How does this plan differ from the earlier discredited GOP ideas for multi-state compacts which were criticized because the insurance companies would immediately bottom feed to operate from states giving them the most favorable conditions and thus defeat the purpose?

Critics pointed to the credit card industry which gravitated to places like South Dakota where they were allowed to charge truly usurious rates because the state was desperate for business.

Carper's plan sounds like more of the same.

It's bullshit. There is plenty of public support for a real, robust, day-1 public option and that support would only grow after its implementation. It's the kind of thing we elect Democrats to do, and there is NO EXCUSE for not getting it done now. None.

Enough of this crap. Govern like Democrats or go home.

i think the major benefit of this proposal -- and probably why the corporate hack/congresscritters like it -- is that sounds like it'll take years and years and years to implement, and be very very very ineffective and inefficient.

ie, corporate ka-ching!

This might be OK for those who live in states with relatively progressive elected officials, but what about those of us who live in hard-core red states? Does anyone think that Bob Riley in Alabama or Rick Perry in Texas or Haley Barbour in Mississippi is going to let their states instigate a "socialist takeover of health care?" People in states that need a public option the most are going to be the ones who get screwed.

How does this plan differ from the earlier discredited GOP ideas for multi-state compacts which were criticized because the insurance companies would immediately bottom feed to operate from states giving them the most favorable conditions and thus defeat the purpose?

These would be state run plans dweb. Not private insurers. So already existing state laws would have to apply in the case of any individual plan. There isn't enough detail put together yet to determine if this is the right solution but the sort of deregulation problem you cite will not be likely to be relevant.

I have small hopes that a state public option would work. Let's not forget the power a public plan run by California and New York (though perhaps offset by Texas) will have in the market. It will be even greater if there is a New England Regional plan as well as a Northwest Regional plan. These won't be as strong as a national plan, but they also won't be as influenced by the whims of any future Republican administration.

I can't believe anyone thinks that's a serious plan. So residents of some states might, maybe have a public option, while others continue to get screwed?
And does anyone really think that state legislators are any less in the pocket of the for-profits?
This is nothing but a way for those in congress to claim they've done something, when in fact they've done nothing at all.

Okay, but why "regions"? Tennessee would be allowed to join with Kentucky or Alabama but not with California, New York, or Illinois, meaning that people living in or adjacent to more populous states would have an advantage. I guess you could engineer it so that every state is in a "region" with a populous state, but since Tennessee is closer to Illinois than Florida or Texas, that decision would be entirely arbitrary. Why not instead let the states choose which other states they want to join with, so that if North Carolina's needs are different from that of Tennessee, we can instead join up with Oregon or Maine?

Of course I already know the answer, which is that given the last choice every state would eventually join up with every other state and then we'd have a national public option by default.

"leaving it to"

I think those are the important three words.

This might be OK for those who live in states with relatively progressive elected officials, but what about those of us who live in hard-core red states?

You make a good point but I think, taking the political long view, that this might be part of why the idea is gaining traction among Senate Democrats. If these multi-state public options work to lower costs, it will create major competitive advantages for the States that implement them. For instance, if businesses can see that in States where there is this type of public option, premiums costs significantly less, they will either move their business or lobby their States to adopt similar plans. either way, progressivism is strengthened by real world and undeniable results.

What nonsense! This simply makes certain that we'll continue to have zero health care precisely where it is needed most: in poor uneducated right-wing states. I know that Texas, where I live, would sit on it and do nothing indefinitely while its less-well-off citizens continue to die of preventable disease.

Around 70% of the citizens of this country support a full government option. Almost three quarters of physicians support a public option.

Where is the issue here? Do insurers have a constitutional right to an obscene profit that I am unaware of?

It's as if the most important issues of our day are being debated by blind deranged chimpanzees yielding whack-a-mole hammers.

Enough! Represent the people of this country.

Leave it to each state and, once again, people in the most backward states (Alabama, Mississippi, etc.) will, once again, get the worst deal.

Okay, you say, they can always vote with their feet. Yeah, right, like anybody can just pack up, move to a more enlightened (less benighted?) state and get another job.

Giving each state the option of providing public health insurance is something I have been talking about for months. Aside from all that's been said, it will have one more effect that might prove a benefit: It will cause mass migrations from Red states (whose state governments will choose not to provide health insurance) to Blue states.

This compromise plan will turn into a gigantic vacuum, sucking white trash out of the South.

I contend that's a good thing because it will shift demographics so that blue states get more representatives, and the migrating population will be exposed to a different, more sensible culture -- they'll be taken out of the right-wing lunatic echo chamber that some regions in the south have become.

Of course, if the Republicans realize what this compromise will entail, they'll fight tooth and claw to stop it.

