Five Remaining Questions on the Public Option Campaign

by: Chris Bowers

Mon Oct 26, 2009 at 16:25


Now that the opt-out public option is in the merged Senate health care bill, and now that the House is debating not whether or not to have a public option but what sort of public option to include in their bill, the chances of having a public option in the final health care bill signed by President Obama have skyrocketed.  Defying the forecasts of numerous pundits, Conservative Democratic Senators and Blue Dogs, it now seems very likely that there will be a public option in health care reform.  Wow!

Still, the campaign is not over yet.  There are still at least five major questions / hurdles to answer / clear before we can celebrate (More in the extended entry):

Chris Bowers :: Five Remaining Questions on the Public Option Campaign
  1. Does Stupak have the votes to kill the bill in the House? It is still possible that health care reform will not pass the House of Representatives. The lone remaining threat comes from Representative Bart Stupak, who is trying to round-up 40 votes to defeat any bill that allows any abortions to be covered under health care insurance plans. If he succeeds, this will kill the entire bill, because such a restriction will cause the bill to lose dozens of pro-choice votes.

    While Stupak was pessimistic on achieving his goal three weeks ago, he now appears more bullish.  Stopping Stupak's "Regressive Block" is an important remaining hurdle to passing health care reform with a public option.

  2. Can we keep 60 votes for cloture in the Senate? While it now appears likely that Harry Reid has 60 votes for cloture on the merged Senate health care bill with an opt-out public option, there is no guarantee those 60 votes will last forever.  As the battle over the Employee Free Choice Act revealed this year, once solid Democratic votes can flip under pressure from right-wing and corporate forces.

    We have a lot of work ahead of us to make sure that we have 60 solid votes for cloture in the Senate.

  3. What sort of public option will the House pass? As of this writing, the Democratic leadership in the House is still finalizing what sort of public option they will bring to the floor as a part of their health care reform package.  It will take one of three forms: a) a public option with Medicare +5% rates indefinitely; b) a public option with Medicare +5% rates for the first three years, and negotiated rates after that; c) negotiated rates from the get-go.  The stronger the public option that comes out of the House, the more chance for improvement of the public option in the conference committee.

  4. Can the public option be strengthened in conference committee? Following on the third question, one has to wonder if it is even possible to strengthen the public option in the conference committee between the House and the Senate. Will the Democratic Senate consensus that Harry Reid spoke of today hold together in the event of a stronger public option coming out of the conference committee?

    Also, as a follow-up question, which is the stronger public option: an opt-out tied to Medicare +5% rates, or a national plan tied to negotiated rates? Answering that question will depend largely on the next question:

  5. How will states opt-out? About all we know at this point is that states will have the ability to opt-out of the public option through 2014. Exactly how they will be able to opt-out, and when they can start to opt-out, remains unclear.

    Some claim that virtually no state will opt-out, because the public option is so popular. Others claim that many red states, plus Florida, will opt-out pretty quickly. Figuring out how states will be able to opt-out will be key to knowing whether it is worth pushing for a better opt-out, or a weaker national public option.

A big step forward today, but there is still work to be done.  We have turned a corner on the public option campaign, but we have not crossed the finish line yet.

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Five Remaining Questions on the Public Option Campaign | 95 comments
With Stupak, it depends (0.00 / 0)

 If his objections are really about abortion, then that's easily dealable with. The Hyde amendment covers just about all he's worried about, and I'm sure a few minor tweaks will close any remaining loopholes in his mind.

 If, on the other hand, he's just using the abortion thing as an excuse for trying to sink the bill at the behest of the insurance lobby, then we've got a bigger problem, because as we've seen with the blue dogs, they don't listen to reason, and if you try to mollify them one way, they just come up with a new batch of excuses.

 So let's hope it's just out of a sincere concern about abortion.

 

"We judge ourselves by our ideals; others by their actions. It is a great convenience." -- Howard Zinn

I do not want any further throwing of women's health, and women, under the bus. (4.00 / 1)
tweaking...

Unsafe women's health provision is a crime.

If this is not what you meant, and I don't see how it isn't, I'm sorry for implying it.

Change
"We must break up the banks and never again let them get so big that they distort our politics and take down the economy.

[ Parent ]
We have ENOUGH anti-abortion controls NOW (4.00 / 2)

 The fact that Stupak seems to pretend otherwise is what suggests to me that this isn't really about abortion.

 That's the part that concerns me. The abortion thing smacks like a front to me. But there's one way to find out.  

"We judge ourselves by our ideals; others by their actions. It is a great convenience." -- Howard Zinn

[ Parent ]
It's sincere... (4.00 / 1)
He's had like a 100% anti-choice rating for years and has been a hero for the dominionists for a long time.

REID: Voting against us was never part of our arrangement!
SPECTER: I am altering the deal! Pray I don't alter it any further!
REID: This deal keeps getting worse all the time!
[ Parent ]
Then what's his problem... (0.00 / 0)

 ...with the Hyde amendment?  

"We judge ourselves by our ideals; others by their actions. It is a great convenience." -- Howard Zinn
[ Parent ]
Stupak's amendment doesn't seem to just apply to federal funding (0.00 / 0)
it seems to apply to ALL health insurance plans
[ Parent ]
No... all insurance plans in the exchange.... (0.00 / 0)
...that receive government subsidies.  

