A Better Public Option
Let's call their bluff.
There's a lot of willful confusion over a Public Option, painting it as a public takeover of American healthcare. Kyl, e.g.: "A stunning assault on liberty."
It seems that the fallback position is a trigger, which is commonly acknowledged among the left to be a fig leaf for capitulation. It bounces the idea down the road to a point where we're more likely to fail in getting it passed. The trigger can be overridden with ease and is therefore not much of a trigger at all.
Governors are complaining loudly that their states would not benefit. So why not give them what they want -- let states opt out?
States could set up their own devices -- triggers, co-ops, whatever. The reason we need to have universal buy-in is to avoid the adverse selection problem. Let's say 40 (or even 30) states do not choose to opt out -- this would still be an adequate size to largely solve that problem.
Sure, we'd have marginally higher premiums due to states with particularly high heart disease rates remaining under the plan and some of the healthiest states opting out. But this difference pales in comparison to the adverse selection problem of only covering those who statistically require the most care (e.g., 50-year-old heart patients who buy versus healthy 18-year-olds who don't).
Let them opt out. Give them the "liberty" of our current health system. The harm to the Public Option would be relatively light; their choice would show quite vividly the difference between states with a strong public option and those without. When offered the actual choice, rather than the rhetorical farce, many teabaggers might choose the very thing they screamed against.
It would accomplish the goal of providing decent health insurance while making the right actually deal with the consequences of their rhetoric, which would be all kinds of fun. So why wouldn't this work?
There's a lot of willful confusion over a Public Option, painting it as a public takeover of American healthcare. Kyl, e.g.: "A stunning assault on liberty."
It seems that the fallback position is a trigger, which is commonly acknowledged among the left to be a fig leaf for capitulation. It bounces the idea down the road to a point where we're more likely to fail in getting it passed. The trigger can be overridden with ease and is therefore not much of a trigger at all.
Governors are complaining loudly that their states would not benefit. So why not give them what they want -- let states opt out?
States could set up their own devices -- triggers, co-ops, whatever. The reason we need to have universal buy-in is to avoid the adverse selection problem. Let's say 40 (or even 30) states do not choose to opt out -- this would still be an adequate size to largely solve that problem.
Sure, we'd have marginally higher premiums due to states with particularly high heart disease rates remaining under the plan and some of the healthiest states opting out. But this difference pales in comparison to the adverse selection problem of only covering those who statistically require the most care (e.g., 50-year-old heart patients who buy versus healthy 18-year-olds who don't).
Let them opt out. Give them the "liberty" of our current health system. The harm to the Public Option would be relatively light; their choice would show quite vividly the difference between states with a strong public option and those without. When offered the actual choice, rather than the rhetorical farce, many teabaggers might choose the very thing they screamed against.
It would accomplish the goal of providing decent health insurance while making the right actually deal with the consequences of their rhetoric, which would be all kinds of fun. So why wouldn't this work?
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Worth remembering that Canada got the system it has because one province, Sascatchewan, implemented it .... and the rest wanted it! I don't think it would require that 30 or 40 States be on a public option, just a few. If they do it right, and it does as well as we think, that might be quite enough.
Actually, I'd rather see that (discrete trial projects in different states or regions) than an overall, nationwide public option implemented right away. Too much attention on it, too easy to sabotage, too much *reason* to sabotage, and failure would be catastrophic.
September 23, 2009 2:35 PM | Reply | Permalink
We may have two different ideas about the "public option."
My understanding of the public option would be a federal health insurance program that individuals could elect to join. Sort of like Medicare, except with premiums paid by the individual based on actuarial costs. The only federal (or state) subsidy would be the same subsidy that will apply to any other health insurance coverage.
So the state government would have nothing to do with it. No funding, no administration, no nothing.
So why should a state be able to elect out of a federal program? Can states elect out of Medicare? Can states elect out of Social Security?
Adverse selection at the state-wide level does not seem actuarially significant. And the states most likely to opt out would be the states with the worst health records.
And there's no reason to believe that Republican Representatives and Senators will vote for the bill merely because the citizens of their states might be denied benefits allowed to citizens of other states.
So I don't see it.
September 23, 2009 11:22 PM | Reply | Permalink
I think I made my point poorly. I was conflating/confusing two things -- the mandate to purchase health insurance and the public option.
I absolutely agree that state government has nothing to do with the issue in its current form. I'm proposing that we allow individual states to withdraw, making their residents both non-obligated to purchase health insurance and ineligible for the public option plan(s). At the very least, this undercuts the most frequently-stated (and least serious) argument against the bills -- that the plan itself is an attempt to force government health care down their throats.
States would be foolish to withdraw, of course. But if a minority of states did so, we would still have an adequate pool (in both size and demographic diversity) for a successful mandate and public plan.
I agree with you significantly on one point, Ecclesiastes -- I don't believe that this would, as you say, get Republican votes. I'm merely saying that this change would give them what they claim they want (i.e., undercut their argument) without neutering the public option as significantly as a "trigger mechanism" would.
I do like Elizabeth2's point about trials, but I don't believe that it could work on an individual state basis. I think it requires a significant percentage of the country in order to get this "bargaining power for drug prices" that everyone keeps talking about.
September 24, 2009 12:20 AM | Reply | Permalink
Good point -- I live in a very populous state (NY) and probably tend to forget that all of, say, Idaho might not be a very powerful purchasing block. Still ..... rather than no operating public option, I think one operating in a single state would be better than nothing. It might not address all problems (e.g., cost), but being able to see the contrast might still be a wake-up call. Totally agree that having a significant percentage of the country would be best ... tho I still see the dangers of jumping in and doing the whole country at once.
Here's an idea that occurred to me and I keep dopping it everywhere hoping for some feedback. If you have any thoughts, I'd appreciate them.
----- Assuming (and I'd like to know the hard info on this) that each state has a favorable, comparatively low-cost coverage for its employees that allows some choice between private insurers and HMOs .... allow any other individual who cannot find equal or better (cost/coverage) policies on their own (or through their employer - haven't thought through that part entirely) to become eligible to sign on as additional 'members' in the State policy .. except they (or, possibly, their employers) pay the full premium - which is equal to that put in by State employee and the State itself in their policies.
The per person cost would be the same regardless of age, health status, etc. just as it is for State employees. -- For people who can't pay the premium, the Feds would come in with their subsidies, which - I believe - would more or less do away with Medicaid.
This is NOT as good as a public option, but it would set up the framework for one, might be more easily passed since it "respects" the role of private insurers and uses existing mechanisms/procedures to enact quickly; provides everyone with basic good, nondiscriminatory coverage; and would allow individual states to establish a public option -- or to band together and establish a public, regional option.
I know there has to be a flaw -- probably a big one -- but no one has pointed it out, so I keep asking.
Thanks -- good thread.
September 24, 2009 12:23 PM | Reply | Permalink
A while back, Thom Hartmann wrote a letter to the President with a simple request: "Let me buy into Medicare". Allow whoever wants to, to buy into Medicare. After all, a public option should be, you know, an OPTION.
And here's an interesting twist on the Repugs idea of a public option
http://firedoglake.com/2009/09/23/gop-favors-public-option-for-property-not-people/
September 24, 2009 10:12 AM | Reply | Permalink
Why wouldn't it work? Although I like your idea; for those who have the bad luck (and not the voting power to kick out the selfish bastards like in Texas) it would be a disaster. But on second thought, if it starts working really well in the states that get it, the others will be under pressure.
Yes! I wholeheartedly agree! Let the suckers opt out!
September 24, 2009 12:53 PM | Reply | Permalink