I fought hard in the last two elections to elect a Democratic administration and a Democratic Congress. I gave money, I wrote letters and made phone calls,... And to me, this so-called compromise would be a slap in the face.

As others have said, it would leave millions without any reform at all. None. It is as conservative, if not more conservative, than the trigger and the co-ops, and would be wholly unacceptable.

Having this horrible proposal taken seriously by the likes of Ezra Klien and Steve Benen, especially at a time when we sense progress on a strong nationwide public option, makes my head explode.

It will cause mass migrations from Red states (whose state governments will choose not to provide health insurance) to Blue states.

Moving is not economically or socially feasible for enormous numbers of people who tend to be concentrated in red states. Many of them have minimum-wage jobs and no savings, and rely on extended family networks for basics like child care, transportation and even housing.

As corrupt as our federal officials are, state officials are a magnitude of order higher in corruption. This is a very very bad idea.

Brent,

In a perfect world, your logic might apply. But just look at Alabama: BC/BS controls 90%+ of the insurance market. If competition and cost reduction were really a concern of elected officials, something would have been done a long time ago. Cheap, non-union labor is the most important thing to companies here...if insurance costs increase, just pass them on to the workers. What are they going to do? They don't have a union; AL is a right-to-work, employment-at-will state so if they get to rambunctious, you just toss them out and hire new ones and there isn't a damned thing they can do about it.

These complex and convoluted schemes are a waste of time and money. We're trying to find clever ways of perpetuating inefficiencies and higher costs into a system that needs to be simplified and made as cost-effective as possible. Only a single-payer or an extremely robust public option will constitute real healthcare reform.

And how many more years, or decades, and countless lost lives, do we have to endure before states get their acts together on this--if ever?

For crying out loud, I live in Pa., fairly "blue", and they still can't agree on a damn budget. Sorry if I don't trust them to put together a decent public plan. I'm with CJ--what did we just vote for? The momentum has swung our way, and now it's all going to get derailed because of some bs one-page "plan" meant to appease a handful of Democrats in the pocket of the insurance industry?
We should just continue to shame them with advertising, so they have to at least along a vote on a bill with a real public option.

This proposal would kill the 50 state strategy approach that Howard Dean has taken in the last two election cycles.

If this proposal were to pass, it would be Democrats living in blue states telling Democrats living in red states to fuck off (essentially what some of the deliberately cold or deliberately naive commenters have done when they take the position that others should just quit their jobs and move their families).

If one assumes that the progressive Democrats can by the force of will force the Ben Nelson's of the world vote for a bill with a public option, then anything less is stupid and backward.

If one assumes that US Senators are independent actors who make their own calculation of risk and benefit for themselves and (imagine! have their own ideas about public policy), then this could be good news.

This idea being floated and gaining "momentum" is a sign that it is more and more likely that a public option will be passed. If it was tanking, it would be the progressives who would be offering compromises and middle grounds.

What others have said. And also, what does this mean with the issue of insurance "portability"? If everything is going to be a "state program", we're back in the same spot w/r/t that issue - if you move from a state that offers the public option to one that doesn't, or even to another one that does, you can't take your insurance with you.

Bad, stupid, dumb, unworkable idea.

I live in Texas, and I can tell you right now what this state's government will do. As an uninsured, unemployed cancer survivor, maybe I should just go ahead and make my funeral arrangements now, because if Carper's "option" is included, I will die if my cancer reappears.

This is a stupid, stupid, stupid idea for anyone living in a red state.

Can residents of other states buy into a say, California public option and will the hospitals honor that coverage? What happens if someone moves out of state. Do they have to give up their PO plan and take a shitty plan offered in that state?

I don't see that working as a result of these interstate issues alone.

Also, can states who allow a public option form a coalition/cooperative to bargain for better rates?

I seem to recall Texas really dragging its feet with regard to the CHIP program, under the administration of another Republican governor.

But I'm sure they'll get right on board with a public insurance plan.

Instead of being owned by various for-profit insurers, state legislators are usually only owned by whatever monopoly controls their state. So at least that part is simpler.

Let's get right down to brass tacks--the only reason we don't have a Kennedy Medicare-for-all plan is because so many congressmen are more concerned with their masters in the insurance industry than they are with their own constituents.
This message was just starting to get through in states like Montana, North Dakota, and Nebraska--and now it's all going to be lost for this crap?
Haven't these idiots finally realized that they can't fool anyone just by slapping the words "public option" on a piece of crap?

Okay, but why "regions"?