REID: Voting against us was never part of our arrangement!
SPECTER: I am altering the deal! Pray I don't alter it any further!
REID: This deal keeps getting worse all the time!
[ Parent ]
Next question... (0.00 / 0)

   If he feels this strongly about it, why didn't he introduce such legislation in the past -- heck, just four years ago it would have sailed through the House, with its Republican majority.

  Maybe he has, who knows. But he's been there since 1993. I find it rather odd that just now, just when we're this close to getting some real health-care reform, he's suddenly concerned about this issue.

  I think he's just hiding behind the abortion issue. It's time to smoke him out.  

"We judge ourselves by our ideals; others by their actions. It is a great convenience." -- Howard Zinn

[ Parent ]
Doesn't Have the Votes (4.00 / 1)
Stupak's math is faulty.  Given 40 votes and all 177 Republicans, he has only 217 votes.  He needs evey Republican vote and I think somewhere from 3 to 12 would defect.

The closest recent House vote on the issue was on a 2007 amendment that would de-fund Family Planning.  Stupak voted against that and so did 21 Republicans.  Nine of the 21 are no longer in the House but that leaves 12 possible defections.  Four are women (Biggert, Brown-Waite, Capito, Granger).  Three are running for state-wide office (Castle, Gerlach, Kirk).  The five others would mostly classify as moderates (Dent, Frelinghuysen, Lewis, Upton, Walden).  My guess is that at least Castle, Biggert, and Frelinghuysen would cross over.  Capito might (or might not) have to run against an incumbent Democrat in 2012 as WV might well lose a seat.  Walden has state wide aspirations.  

[ Parent ]
But those Republicans won't vote for the whole bill (0.00 / 0)
so the 40 votes can kill the entire bill.  
[ Parent ]
After parsing his demand, though (0.00 / 0)
I'm a little happier about it:


"about 40 likeminded Democrats" who will vote to kill the health-care bill if House Speaker Nancy Pelosi (D.-Calif.) does not allow a floor vote on his amendment to prohibit federal funds from going to insurance plans that cover abortion.

It looks like all he is demanding is a floor vote on his amendment, and that he is claiming that he will kill the bill if he doesn't get his floor vote.  What he is not saying is that he has the votes to kill the bill if the final bill does not contain his amendment.  If that's all he's saying, then whatever.

And I really hope that Pelosi knows what's going on with this one.

[ Parent ]
so then why won't they allow a vote on the amendment (4.00 / 1)
probably because it might pass.  
[ Parent ]
question #6: (4.00 / 1)
Will the White House veto a bill with a public option in it, no matter how weakened it may be?

That's the hardest one to answer, and the one where we really have the least influence.

that is very easy to answer (4.00 / 5)
No.

Yeah--the White house is going to veto a health care bill. Sure. That's a real strong possibility.

There is no chance of that happening. None. Not a serious question.

[ Parent ]
LOL (0.00 / 0)

[ Parent ]
it's absolutely a serious question (4.00 / 1)
If the bill comes out and the administration is unsuccessful in getting a trigger, or some other way of gutting the public option, will the administration veto it?

It would be horrible politically for him, but the insurance companies don't want a public option. Opt-outs or no. And they're going to pressure the administration to kill it.

They certainly still want a trigger, even though Senate opinion has turned against it. I don't think they've given up, they're going to try to kill it in reconciliation.

I'm not saying the WH wants to do this. I'm saying, if the administration's back is against the wall, will they do it?

[ Parent ]
Serious paranoia maybe (0.00 / 0)
"Back against the wall"? What are the insurance companies gonna do to him? Hold him in for recess?

Jesus.

Conduct your own interview of Sarah Palin!

[ Parent ]
LOL (0.00 / 0)
If you can't answer that question for yourself, it's not worth answering because you already decided what the answer is.
[ Parent ]
I really think... (4.00 / 1)
Chris was pretty right and pretty clear.

The CEO of Wellpoint could be holding Rahm Emanuel hostage and the President would. not. in a million. years. veto healthcare legislation. It simply is not a possibility in any realm that we live in.

And if he does veto it, I'll be the first to say I was wrong, and try to find my way out of the Twilight Zone.

[ Parent ]
Precisely. (0.00 / 0)
Obama's apologists here don't care to acknowledge that he is their enemy and has been all along.  They didn't admit he is on the side of pharmaceutical companies when he was caught making back room deals with their lobbyists to sell us out on negotiating drug prices, and they won't admit it even when they see him vetoing a public option (assuming his fellow right-wingers in Congress even pass one).  Even then, they'll continue making excuses for him.


[ Parent ]
Easy answer (4.00 / 5)
Will the White House veto a bill with a public option in it, no matter how weakened it may be?

No.

[ Parent ]
Yeah right, hes says hes for it, over nad over and over, then he vetos it cause really all that talk, was just talk. (0.00 / 0)
I am sorry but that isn't pressure on the Pres, or pushing him or "opening up a little room on the left" thats just ...odd.

He didnt do enough is the statement, and maybe because he's a centrist, but no real analysis thinks that.  

Change
"We must break up the banks and never again let them get so big that they distort our politics and take down the economy.

[ Parent ]
Do (4.00 / 1)
you really think Florida would opt out? That's my state, and even though I'll be happy to see some form of public option pass, knowing it won't affect this very "purple" state would be highly disappointing.
Absolutely (4.00 / 1)
Yeah, those of us in the flaccid wiener state are screwed. It's still better than a trigger.

