Don't Let States Opt Out Of The Public Option
Ezra Klein suggests today that a reasonable compromise on the public option would be to let states, by whatever legislative or administrative methods they want, opt out of offering a public health care option to its citizens.
I admit that this has some appeal. It'd make some red state governors really have to put their political courage behind their convictions and it'd prevent the states from complaining that nationalized health care is being "rammed down their throats" or some such nonsense. This one could score some pretty big political points.
But it's entirely immoral. No governor should be allowed to stand in the way of an individuals who want to avail themselves of the public health care option. The option part of "public option" is supposed to stand for an individual's choice, not for a legislature's choice, a governor's choice or even a referendum.
We've already debased the public option by not making it available to every individual who would rather contract with the government rather than a private insurance company. To allow states to put up ideological road blocks in the way of people who might need or want the public option isn't a compromise we can live with.
That we're even having this discussion is proof of a compromise that's gone too far. Most of us were always happy to say "If you love your private insurer, keep them." That was a fair compromise from single payer. As soon as we compromised again and didn't allow the public option to be available to any citizen who would choose it over another we gave up too much. Let's not make that mistake again.
I admit that this has some appeal. It'd make some red state governors really have to put their political courage behind their convictions and it'd prevent the states from complaining that nationalized health care is being "rammed down their throats" or some such nonsense. This one could score some pretty big political points.
But it's entirely immoral. No governor should be allowed to stand in the way of an individuals who want to avail themselves of the public health care option. The option part of "public option" is supposed to stand for an individual's choice, not for a legislature's choice, a governor's choice or even a referendum.
We've already debased the public option by not making it available to every individual who would rather contract with the government rather than a private insurance company. To allow states to put up ideological road blocks in the way of people who might need or want the public option isn't a compromise we can live with.
That we're even having this discussion is proof of a compromise that's gone too far. Most of us were always happy to say "If you love your private insurer, keep them." That was a fair compromise from single payer. As soon as we compromised again and didn't allow the public option to be available to any citizen who would choose it over another we gave up too much. Let's not make that mistake again.
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I agree with you, but it would make for a interesting campaign season in 2010 for those states that did opt out.
October 8, 2009 6:26 PM | Reply | Permalink
I think it plays to states' rights and invokes the ghosts of compromise past... The Missouri Compromise in particular.
Which states shall remain free, and which shall remain slave?
That being said, it does create a political gamble that could turn the tide. I would like to read the opt-out language being proposed. Can a state choose to opt in at any point via state government fiat?
My support depends on the semantics.
October 8, 2009 6:52 PM | Reply | Permalink
I agree that the devil is in the details. If opt-in states mandated universal coverage and prohibited either in-state or out-of-state private insurers from cherry picking, but required them to compete on a level playing field with the public option, it would put pressure on the other states to participate. Presumably states, like the federal government, are responsible to their constituents, and so the democratic process in non-participating states might well work toward making the public option universal.
October 8, 2009 7:14 PM | Reply | Permalink
FM
" it would put pressure on the other states to participate"
One of the thoughts I had while writing my post below.
M. Paul
October 9, 2009 12:37 AM | Reply | Permalink
I am feeling more and more like a radical radical leftist. fuck compromise.
October 8, 2009 7:16 PM | Reply | Permalink
I see this as a scam in a sense. Allowing the insurance companies to mount state by state fights. Divide and Conquer is how it will be. With each state having to fight them on its own. One by one.....
It looks a like a Trojan Horse to me.
I just don't trust the forces that will array themselves against those who really need the public option. I can just see all the lies that will be told by the insurance cartels.
I rarely comment here anymore. But color me very, very skeptical of this so-called compromise.
Thanks for this oppotunity, Destor. :)
October 8, 2009 7:27 PM | Reply | Permalink
I've been missing you, TheraP!
And you're right, I hadn't even considered but you're right -- any state that opts out becomes a new lobbyist battleground, which is just what they want.
October 8, 2009 7:43 PM | Reply | Permalink
Indeed it is! Just look at the number of States that are cutting back on social spending simply because it's the easiest to cut because those who need it the most don't have the political clout to stop them.
