehow removed from equation.)


[ Parent ]
When it comes to health care discourse, a lot has changed since 2004. (0.00 / 0)
I think that now an insurance-industry funded initiative to opt out would have a tough time, no matter how well funded. "Bought with insurance company profits" is a meme that resonates strongly now.  

[ Parent ]
I live in a Red State (4.00 / 1)
I am actually for the opt out. This bill is obviously not the last battle we are going to have over health care. It is a long term game. So while I will likely be tea-bagged here in Arizona under an opt out, the result will be clear cut data that either shows we are right and a PO drives costs down or it does not. Once that data starts coming in, the field will shift.
I think it also puts the onus on Republicans who continue to selectively whine about Federalism.

I also live in a Red State, and I disagree. (4.00 / 3)
Here in Idaho, there are comparatively large urban areas (Boise, Pocatello, a couple others) where the population is, by and large, progressive and very blue.  However, much like the U.S. as a whole, there is a disparity between the voting power between the urban and rural areas of the state, with the rural areas having substantially more representation in both houses of the legislature.  Thus, while close to, if not the actual majority of Idahoans would probably want to opt in, the legislature would almost certainly opt out.  Thus, we would be left out, even though we are also one of the states with the highest per capita of credit card debts (bankruptcy rates are skyrocketing here), and one of the higher ranking in terms of the number of uninsured (per capita).  You would be condemning a lot of people to going without what the desparately need.

Perhaps more important though, I believe the fundamental premise, that Red-staters will want to opt in later, after they see neighboring states doing better, is flawed.  I think it is much more persuasive for people to experience the benefits of seeing their next-door neighbor (who has opted in) enjoying lower costs and better care.  Just as with Medicare, even a lot of those who resisted it in the beginning love it now, because they've actually experienced it working.  


[ Parent ]
Yes, just like Senator Kyl would be defeated... (4.00 / 2)
I thought that with two wars going badly that Senator Jon Kyl of Arizona would be defeated in 2006. Wouldn't voters see what a disaster George W. Bush's policies were and wouldn't they punish senators like Kyl that strongly supported every wrong-headed policy?

But no, Kyl was re-elected with 53% of the vote. All that money from defense contractors that are doing well with these wars and all that money from health insurers that are doing well under our current monopolistic system contributed vast amounts of money to Kyl and helped him win. Given this, why would Arizona punish the state legislature for opting out of a public option program?  


[ Parent ]
So it's okay for you to go and kill people in these states due to lack of access/coverage because... (0.00 / 0)
"the result will be clear cut data that either shows we are right". Wow! Just wow!

[ Parent ]
can't we have a little spite too? (0.00 / 0)
How about a public plan that covers everywhere but Alaska? Call it the Lower 49 Plan.

It's not a middle finger to the red states (4.00 / 4)
It's an opportunity to deliver a public option to those states, or force Republicans into a politically difficult - I am tempted to think impossible - position and change politics. Public interest in any state's debate over opting out will be high, and the core principles of the debate will reach even the lowest-information voters.

And I think that in most states, the PO wins. Hell, even Shepard Smith was all over the core talking points on the PO.

Opt-out offers a chance to bring the country closer together, nor force it further apart, and end a reign of bad governance in the supposedly deep, immutably red states. Most of these states have been red at the state government level only for the last 10-15 years. We should look at this opportunity very closely.

Thanks for the check on emotion, though.


Who decides whether a State opts out? (0.00 / 0)
Take a hint from the "stronger trigger" scenario, perhaps? Make the mechanism of opting out require a public referendum, require States that wishing to opt out put the question on the ballot and let the people vote.

In that scenario, I think a lot of States would find it much harder to opt out and the onus would be on the detractors to make a public case for getting out.

Question: If my State opts out, do I still have to pay Federal taxes on my "platinum plan"?  If so, why?

Furthermore, if my corporation has offices in multiple states, which state law applies?  

"It sounds wrong...
     ...but its right."


What are the states opting out of? (0.00 / 0)
I thought that what was happening was that they were creating a federal exchange, where insurers could sell to anyone, in any state, in exchange for accepting federal regulation.  Then, the public option was going to be placed in this exchange.  

It seems bizarre to exempt citizens from individual states from buying into the PO, so does this mean that the opt-out would be from letting the states participate in the exchange?

How would you even implement an opt-out?


that's why states wouldn't opt-out (4.00 / 2)
The public option is essentially a free, no-strings-attached, grant to the states. And even Arkansas supports the public option strongly.

The only states which could possibly vote against it would only opt-out based on spite.