Conduct your own interview of Sarah Palin!
[ Parent ]
If it does then the repubs are toast in the next state elections. (4.00 / 1)
[ Parent ]
No idea (4.00 / 2)
You have no idea how fucked up our state government is. It's gerrymandered to insanity. Democrats will never control the state legislature here in my lifetime barring act of asteroid. As Ray Seaman posted further down the thread:

...The Florida House is 76R-44D, and the Senate is 26R-14D...


Conduct your own interview of Sarah Palin!
[ Parent ]
This might just be an asteroid. (0.00 / 0)
Good luck.

I for one wonder what a real "defence of voting act" would be. Gerrymandering is corruption, and while corruption is rife, fighting corruption is too, eps. when its somebody else's' corruption. That may the avenue to reform.

Change
"We must break up the banks and never again let them get so big that they distort our politics and take down the economy.

[ Parent ]
Isn't the public option popular even with Republicans? (0.00 / 0)
so what's the problem, I don't get it.
[ Parent ]
Not really (4.00 / 2)
If it's popular with Republicans, why does it have zero support from Republicans in congress?

There's a difference between "members of the public who identify themselves as Republicans to pollsters" and Republican politicians.

Conduct your own interview of Sarah Palin!

[ Parent ]
Yes. Because all the remaining Republican politicians... (0.00 / 0)
...represent a narrow strand of the actual Republican party on the ground. All the reasonable people (except a few NY Reps and those two lady senators from Maine) have lost in the 2006 and 2008 landslides.

It's as if all of the Democrats were Dennis Kucinich. Personally, I like Dennis fine, but, like most readers of this weblog, I'm to the left of most Democrats. He doesn't do a great job representing all Democratic voters.

Eric Cantor is the Dennis Kucinich of the right. And he's in leadership.  

[ Parent ]
I don't understand what you are saying (0.00 / 0)
the 2nd paragraph seems to say the opposite of the 1st

can you explain please?

[ Parent ]
This Cause Will Have A Lot Of Support (4.00 / 2)
     While, I do not think it is possible at this momennt--unless the Republican Primary gets very ugly, which it seems to be heading--I do think using this HRC will help candidate Meeks and others to push it towards a bluer state in the years to come.
     When is the next Governor's race?  And who is the leading the pack for the Dems?
     Lastly, let's re-read David's recent diary, and remember to push Congress--and state assemblies, etc. to bring about HCR and put extreme pressure on Congress so every state will be able to have a chance at single-payer health-care.
[ Parent ]
Some thoughts on my effed up state (0.00 / 0)
1.We don't know HOW the opt out will work.  If the bill leaves it up to the legislature then absolutely there is a very real risk of Florida opting out.  Not guaranteed but more likely than not.  If it goes to a referendum, then it's a crapshoot - you can never predict what mud will stick and what won't.  And if it's up to the governor (doubtful Reid and Co. would propose that), then it depends on the next election.

2.Speaking of the next governor's election, it will almost certainly be AG Bill McCollum (R) versus CFO Alex Sink (D) in 2010.  I haven't seen polls, but I suspect McCollum is favored but not by a large amount.  It could go either way.  Sink is reasonably well-liked but not at all exciting to the base.  She's not that conservative, she's just kind of blah. She's got strong ties to Central Florida, which seems to make or break statewide campaigns nowadays. So she's got a shot.

3.Given the horrible state of jobs and housing and insurance and property taxes in the state (and I know some other states are bad too) as well as the history of corrupt Dems from the 60's or earlier through the early 90's, I do not think that the legislature opting out of the P.O. would help Dems much.  maybe in the very long term like a decade or more.

4.Meeks will lose by 15-20 points unless Rubio beats Crist in the primary.  No vote on the opt-out will take place before Nov 2010 unless somehow the Repubs think it will help Rubio beat Crist - keeping in mind that Crist does still have some allies there.  The Repub primary will be the best spectator sport in politics for the next year.

Want a progressive global warming novel, not a right wing rant? Go to www.edwardgtalbot.com for a free audio thriller.

[ Parent ]
Don't confuse "Level playing field" with negotiated rates (4.00 / 1)
1. Medicare+5 is good.
2. Neogiated rates is okay.
3. "Level playing field" is terrible -- from what I understand, this means they have to charge the same rates as the industry average, and cannot negotiate lower rates. There goes most of the cost savings.

We need to make sure we oppose the "Level playing field."

Agreed. (4.00 / 1)
"Level playing field" does not fit the definition of robust we were using to describe the minimum requirements of the PO.  That being the case, we must be willing to walk away if that's what ends up in the final version.

Health insurance is not health care.
If you don't fight, you can't win.
Never give up. Never Surrender.
Watch out for flying kabuki.
[ Parent ]
Agreed if thats what it means, odd weirdness like that hasn't been my attention. (4.00 / 1)
And I admit it should have. but if that's level, then it's NOT playing, and its time to kill the bill, out in the field it goes.

Change
"We must break up the banks and never again let them get so big that they distort our politics and take down the economy.
[ Parent ]
My understanding (4.00 / 1)
I is my understanding that the level playing field means the startup costs are paid through a loan instead of pure tax dollars.  This levels the playing field since the money has to be paid back.  

Does anyone know for sure?