Also, because States used the 10th Amendment to bar the federal government from the process, health insurance has been a single dance with each State. And each State reached compromise with the industry over coverage and cost. That's why there's no conformity between States on health care quality and costs - it's determined at the State level and the details are subject to the whims of the legislature, insurance commission and governors. It's the major reason why it's so screwed up and the federal government needs to intervene.
So giving the States the option to opt-out defeats the purpose of health care reform.
October 8, 2009 10:38 PM | Reply | Permalink
Let's have some single payer states too then.
October 8, 2009 7:40 PM | Reply | Permalink
Hey, I want single-provider states.
Actually, I don't see how it matters as long as rates are regulated and acceptance/portability required.
October 9, 2009 5:30 PM | Reply | Permalink
go read Nate over at 538.com It's a good rundown on why this might be a good idea. Next for what it's worth Dean likes it.
October 8, 2009 7:46 PM | Reply | Permalink
I think it's a good idea, too.
There will be a handfull of Red states that Opt Out.
They do so at their own PERIL!
In effect it will mean that the citizens of those states pay MORE for healthcare than the states that participate.
In effect it will mean more people suffer and die in those states because they don't have access to healthcare compared to citizens of other states that do.
The next election cycle would be a huge GAIN for politicians campaigning to Opt-In.
The end result is gold. Repiggies loyalty to the Insurance Industry would be their own undoing.
Yay!
October 9, 2009 1:19 PM | Reply | Permalink
It's a good compromise for the problem of the House, representing the people, and the Senate, representing the states. Yes, it might be better to just abolish the Senate, but the states with small,stupid populations must have their voices heard. Disproportionately!
October 8, 2009 8:23 PM | Reply | Permalink
That we're even having this discussion is proof of a compromise that's gone too far.
Hear hear to that.
My inclination is to agree with you, despite the potential political advantages. I am weary of further separation between the red and the blue. I would like to know the details though.
October 8, 2009 8:59 PM | Reply | Permalink
I've blogged and commented many times here about what's holding up the public option and the health care reform efforts. The Senate, specifically, democratic senators in key swing states - and republicans too - Snowe in Maine, for example.
To change the Senatorial map, you've got to change the game.
Do you think slavery would have ever been abolished legislatively? Go back and look at that map, and you may find some striking Southern parallels.
Like Fred Moolten said on another blog, the devil is in the details, but as a strategy, this looks promising. It gives Blue Dogs such as Nelson, Baucus, Lincoln, and republicans like Snowe a political life raft.
I'd like to be an absolutist and "fight to the bitter end," but the cornerstone of this bridge is a handful of votes in the Senate, not the states.
Speaking about my home state of Colorado, my state rep and senator can actually be reached - in person - and a grassroots effort can sink one of their ships far faster if they don't back reform, money or no money from the insurance lobby.
(It would be very amusing if, say, Colorado Springs opted out as well, but as so many there are already on government plans...ah, irony)
October 8, 2009 11:53 PM | Reply | Permalink
The voters who elected legislatures and governors which choose to "opt out" deserve to pay higher health insurance costs.
The reality is that the "opt out" public option is the best, we who support a single payer, publicly owned, government administered, not for profit health insurance system, can hope for from our bought and paid for congress.
The opt out public option provides the political cover the cowardly "blue dogs" need to disclaim responsibility.
I’ll gladly take the “opt out” public option proposal and let the voters of each state decide whether they prefer more expensive, profit motivated health care to a public health insurance system subject to their political control.
Eventually, after knee jerk private enterprise ideology succumbs to economic reality, every state will opt in to the federally administered publicly owned insurer.
One day, perhaps, even the voters of Oklahoma may wise up.
October 9, 2009 12:02 AM | Reply | Permalink
I hear yam Chris.
But the health care debate is supposed to be about universal access, not access for those who agree with us.
And... in the reddest of states there's a significant minority who votes with us and they deserve not only our moral support but everything we can practically give them. Only by showing that we can deliver to our supporters can we ever hope to win new converts. Just look at the third rails like social security and medicare -- we delivered, people defend them. The best way to win red states is to deliver the goods.
When we leave our supporters behind, they leave us.
October 9, 2009 12:17 AM | Reply | Permalink
There is an alternative - let the red states deny their people coverage, and make it clear that it's the state government doing it. Hopefully sensible non-Red people in the state will decide that they're tired of living with a bunch of ignorant hicks and move.