So that the private health insurers can gerrymander a nice little market for themselves. Let's see, limit these state co-op hybrids to certain locales, many of which are already monopolized. Let individual mandates create a favorable business model in which revenues skyrocket while pushing the 'low-profit customers' onto state co-ops. Let the state co-ops struggle or fail and walk away with years' worth of cream off the top profits. Ka-ching.

I think you misspelled the name of the compromise: shouldn't that be Crapper?

Maine tried this with its Dirigo Plan and it didn't work. The state didn't have the money to support it and the premiums were still not affordable.

No good. I worked hard to elect this president. Let's get a real public option.

I would have no problem with this idea if Congress allows interstate purchasing of health insurance. That way, someone in Alabama could by health insurance from a State public option in Illinois. Even those folks living in state's that have public options could choose to purchase coverage from a different state with a public option.

That is true competition.

Heck, we (in VA) have a Democratic Governor but, with the mostly red State Congress, we didn't "accept" the stimulus funds for unemployment benefits extension. If the matter of insuring people is left to us to decide, we'll all end up with Grayson's vision: don't get sick but, if you do... We already have the most brutal requirements regarding Medicaid enrollment; I expect general health insurance would be similar.

I live in Texas, and I can tell you right now what this state's government will do. As an uninsured, unemployed cancer survivor, maybe I should just go ahead and make my funeral arrangements now, because if Carper's "option" is included, I will die if my cancer reappears.

This is a stupid, stupid, stupid idea for anyone living in a red state.
Posted by: Donna

So the great compromise is letting the red states kill their own. What happened to all the talk of 'compromise is ridiculous' ?

I am from Texas as well and for anyone to get on board with this is the same as my well insured ass saying, 'screw them, I have insurance' or for the blue states, 'I will have insurance'. If the plan is to only help some Americans, then leave the system the way it is. If the plan is to help all Americans, especially the most needy, then see this compromise for what it is.

No one has even mentioned the complications of having some people with access to affordable care and other with none and the only thing separating them would be the state borders. Who would take govt insurance, all states, some states, where do the uninsured go for insurance, from red to blue states ? Will red states honor blue state govt insurance ? This is a ridiculous proposal that will result in mass fraud and/or mass migration and an even greater disparity between classes.

So, the South won't join in, they'll get sicker sooner and die younger.

What's not to like about this? We'll even save money, letting the morons go die.

TC, you seriously need professional help. They can't cure your congenital assholism, but they might be able to do something about your mental instability.

Is there any reason why states can't already do this? Massachusetts and California have, if I understand correctly.

So if there's nothing preventing states from doing it now, how does health care reform that "allows" states to do this differ from doing nothing?

No wonder conservadems like it...

It will cause mass migrations from Red states (whose state governments will choose not to provide health insurance) to Blue states.

Moving is not economically or socially feasible for enormous numbers of people who tend to be concentrated in red states. Many of them have minimum-wage jobs and no savings, and rely on extended family networks for basics like child care, transportation and even housing.

Anyone who is going bankrupt because of an illness in their family will find a way to move. The options is literally between either moving or being both broke and dead. There may be some people too fearful of change to pick up roots, but there will be a tsunami of migrants who are not that terminally stupid.

"There may be some people too fearful of change to pick up roots, but there will be a tsunami of migrants who are not that terminally stupid."

This quote is the very definition of terminally stupid.

Anyone who is going bankrupt because of an illness in their family will find a way to move.

Anyone? Really? Using what for money if they're critically poor? Using what network to help them with the basic life needs I mentioned? Do you not get that a lot of people worry less about bankruptcy -- they don't have anything; get it? -- than about hanging onto the jobs they feel they're lucky to have if they're uneducated and no longer young in this economy? Do you really not understand how central extended family is to a lot of people, particularly those who can't afford child care, need to share a car or live with relatives?

The options is literally between either moving or being both broke and dead.

I've got news for you. A lot of Americans' lives are held together with gum and tape, and looking six seconds down the road is a luxury. They're too busy figuring out how to feed the family on the dwindling funds left before the next payday or whether the funny noise the car is making is going to mean that they can't make the rent next month. This doesn't make them stupid. This makes them much closer to the edge of survival than you and I are. Try to understand what it's like for them.

There may be some people too fearful of change to pick up roots...

Unbelievably condescending and arrogant.

but there will be a tsunami of migrants who are not that terminally stupid.

...and who can afford it. You are really, really oblivious to people whose circumstances are far more constrained than your own. Your willingness to abandon the most vulnerable among us, and your casual brushing off of the serious struggles other people face, are more reminiscent of Republicans' words ("They can just go to the emergency room!") than of what I'd hope a progressive would say.

Voting "No" on this one from Arizona. There is not a snowball's chance in hell of the AZ Leg ever, ever, ever developing a public option. And we can't sell our houses down here and move, either, since we're all underwater.