[ Parent ]
Update (4.00 / 1)
I might be mistaken on my definition. Couldn't find any evidence to support what I said.
[ Parent ]
Found this at Think Progress: (4.00 / 1)
Schumer Explains How He Would Level Playing Field Between Private And Public Health Plans

   - The public plan must be self-sustaining. It should pay claims with money raised from premiums and co-payments. It should not receive tax revenue or appropriations from the government.

   - The public plan should pay doctors and hospitals more than what Medicare pays.

   - The government should not compel doctors and hospitals to participate in a public plan just because they participate in Medicare.

   - The officials who manage a public plan should be different from those who regulate the insurance market.

   - The public plan should be required to establish a reserve fund, just as private insurers must maintain reserves for the payment of anticipated claims.

   - The public plan should be required to provide the same minimum benefits as private insurers.



Health insurance is not health care.
If you don't fight, you can't win.
Never give up. Never Surrender.
Watch out for flying kabuki.
[ Parent ]
from a link in the top quickhit (4.00 / 1)
Rates paid to providers would be negotiated by the government.
http://abcnews.go.com/Business...
[ Parent ]
Amendments (0.00 / 0)
Is there a realistic chance of any significant improvements through amendments, or have the deals already been made to avoid that?
Deals have been made (4.00 / 4)
Amendments and floor debate are usually just kabuki. The real negotiations happen behind the scenes.

Small changes can be made, and sometimes a surprising roadblock is thrown up, but usually the floor debate and amendments don't change much.

[ Parent ]
Not in the Senate (4.00 / 2)
The the climate in the Senate, the only amendments that will get passed will either be of the un-vote-againstable sort, (e.g. "prohibit health insurance CEOs from spending taxpayer dollars on ottomans upholstered with angels and puppy fur") or the Tom Coburn type (e.g. "no manditory genital piercing" and "no taxpayer dollars for human-animal hybrids, aromatherapy or anti-gravity chairs".)

Conduct your own interview of Sarah Palin!
[ Parent ]
but but but....... (0.00 / 0)
[ Parent ]
Too bad (0.00 / 0)
I was really hoping someone could sneak in an amendment to allow anyone to enroll.
[ Parent ]
What I found (4.00 / 2)
I'm not sure what is in the bill, but I found the paper I think that suggested the idea.

Conditions for Fair Competition

The administrators of the public plan must be accountable to an entity other than the one identified to govern the marketplace. In other words, the authority overseeing the marketplace (exchange) and enforcing its rules should not have an incentive to favor the public plan over private plans.  

The public plan cannot be Medicare. Creating a marketplace where private insurance plans could compete fairly with Medicare for the under-65 population would be difficult and complex for a number of reasons. Therefore, we believe the public plan option cannot be Medicare.  

The new public plan must be actuarially sound. This means it must charge premiums that cover its costs. The public plan may not be subsidized using additional government revenues.

The public plan cannot leverage Medicare (or any other public program) to force providers to participate. For example, the public plan cannot require providers to serve public plan patients as a condition of participating in the Medicare program.

The public plan should not be required to use Medicare payment rates. Instead it must offer rates that elicit voluntary participation, which means providers should have the same freedom to negotiate with the public plan as they do with other private carriers.  

The insurance market rules and regulations governing the public plan must be the same as those governing private plans.  These rules and regulations include: guaranteed issue, guaranteed renewal, modified community rating, flexibility to charge different rates on geography, risk adjustment, no pre-existing condition exclusions, marketing rules, open enrollment periods, limits or reporting requirements based on premiums to claims ratios, minimum benefit package.

The public plan cannot be granted an unfair advantage in enrolling the uninsured or low-income individuals who will presumably be eligible for subsidies in the new marketplace. This means individuals should be able to apply subsidies to the public or private plan of their choice.

Public and private insurers should be required to adhere to the same rules regarding reserve funds. All insurers operating in the exchange should be required to have reserve funds equaling their incurred but not reported (IBNR) claims. In lieu of solvency requirements (because a state or government cannot be insolvent), the public plan must also establish a Premium Stabilization Fund. This model is currently used by the Federal Employees Health Benefit Program (FEHBP).  

The public plan would also need to contribute to value-based initiatives that benefit all payers. For example, if an assessment for funding comparative effectiveness research is levied, private plans and the new public plan must be required to contribute proportionately.


[ Parent ]
How to opt-out is key in Florida (4.00 / 1)
If the opt-out occurs via a vote in the legislature and signed by the governor, than Florida will likely opt-out. Mostly due to crazy gerrymandering, the Florida House is 76R-44D, and the Senate is 26R-14D. Our legislature would likely vote to opt-out if it only requires a majority vote. If 2/3rds, we might have a fighting chance. With Gov. Crist facing a strong challenge in Marco Rubio from his right, he would likely sign an opt-out.

However, if an opt-out occurs via a constitutional amendment, in FL any amendment requires 60% + 1 to pass, which I think would be a tough hurdle for public option opponents.

Bottom line is it would be best if there wasn't an opt-out at all in the final bill. If not, make it very tough to opt-out.

http://www.ProgressFlorida.org

Sure (4.00 / 2)
but would that lead to Governor Alex Sink and enough of a legislative gain to opt back in?

if the publi option is as popular as we say it is, then yes it would.  