[ Parent ]
How would states opt out? (4.00 / 1)
I'm wondering how states would opt out under the proposal.  Say, for instance, that to opt out states had to hold a popular referendum.  I think in that case you'd find widespread support for the public option and it would be unlikely to fail in many states.  That would be an opt-out I could live with, especially if combined with Wyden's free-choice amendment for the public option on the exchange.

I'm sorry, but... (4.00 / 3)
Provided the public option was robust enough to be substantially cheaper than private insurance, I would not have any issue with this.  Hell, I wouldn't even have an issue with "opt-in" public options.  

Consider the following:

1.  Pool size is important for bargaining purposes, but except for a few for-profit hospital chains, there are no national health care providers.  If the public option has to bargain rates with New York hospitals not covering people from Texas isn't going to matter much if at all.  The only areas this would substantially weaken the public option are border regions between states with and without the Public Option.

2.  Although I'll sound like a libertarian saying this for a moment, the market will win over ideology if some states have a robust public option.  Since the provision of health care will be cheaper for employers in public option states (hell, business startups probably won't even bother providing it any more), job growth will become substantially higher in "blue" states than "red" states.  Red state politicians won't be able to argue very long against a system that works - I would give 8-12 years max before the opt-outs start filtering into the national system.  Sort of similar to how the American elite is finally realizing it can't retain a health care system which is twice as expensive as other industrialized nations.  

3.  Remember, single-payer started in Canada in one small province - Saskatchewan.  It was successful enough that the whole country adopted single payer within twenty years.  

So I'm not overly concerned about the opt-out system.  The devil is in the other details of the system.  If a public option ends up say at least 15% cheaper than employer-provided insurance, we'll backdoor into a Australian-style health care system within two decades.


Neighbor envy doesn't work when people are heavily propagandized (4.00 / 1)
If envy of your neighbor works so well, then why haven't we adopted Canada's single-payer system yet. Instead, we have a system that costs twice as much and provides worse outcomes. The problem is that the insurers are really good at propagandizing the American public into thinking we should keep our crappy system. And they'll be equally good at keeping Texas and Florida voters convinced that the rest of the country is going "socialist" and what a horrible thing that is.

[ Parent ]
Nope... (4.00 / 2)
I'm sorry, but there's a world of difference between different systems between nations and states.  If nothing else, millions of Americans will have brothers, sisters, children, or parents with substantially cheaper health care due to a public option.  We'd be lucky if one in five people actually understand the Canadian system in the U.S. right now.  

And again, I think you fail to see, we've already won half the battle.  Instead of fighting the insurers nationwide, we'll be fighting them in perhaps 20 states.  And every time a state decides to opt in, a built-in constituency develops, making it all but impossible to opt out again.  It might take decades to fully phase in, but (provided it's a good public option), it will become a national health plan.  


[ Parent ]
For a numbers guy, Chris.... (4.00 / 3)
...your arguments against the opt-out are lame. A robust public option will not pass the Senate now, and it won't survive conference even if the House musters the nine votes it still needs to pass the strong, Medicare + 5 public option. We've been down this road too many times to reasonably think the best public option will survive in the conference report.

The other compromises proposed are in-name-only public options that, if adopted, will be worthless.

It's childish to continue saying that "Democrats are compromising with themselves." You like to think the Senate is a simple two-party, red-blue, legislative body. It's not. It's 45 liberal Democrats. 38 ultra-conservative Republicans. And 17 moderate Republicans, most of which have a D after their name. The fact that they call themselves Democrats doesn't mean a damn thing; and you know it, Chris. Democrats are not negotiating with themselves. Liberal Democrats (the largest single block, granted) are negotiating with moderate Democrats, most of whom are owned my special interests that would just as soon health care reform die.

So, at the end, there will be a compromise between two of the three parties in the Senate. The best plan, Medicare-for-all, was compromised at the beginning so the debate could begin. The public option will be compromised down before the two factions of the Democratic Party will pass it. The only question left, is what compromise is the best. Of everything proposed, this opt-out compromise seems to be the best.

It's hard to care that several southern and mountain states may be forced to opt-out by their corporate-controlled elected officials when nothing in the bill will have go into effect until after the 2012 election cycle. Hopefully by then, if the demographic trends continue to move the country toward Democrats (liberal or conservative ones), the bill will survive and some states that seem like opt-out states now will become opt-in states. In fact, as many others have already said, some of those state leaders may find themselves out of office if they threaten to take the option away from their people. Wherever politics takes us after this year's bill is passed and enacted, the strongest version of a public option make better policy.