Remus,

++Anyone who is going bankrupt because of an illness in their family will find a way to move. ++

Bull$hit. We're having to file bankruptcy because of my medical bills and there is NO WAY we can afford to pick up and move anywhere. Having no money is sort of why a person files bankruptcy in the first place.

I can't decide whether that comment is insanely arrogant or insanely stupid. Whichever it is, it's absolutely incorrect.

To those who commented that they voted for Democrats because they hoped that the Democratic Party would support a strong public option, I had the same hopes. However, obviously, not all Democrats in the Senate support a strong public option and the Admininstration and its supporters have to deal with the political reality.

This proposal sounds like a very interesting compromise. As a resident of NY, I would expect my state to pursue this option, perhaps in conjunction with other states in the region. Yes, residents of some of the real red states won't at least initially benefit from this. However, the beauty of the proposal is that, if in time it becomes clear that the various state-sponsored "public" plans create a public benefit, there will be immense pressure in the other states to get with the program.

As a resident of NY, I would expect my state to pursue this option, perhaps in conjunction with other states in the region.

It seems like everyone here does. But states already have the right to create a public option and, unless I'm mistaken, none of them have done so. Even the Massachusetts plan relies on the private insurance industry (coupled with a mandate to buy insurance).

What Carper's plan does is kick the ball out of the national debate, adds to the delay that any public plan gets started and allows the insurance industry to fight the battle in small pieces, exclusively in those states that might consider dipping their toes in the water.

Donna, shortstop and others of like mind: you really get it, and are living the catastrophe that is America(n)(really United States of)healthcare...sickcare, really. Those that oppose a public option, and preferably Single Payer, are so out of touch with the actual conditions in this country as to be irrelevant. No amount of insurance money contributions to Congress justifies the ignorant and selfish position on a limited public option, state by state. I live in CA and we are virtually bankrupt. Where does our public option come from? We are not allowed to run a deficit, I believe, and paying Prison Guards is much more of a priority than funding healtcare. /snark/

I was hoping Remus was being facetious...if not, I agree with those opposing him/her.

"...the beauty of the proposal is that, if in time it becomes clear that the various state-sponsored "public" plans create a public benefit, there will be immense pressure in the other states to get with the program."

This beauty of this comment is that it's based on pure fantasy.

This person makes the incorrect assumption that Republican governors and Republican-led state houses are logical. They're not. They're idealogues, and it would be a cold day in hell before a red state would implement such a plan, or an effective version of such a plan, regardless of how successful elsewhere.

Assuming that drf is a progressive, I suspect that she wouldn't find this proposal remotely interesting if she were a resident of Georgia rather than NY.

This crap sounds an awful lot like the purchasing exchanges that were tried in various forms in Texas, California, Florida and NC in the 1990's - and failed. According the a NYTimes Op-Ed by the former administrator of the Texas plan, Cappy McGarr, the primary reason for the failure was cherry picking by private insurers of the young and healthy, leaving the sick and infirm for the states to insure. Even in large states like Cali and Texas, the costs can get huge, fast.
http://www.nytimes.com/2009/10/06/opinion/06mcgarr.html

the primary reason for the failure was cherry picking by private insurers of the young and healthy, leaving the sick and infirm for the states to insure.

But the other parts of the legislation already attempt to address this question. That is, insurance companies, if the legislation succeeds, will not be able to cherry pick who they cover. For instance, they have to accept people regardless of pre-existing condition and they have to offer community rated fees so that those people are not just priced out of the system. That will be true, or not, whether or not this compromise is implemented.

I think it's an awesome idea. The point is that Republicans claim that the public option will be bad for policy holders (death panels much) when, in fact, they oppose the public option because it will be bad for insurance companies. Carper will give Republican Governors+state legislatures a choice -- Break with Republicans in congress and admit that they were lying or deprive citizens in their states of cheap health insurance.

Either way it's political dynamite. My guess is that many Republican governors who want to be president will commit political suicide and veto setting up a public option (recall those refusing stimulus funds).

Then the stress will cause them to hike on the Appalachian trail, and in 2014 we will have 35 Democratic governors.

Check the op ed in the New York Times the other day by the person who was in charge of a similar program in Texas at the end of the past century. It started out well but failed because 1) Bush got to be governor and didn't like it and 2) the insurance companies cherry picked the small businesses with healthy employees and left the older employees for the state program.

So Texas says hell no. I, in turn, go naked, no insurance. I pay for the little stuff out of pocket. So if I get cancer or heart disease I just need to move to New York?

I live in Texas. Does anyone think a plan which leaves health insurance to the states will help anyone living in Texas.

I have quit writing my representatives about anything, since I never get an answer.