[ Parent ]
No it wouldn't (0.00 / 0)
I doubt we have enough people who would otherwise vote for the Repub who would switch just because of a public option that won't even kick in for four years.  Now Sink might win anyway and the P.O. could make a difference in a close race, but it would be impossible to say that the P.O. was the reason she won.  As for legislative gains, without redistricting, there will be snow in Miami in July before Dems come anywhere near the Republicans.

Want a progressive global warming novel, not a right wing rant? Go to www.edwardgtalbot.com for a free audio thriller.
[ Parent ]
Then the public option isn't as important (0.00 / 0)
as everyone is making it out to be, because if it was, there would be widespread electoral consequences for opting out.  
[ Parent ]
And, of course, (4.00 / 1)
a time-delayed opt-out would be a hard political pill to swallow if the public option turns out to be anything half worthwhile.  (not to mention that a successful PO would proabably swing the country to the D side anyway)
[ Parent ]
Regarding questions 2 and 4. (0.00 / 0)
  1. Doesn't matter.  Chris, you of all people here should know that there are other routes for health care reform.  If any Dem filibusters this bill, they would filibuster any HCR bill.  It's a POS bill that if it were to pass into law would be on life support from day one.  We should be calling their bluff at this point.

  1. No.  The final bill will be a product of the House and Senate versions.  The best we can possibly hope for is to keep the House version (with maybe the Wyden amendment (available to everyone on day one) somehow managing to stick on, too).  Wiener's amendment (substitute medicare for all for the current bill) will get shot down.  We'll be lucky to keep Kucinich's amendment (allow states to set up state-wide single-payer systems).  So, there is no possible way in which the final bill is better than whatever version the House finally brings to the table.

    The only way we can strengthen the PO at this point is to actually be willing to walk away if the opt-out remains in the bill.  Because right now, the opt-out is what Reid is using to keep Dems from filibustering.  Like I said in answer to question 2, these Dems would either filibuster anything, or they won't filibuster at all, and in any case, there are other methods to pass HCR.  We need to get something for the opt-out.  Right now, we get nothing and lose a great deal.



Health insurance is not health care.
If you don't fight, you can't win.
Never give up. Never Surrender.
Watch out for flying kabuki.
Kucinich's amendemnt will stay in... (4.00 / 2)
Finance has it's own version of the Kucinich amendemnt... I assume it survived the melding process.

REID: Voting against us was never part of our arrangement!
SPECTER: I am altering the deal! Pray I don't alter it any further!
REID: This deal keeps getting worse all the time!
[ Parent ]
Right (0.00 / 0)
Kucinich wrote an amendment that specifically allows for "single payer".  The Finance bill, as I understand it, allows for states to make modifications in a way that is consistent with single payer, but doesn't spell it out.  In fact, I think the states can do something more conservative if they wish, as well.  All this is possible, I believe, because the health insurance exchanges are at the state level.
[ Parent ]
I am not in favour of walking for the opt -out (0.00 / 0)
I am in favour of killing a bill with a trigger, or what some up comment line are calling the level playing field, not allowing lower rates to consumers than average private insurance costs (spit yeck!) but not opt out.

Its not good, its bad, but its a sure path to further major reform and the defeat of lots of republicans.

Change
"We must break up the banks and never again let them get so big that they distort our politics and take down the economy.

[ Parent ]
I view the opt-out (0.00 / 0)
as being functionally equivalent to a trigger (among other things that are wrong with it).  That is, it's a back-door method to kill the PO.  The more states that opt out, the smaller the risk pool for the PO.  The smaller the risk pool, the more likely it is to fail.  What's the minimum number of states (and which ones) that are needed to keep the PO functional?  Can anyone answer that?  It's a nightmare.

Health insurance is not health care.
If you don't fight, you can't win.
Never give up. Never Surrender.
Watch out for flying kabuki.
[ Parent ]
1 (0.00 / 0)
I believe California alone is big enough.  As long as California, New York and a few other large blue states stay in, I don't think there will be any problems with viability.

[ Parent ]
Last time I checked (0.00 / 0)
According to my understanding of how any of these bills will handle things, unless we get the Wyden amendment, the only people who will have access to the PO will be those who already don't have health insurance, and we'll be giving a pass to the desperately poor.  Since many of those people are sick, and since risk pools need a lot of healthy people for any health insurance plan to be successful, we need a lot more people in the PO than you would normally think.

I don't think just the big blue states will be enough.  I hope I'm wrong.

Health insurance is not health care.
If you don't fight, you can't win.
Never give up. Never Surrender.
Watch out for flying kabuki.

[ Parent ]
Confusion (4.00 / 1)
Changing the number of people who can participate in the public option does not change the ratio between healthy and sick people on the plan.  Mathematically, you need enough people to shrink the standard deviation, but that is it.

The reason the ratio of health to sick isn't expected to be a problem is because many people without insurance are actually young and healthy.  I haven't seen any real data, but it makes sense that the pool of uninsured has a camel hump distribution, with above average numbers of both people who are sick and can't get insurance and young, healthy people who don't think they need it.

[ Parent ]
You're right. (0.00 / 0)
Thanks for unconfusing me. :)

I know the risk pool size is important for other things, too, like negotiating rates, but that may be overshadowed by the fact that the PO is federally run.  Depends on the details.

Health insurance is not health care.
If you don't fight, you can't win.
Never give up. Never Surrender.
Watch out for flying kabuki.

[ Parent ]
No I don't think it is a functional equivalent at all (0.00 / 0)
I think its the opposite. I do not think many republican governors will be willing to face that level of motivated backlash, but one comment from Florida said its so corrupt that even this would budge the Republicans.