Votes (4.00 / 2)
It all comes down to the votes.  If we don't need the votes and can keep Lieberman away from the filibuster, then we shouldn't do this.  But if this version of the public option can get the whip count, I say go for it.

Spite has nothing to do with it.  Hell, there isn't a single proposal out there that will let me buy into the public option in the first place.  So this certainly has nothing to do with me getting mine and forget everyone else.

For me, at least, the two keys to a strong public option are:

1) it is large enough and given enough tools to establish itself and

2) has the ability through use over time to prove it is more popular than for-profit insurance and, thus, expand into something larger and available to all of us.

This compromise meets both of those criteria.

I think everyone knows the reality is some kind of "public option" was going to be in the final bill, but odds were small it would be a very good version.  This is the first proposal I've seen that weakens the PO in a way that doesn't make any difference in the long run.


If the public option is truly popular... (4.00 / 2)
Then this idea should be beloved by any Democrat running for election.

Those who worry that blue-states would opt-out seem to lack confidence in the polls that supposedly show that the public option truly has wide-spread support.  If that support is real, then keeping this issue alive at the state level would be good politics.


What do we want in return? (4.00 / 3)
The only floated compromise where this was not the case was the "stronger trigger" Pelosi floated last month. In that compromise, Progressives would be allowed to write trigger language, thereby making it a certainty to kick in and also allowing for a much stronger public option than any of the ones currently on the table.

I think this leads to the correct counter proposal.  Now that we have a compromise mechanism we are willing to discuss, what do we get out of it?  How can we make the Public Option better in exchange for the opt-out clause?  Can we make it literally the ability to buy into Medicare?  Can we open the health exchange to all employers?

What do we want in return?


Opt in to Medicare (4.00 / 1)
Yes, let's let anyone opt in to the Medicare system.  

[ Parent ]
Aye aye (4.00 / 1)
There's no point in giving in without getting anything.  Let's go all the way with a Medicare buy-in.

[ Parent ]
Irony is truly dead (0.00 / 0)
An [a|the] [Federalist?] public [health insurance]? option [option|plan] advocate writes:

... [Y]et another example of compromising with ourselves....

OMFG, I think this guy's serious!

[pounds head on desk]

I am in earnest -- I will not equivocate -- I will not excuse -- I will not retreat a single inch -- AND I WILL BE HEARD.  


Is it Spite (4.00 / 1)
I'd like to see somebody ask McDonnell in Virginia if he would opt-out.

Admittedly it would depend on the public option that is being opted out of. But this is potentially a powerful election issue for 2010 at the state level.  


What (0.00 / 0)
are the odds that Florida would opt out? That's where I live and a lot of people I know here need health insurance.

why stop (0.00 / 0)
with health care? let's let them opt out of Social Security and the 14th Amendment while we're at it. that would be real popular with the right people.

not everything worth doing is profitable. not everything profitable is worth doing.

What happened to... (4.00 / 1)
- Health insurance that is available to EVERYONE?
- Dropping the "i've got mine" republican meme in support of helping all those without have?
- Going after the insurance companies instead of EACH OTHER?

...oh yeah, telling those outside your state to 'eff off' is good politics, mmhmmm. And what happens if these states who aren't opting out have skyrocketing health care and the opt-out states don't? Then what? How do we prove a better model then? And what if these opt-in states do have more people from the opt-out states move there and the system can't handle it in that state? Do we throw them under the bus like the immigrants? This is yet the saddest piece of legislation "bone" the Congress has us scrambling over...brilliant work on their part to get our attention off their lack of ability to govern in a progressive way. I can't believe some of these comments! Just listen to yourselves! You're saying that because people live in red states, they deserve to die! When the repubs said that opting-in would cause deaths, WE freaked! Now because we got ours, it's okay to say that to them? If we truly know that 45,000 deaths are occurring due to lack of health insurance, we are okay to say...aah - you're a republican or in a red state surrounded by republicans, so your health doesn't matter. Seriously? The Progressive Movement has come to this? You're 'spite campaign' is turning me off - and I live in Washington State!


I don't thet the spite (0.00 / 0)
People keep talking about spite, but I don't seeing anyone actually being spiteful.  Everyone thinks everyone else might like the spite aspect.

Personally, I think the single payer folks have this partially correct.  The Public Option simply isn't all that wonderful, at least at first.  Remember, only a small fraction of the population is even allowed to use the PO in any of these plans.

The lack of the Public Option isn't going to kill people.  The other provisions of preventing care from being denied, subsidizing payments and so on -- all of which are still available in opt-out states -- are what are going to save people.