Too bad this couldn't have happened a couple years ago; if people move as a result now, it won't show up in the census until 2020 - and the Red states get to keep their House seats until then.
October 9, 2009 12:05 PM | Reply | Permalink
D23
My first reaction to letting the states choose was to remember Jindal having to backpedal on his no stimulus for my state stance. Also here in alaska Palin tried the same tactic for some of the stimulus moneys and i believe all were overturned by our state legislators.
I think the governors are directly more accountable to there constituents but his could be counterbalanced by the insurance lobbies ability to be more focused in each market.
Ether way I feel anything is better than our current options.
M. Paul
October 9, 2009 12:30 AM | Reply | Permalink
Is it not a little like fighting Jim Crow by allowing states to opt out of civil rights legislation, just to get it passed? The places that need it the most with the most powerless citizens will suffer.
Perhaps it could be handled like seatbelts and speed laws - states can do as they want, but expect to lose a lot of federal funding if you opt out.
I think all the comments have been thoughtful, but you'll notice that those who live in backward red states have a different view from those who live in places more likely to opt in.
October 9, 2009 1:39 AM | Reply | Permalink
Sure, compromise has gone too far, yadayada. But you go to war with the Senate you've got - I don't see a strong national public option passing the senate. It'd be some toothless Schumeresque animal. And I'd much prefer a strong public option - piggybacking on medicare rates - with an opt out clause. The public option is an experiment, so it is worth seeing the advantages it actually produces against states that initially reject it.
Moreover it's not like governors and state legislatures are themselves not accountable to their citizens. If people in states who opt out want to opt back in, they know who to call.
October 9, 2009 7:05 AM | Reply | Permalink
rikyrah over at Jack & Jill Politics keepin' real for the likes of Ezra
http://www.jackandjillpolitics.com/2009/10/dems-discussing-public-option-with-opt-out-clause-the-silver-bullet/
October 9, 2009 12:27 PM | Reply | Permalink
Yo, destor. I just got done writing about this, here, but lest you end up thinking that I just dropped by to plug my own shit, here's my take:
As a matter of policy-making, you're absolutely right that it's immoral. On what basis should citizens in one state be denied the right to participate in a federal program that is available to other citizens? What would people think if their states could just opt out of other federal programs? Would they like it if their state opted out of, say, the USPS?
Better still, why don't the option-option Senators go to their constituents and ask them whether they'd like to opt out of Medicare? I'll bet we won't see that happening anytime soon.
However, as a matter of positioning to get the bill through the Senate, this could be a winner, as AlaskaGrown noted above. I think it might be the wrong view here to look at this strictly as a matter of policy-making, but strictly as policy it sucks.
October 9, 2009 3:15 PM | Reply | Permalink
Far as I'm concerned you never have to apologize for plugging. Your posts are good for people. Nutritious and informative!
October 9, 2009 3:52 PM | Reply | Permalink
If one considers the issue of opting out as denying people of their rights, one has to wonder how a court would respond to a legal challange that their state legislator denied them of a benefit and demand that benefit? No state will have their taxes reduced because they opt out. People will be paying for services they do not receive, but I suppose my tax dollars have gone to roads I never drove either, so it's a weak argument. At any rate, I would look forward to seeing the success of a public option unfold and be eager to see a legal challange also come from people with employer insurance who want to participate. I abhor the way employers have entrenched themselves in the health and well being of my family. That relationship should be purely financial, but given the way things are, it has become a much more extensive relationship in which I have fewer reasonable options then I would prefer, such as a public one, if I can't have single payer.
October 9, 2009 4:12 PM | Reply | Permalink
Agreed 100% Destor for all the reasons mentioned and more. There is nothing whatever about this idea that is good and it's no surprise that our DC Democrats have managed to concoct such a bad idea and think it is good. All it really is, is yet another means of allowing the insurance companies and their allies to kill the public option only this time on a state by state basis. It's a reprehensible idea being pushed by a group of politicians who have grown so accustomed to operating from a position of weakness that they don't know what to do with the very real power they now hold. It's pathetic really.
October 9, 2009 4:57 PM | Reply | Permalink