Another, lordmike?,  said it might all go to r3eferndum in the state which could guarantee passage.

But in general it looks to me to be the opposite of a trigger, in that it means it will happen, but give saving face to people who say they oppose a PO, but will vote for the Bill.

Change
"We must break up the banks and never again let them get so big that they distort our politics and take down the economy.

[ Parent ]
Obviously we disagree. (0.00 / 0)
I don't see it as a face-saving maneuver that won't go anywhere (or almost nowhere) once it gets to the states.  I see it as a direct threat to the success of the PO, just like the trigger.  As states opt out (and I have no doubts they will), that will shrink the risk pool.  Shrink it enough, and the PO dies, just as if there had been a trigger.  That's what makes it functionally equivalent.  It's a method to kill the PO while still passing a HCR bill.

Wyden's amendment will make this much, much harder to accomplish.  Couple that with requiring states to be part of the PO for at least a few years before they make any attempt to opt-out, and then make the opt-out process as difficult as possible, then I'll agree with you the opt-out isn't the same as a trigger.

Health insurance is not health care.
If you don't fight, you can't win.
Never give up. Never Surrender.
Watch out for flying kabuki.

[ Parent ]
I Truly Believe Wyden' Amendment (4.00 / 4)
will show up in some form of the bill.  He needed to be mollified by Baucus to vote Yea on the Senate Finance Bill; that said, I don't think it will be as sweeping as Wyden hopes.
    Still, I think the Wyden Amendment of sort can really strengthen this bill.  This amendment is being overlooked by a lot of followers of this debate; yet ironically, I think this amendment would garner wider support in both chambers, if it make "proper" concessions. The Wyden Amendment is one the best proposals out there, and saves money.
    Anyway, I realize this may be wishful thinking. Comments?
[ Parent ]
I couldn't find anything (4.00 / 2)
I Googled around for any news and couldn't find anything.  Blue Oregon states:

No word yet on all the other details, including who would be eligible to participate (just a few million Americans, or all Americans - as Senator Ron Wyden wants?)

[ Parent ]
I really hope you're right. (4.00 / 2)
We need Wyden's amendment in some form or other to allow more people access to health care.  It's also what will ensure the PO remains strong enough to have even a chance of surviving the opt-out.

I fear however, that it will meet the same fate that it met in the Finance committee.

Health insurance is not health care.
If you don't fight, you can't win.
Never give up. Never Surrender.
Watch out for flying kabuki.

[ Parent ]
So Do I (4.00 / 1)
A version of the Wyden Amendment would rein in costs, allow portable, and give more choices to more Americans.  This something small business groups and other HCR advocates should get behind asap.

Bottom Line:  This is the Owner, Slave relationship that Neitzsche described so well.  Businesses don't want to spend on health-care benefits; they want control.

[ Parent ]
Oops! (0.00 / 0)
Master/Slave
[ Parent ]
need to keep pushing but (4.00 / 3)
i would like to say: what a huge win for the progressives who been pushing on this for so long. And the pushback was and has been depressing at times, especially when it came from Democrats. Hey, you don't win anything without making a hell of a lot of noise and, dare I say it, "making them do it."

When I wrote this about Harry Reid 11 days I go I was hoping he or his staff would realize this was his lifeline. I'm sure that post didn't do it but at least they seem to have realized the obvious, finally.

Now back to pushing. We need to really dare fence sitters to vote no on this. They won't if they like their jobs and I still bet you a bunch of Republicans will peel off at the end to vote yes. We'll give them nothing and some will vote yes to keep their jobs.

DC residents? (4.00 / 5)
Any news or ideas of how this covers DC residents? Since it's opt-out I'd imagine that puts DC in, but they are talking about states with the option, so where does that put DC? Does Congress get the final vote on DC or would we automatically be in?
VOTING RIGHTS FOR DC!!!! (4.00 / 2)
[ Parent ]
Opt-out mechanism? (4.00 / 2)
I'm guessing that the bill does not specify how a state might choose to opt-out because if it did, there wouldn't be so much confusion on the issue.

I'd suggest a strategy that is akin to the triggers that were designed never to be pulled. If the opt-out mechanism were specified as a public referendum and included on a state-wide ballot during the yearly election cycle, how many states would actually be able to garner enough votes to opt-out?

That is, design and opt-out mechanism designed to be very difficult for opponents to accomplish.


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

very good (0.00 / 0)
I would love to use this bad idea to destroy conservatives, but your suggestion is better for getting people into affordable healthcare, and that is the main point and first principle.

Change
"We must break up the banks and never again let them get so big that they distort our politics and take down the economy.
[ Parent ]
Questions: (4.00 / 3)
Assuming the opt-out (as much as I detest it) remains in the bill,
  1. Once a state opts out, is it possible for the state to opt back in?  If so, how?

  2. Assuming states can opt back in, is there any limit to the number of times a state can opt out and in?  The function of the 2014 date is not very clear (at least to me).


Health insurance is not health care.
If you don't fight, you can't win.
Never give up. Never Surrender.
Watch out for flying kabuki.
Inertia (4.00 / 1)
Just as a general principle I would imagine repetitive opt-ins/outs wouldn't happen due to institutional inertia.
[ Parent ]
Probably, but I don't like relying on that if I can help it. (0.00 / 0)
I mean, I can imagine a situation for borderline states where the hard right manage to force an opt out, the residents vote them out and the state opts back in, then with everything going along fine, the state goes right again and the hardliners push them out.  It might happen over the span of a decade or two, but that's kinda the reason we don't want it to happen in the first place.