What makes the Public Option worth while is, over the long hall, it holds everything in place.  It applies pressure to the insurance companies.  It has the opportunity to grow into something better, something we can all participate in and something that can really revolutionize our health care system.  But it wasn't going to do any of that in the short term.

The only question that really matters, then, is how does this proposal effect the long term possibility of that transformation.  It seems to me, that the opt-out clause does nothing to hurt the PO in the long term, so I'm okay with it.


[ Parent ]
not with a mandate (0.00 / 0)
i think that's the key. i don't know when the mandate kicks in - if it goes into effect before the PO even becomes available, then you're right, it's moot.

but if people find themselves in a situation where they must buy health insurance by law and there is no public option - no alternative to for-profit or "non-profit" sharks like Blue Cross - that is not going to work out well for anyone.

not everything worth doing is profitable. not everything profitable is worth doing.


[ Parent ]
This is a good point... (4.00 / 1)
I'm not as against the "Opt-out" as Chris is... But if states are going to opt-out, then they shouldn't be mandated to buy in those states either.  The mandate should only apply to states that have access to the public option...

Now, there is a slight danger-zone here in that it will actually be easier to demagogue against the PO in swingy/red states, since Cons will be able to say "You'll be forced to buy insurance if we accept the PO", but I dunno... Certainly can't be making people buy insurance with no PO available.


[ Parent ]
I certainly see Chris' point about not negotiating with ourselves (0.00 / 0)
And would really, really like to see and up or down vote on a really robust public option. But if the PO came with Federal funds, I think there would be very little opting out. Look at the stimulus, there was a lot of posturing, but in reality, almost none of the funds were refused.

I think health care is even easier for people to understand. The key would be that the legislature would have to vote on it and the govornor sign it to opt out.  And hell, you could also make it easy to put it to a referendum.

That said, it would be nice if in exchange for that provision, we get to extend schip, medicare, or the subsidy for more people.  


One of the better compromises we've seen so far (0.00 / 0)
The folks at FiveThirtyEight, including Nate Silver, seem to be enthusiastic about this.

In any case, I have to say that of all the terrible compromise proposals we've seen so far, this one is one of the better ones, especially if the PO it sets up is a robust one or even a Medicare buy-in.  That said, I don't see that it's really necessary at this point, since there are signs that the PO may be gaining momentum in the Senate, and the PO is itself already opt-in on an individual basis.  Of course, I still much prefer a robust PO with no opt-out, but I think between a robust PO with opt-out and a weak one with no opt-out, it might be a toss-up or the robust w/opt-out may even be better.

I think what would really be great is if a robust PO with opt-out is what passes the Senate, and the House passes a robust PO with no opt-out, and the haggling in conference will be over whether this robust PO is opt-out or not.  Either way, we get a default robust PO, which is a lot better than anyone can hope for at this point in the game.

In regards to the argument that those who may favor this compromise "don't care about red state people", I for one of course deeply care about my fellow Americans in red states.  And in general I favor national programs where we as a nation pool all our resources for national benefit.  Ideally we'd have Medicare for All which would be such a program.  But there's a difference between providing something for everyone and forcing it on everyone.  With a PO with opt-out, the federal government will be handing something to every state.  If the states don't want it, they have the right to push it away, and that's the choice they make.  If they choose to screw themselves over that's still their choice whether we like it or not.

In most cases I would insist on everyone being in.  But with the level of vitriol that we've seen in this debate I think that if we're gonna compromise (yet again) let this be it.


Oh, and there is one added benefit to having this compromise (0.00 / 0)
It calls the conservatives' bluff.  And I'm not talking about just politicians - I also refer to conservative voters, all those annoying teabaggers and mobs at the town halls who scream for less and less government.  Well, if there's an opt-out we finally get to put those anti-government convictions to the test.  Either stick to your guns and accept the (presumably) higher costs that you'll be stuck with, or abandon your cherished principles to go suck on the government's teat.  Given what's happened with the stimulus, Medicare, and just about every successful government program, I think I know which choice these "principled" conservatives will make.

That alone would be very fun to watch, but there's more: when even the principled conservatives ditch their principles and run to the government, that presents a golden opportunity for liberals to say, altogether: "See?  Government WORKS!"  And that may be our best chance to start changing the negative views people have towards more government.  Reversing the prevalent anti-government mentality in our society would have greatly helped in this current debate over health care and is really the ONLY way we will be able to enact significant, long-term progressive change in this country.


[ Parent ]
Opt-Out Of Spite | 61 comments
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