Once in, a state should stay in.  (Though why we're even debating whether a state has the right to deny citizens access to a federal program is beyond me.)

Health insurance is not health care.
If you don't fight, you can't win.
Never give up. Never Surrender.
Watch out for flying kabuki.

[ Parent ]
Regarding #5 (4.00 / 1)
* Will there be a delay before the opt out window (i.e. it starts in 2014) so we have a true, national PO for a few years? It's critical for the coming opt out fights in the states that they not opt out before even trying it.

* Obviously method/means of opting out is important. How can we make it as difficult as possible? Is setting a super-majority (60%? 67%) of legislature requirement possible? Popular vote referendum? Expensive, labor/time consuming, but also mitigates industry legislative influence.

* Does the opt out sunset or is it available (we have to continue this fight) forever?

IMO, the biggest problem with the opt out is that it continues the health care fight indefinitely. We've put ourselves in position and now have a unique opportunity to favorably settle this issue. Instead, we're going to extend this fight to the states, perhaps forever.

"The White House obviously has a loser mentality - but America rallies around winners."

Let me tell you as an American living in Canada... (0.00 / 0)
The debate never ends. The struggle never ends.

Just on principle we must always remember, everything good we do is temporary, every failure we suffer is permanent. We must rethink citizenship to be part of who and what we are. Vigilance and constant organizing is the way to stop FDR from turning into Reagan, Deeds, war on Iraq and opt-outs.

Change
"We must break up the banks and never again let them get so big that they distort our politics and take down the economy.

[ Parent ]
True indeed (4.00 / 2)
As witnessed by the recent fight here to stop the privatization and gutting of Social Security. That said, we could do without deliberately designing more fights as part of the solution.

"The White House obviously has a loser mentality - but America rallies around winners."
[ Parent ]
opt-out? (0.00 / 0)
I haven't seen any specifics on how a state would choose to opt out of the public plan.  Would it be an executive decision by the Governor, a vote of the legislature, or a special election where the citizrens would vote?
hasnt been written, and if written hasn't been distributed and if distributed hasn't been voted on. (0.00 / 0)
[ Parent ]
It seems like everyone is assuming that the opt-out will survive conference committee (0.00 / 0)
, but if the House passes PO with Medicare + 5%, wouldn't the most natural compromise between the House and Senate be a full public option with its own negotiated rates?
Or a Medicare+5 with opt out (4.00 / 1)
Or more realistically, the "compromise" will be the Senate bill with some fluff added.
[ Parent ]
If the "fluff" includes starting the PO up in 2010 instead of 2013 (4.00 / 1)
then I'll take it.
[ Parent ]
The CC bill is subject to filibuster (0.00 / 0)
unless Reid has a 'no filibuster the CC bill' pledge from people, then it is still up in the air.
[ Parent ]
Another problem with opt outs (0.00 / 0)
The whole point of the public option is to force competition, which would then lower prices.  Wouldn't the states that are the most likely to opt out the very states where the local healthcare system is the strongest?  But wouldn't this be where the cost overruns are the worst?  
And force people to buy private insurance they don't want. Oh yes, its a clusterfrak waiting to happen. (0.00 / 0)
Any competent legislator will make sure this spills hot grease in the laps of politicians opposed to health reform.

Change
"We must break up the banks and never again let them get so big that they distort our politics and take down the economy.
[ Parent ]
It's all in what the mechanism of the opt out is (4.00 / 1)
and whether they begin or end on 2014.  But then again, haven't all of these compromises been about whether they are political cover for the Dems or poison pills by the Libercrats?
[ Parent ]
Another question: (0.00 / 0)
Not sure if there are enough people still paying attention to this thread to answer, but here goes.

What do we get by agreeing to an opt-out?  A robust, medicare-like PO with no triggers?  That was a given.  Either we got that or we walked.  Right?  RIGHT???  I'm not going to bargain with basics necessities, and I hope no one else here would, either.

So what are we getting for the opt-out?  Universal coverage?  Well, no, by definition that's impossible with an opt-out.  Better rates?  Lower drug prices?  More health insurer accountability?  What?

Health insurance is not health care.
If you don't fight, you can't win.
Never give up. Never Surrender.
Watch out for flying kabuki.

We get the public option (0.00 / 0)

[ Parent ]
Again. (0.00 / 0)
We already have that.  Or we walk.  That's not part of the negotiation.

So I ask again, what do we get for agreeing to an opt-out?

Health insurance is not health care.
If you don't fight, you can't win.
Never give up. Never Surrender.
Watch out for flying kabuki.

[ Parent ]
No we don't already have that (0.00 / 0)
We think that the progressive bloc in the House and the smaller progressive bloc in the Senate MIGHT hold fast.  But it's clear that the Senate progressives already agreed to the opt-out.  So it's not accurate to say we have the public option.  In fact - it's possible taht even now, we don't even have the public option with opt-out.  All it takes is an Insurance company to pay Evan Bayh or Blanche Lincoln five million dollars under the table and they can join a filibuster and kill it.  Obviously that is easier said than done, but you get my point.

There is a valid argument to oppose the opt-out under all circumstances.  But to make the argument you have to believe it is worse than no reform.  That doesn't mean we can't forcefully advocate for a P.O. without one, but no way should we assume a P.O. is in the bag.

Want a progressive global warming novel, not a right wing rant? Go to www.edwardgtalbot.com for a free audio thriller.

[ Parent ]
If the prog bloc et. al. won't hold (0.00 / 0)
then we have nothing, no matter what we do, and nothing we do or say will change things.  The bill could be a travesty of mandates and jail terms, and there's not a damn thing any of us could do about it.

So we are better off working under the assumption that the prog bloc will hold.  (They may need prodding and encouragement, but they'll hold.)

With that assumption set, we can then say that yes, we do have the public option, because the prog bloc will kill a bill without it, and the Dem leadership is more afraid of not passing anything than passing a bill with a PO.

And to be clear, I'm not saying that the PO is in the bag for this bill.  That's not set in stone.  My point is that if there is a bill, the only reason will be because the PO is in it.  That's non-negotiable.

Health insurance is not health care.
If you don't fight, you can't win.
Never give up. Never Surrender.
Watch out for flying kabuki.

[ Parent ]
When to say yes (0.00 / 0)
Part of negotiating is when to accept yes as an answer.  There was a lot compromised here, but I have little reason to believe there was much additional room to make this work, at least in the Senate bill.  We still don't know for sure this will pass.  On the other hand, we still have a chance at a more liberal House bill and a slightly beefed up PO in the final merger.

But the reason this compromise was judged acceptable is the public option has enough tools to started.

Think of this as the very first light rail line running to downtown.  The first one is nice and you hope it is successful, but it really isn't all that important for overall transportation needs.  It is only after you build the second and third line you start to get enough density and synergy for the lines to really become a vital part of the transportation grid.

This public option is our first line.  It serves a needed purpose and will get passengers.  It has the tools to survive.  But none of these plans was actually big enough or vital enough to actually change the system.  But this gives us something to build from.

[ Parent ]
I'm all for building up from a small starting point. (0.00 / 0)
If I weren't, I would have said no to anything less than a national health care system (something like what the British have).  But there's no reason to start out smaller than we have to.

There are not enough votes in the Senate to kill a bill without an opt-out.  Therefor, the opt-out is unnecessary to pass the bill.  There are enough votes in the House to kill a bill without a PO.  The PO is necessary for passing the bill.  We have the upper hand!  Or had.  It's still possible that we could get the opt-out stripped from the final bill if we push for that to happen in conference.*  But that requires that we recognize that we are actually sitting in a position of power.  For once.

We should recognize now that any Dem (including Lieberman) filibustering the bill is going to catch political hell.  (I'm guilty of not recognizing this sooner.)  That would have been true no matter what Reid came out with.  The leadership wants to pass a bill more than anything else, so they'll do whatever it takes to pass a bill--any bill.  That's their weakness!  They're willing to accept any bill, so long as it passes.

They're afraid of going the Budget Reconciliation route, sure, but they've said they'll do it if that's what it takes, and that's coming from Harry "Wat's a Spine?" Reid.  The "Nuclear Option" is not something they'll use, but we wouldn't need it, since we already know we have the votes to pass HCR with a PO through Reconciliation.

So I repeat, again, the opt-out gets us nothing we don't already have, and we haven't gained anything by including it.  And that's on top of all the other reasons to be against it in the first place.

* Or we could get a couple of very strong amendments in exchange.  Say a pristine Wyden amendment plus an earlier start time, like late 2010 or early 2011.  And put some strong restrictions on the opt-out, like requiring states to show that insurance companies there are providing coverage at costs similar to the PO, which is examined yearly so that any states not in compliance are automatically opted in.  Actually that makes it a kind of reverse opt-in.  That is, states are opting into an alternate cost control method, and if they don't remain in compliance, the federal government steps in with the PO, just like it's supposed to.  So I could get behind that.  (Devil's in the details, and all.)

Health insurance is not health care.
If you don't fight, you can't win.
Never give up. Never Surrender.
Watch out for flying kabuki.

[ Parent ]
I'm with Gabriel D on this one (0.00 / 0)
It seems like that not only was this opt-out compromise unnecessary, we didn't even get anything out of it.  It's still a Level Playing Field PO, with no Wyden amendment to make it at least universally available even in the states that have it, and states can apparently opt-out until 2014, giving the PO just a year to work its magic.  And is there any way to change any of this besides 60-vote amendments or in conference?

Okay, so we got a public option.  But would we have not gotten it without the opt-out?  I want someone to point out which votes did we secure with an opt-out, that we would not have had with no opt-out.  We know it's not Lieberman, who has come out and said he'd filibuster ANY public option (which he probably would've also done had it'd been a PO with no opt-out), and the rest of the usual suspects - Lincoln, Bayh, Nelson, Snowe - have been noncommital at best.  I haven't seen any Senator step forward and say, okay now that it's opt-out it's got my vote.

In watching this whole opt-out thing I get the feeling we liberals, in being so nice and accommodating and open-minded, are addicted to caving in.  We were able to resist the temptations of triggers and co-ops but when the opt-out came along it was too tempting to resist.  We should've instead rejected the opt-out and kept fighting so long as we knew that having the opt-out or not didn't make a difference in the whip count.

[ Parent ]
Five Remaining Questions on the Public Option Campaign | 95 comments





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