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Tilting at Windmills

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October 8, 2009

A NEW TWIST ON A PUBLIC OPTION COMPROMISE.... I'd much prefer a legislative landscape in which the search for a public option compromise was entirely unnecessary. Write up the reform bill with a robust public plan, get an up-or-down vote in the Senate, and send it to the president's desk.

But if a compromise is going to be struck, lawmakers have several possible alternatives to consider, some of which are preferable to others. Tim Noah goes through some of the top contenders, including Kent Conrad's co-ops, Olympia Snowe's triggers, Maria Cantwell's low-income state plan, and Tom Carper's state-based, opt-in public options. All have advantages and disadvantages (mostly disadvantages).

Sam Stein, however, reports on a new compromise proposal that's easily the best of the bunch.

Senate Democrats have begun discussions on a compromise approach to health care reform that would establish a robust, national public option for insurance coverage but give individual states the right to opt out of the program.

The proposal is envisioned as a means of getting the necessary support from progressive members of the Democratic Caucus -- who have insisted that a government-run insurance option remain in the bill -- and conservative Democrats who are worried about what a public plan would mean for insurers in their states.

"What folks are looking for is what gets 60 votes," said a senior Democratic Hill aide. "The opt-out idea is very appealing to people. It has come up in conversations. I know personally that a handful of members have discussed it amongst themselves."

This effectively takes Carper's idea, and makes it better. Carper would let states create their own public options, and possibly increase their economies of scale by partnering with other states. This new alternative makes it an opt-out, instead of an opt-in -- Congress would create the public plan, and if states didn't want to participate, they wouldn't have to.

As a rule, it's tough to figure out what public option opponents will come up with in terms of rationales, but this really should satisfy the concerns of Ben Nelson & Co.

It's not altogether clear who's championing this approach, but if a compromise has to be part of the mix, this one has real promise.

Steve Benen 10:40 AM Permalink | Trackbacks | Comments (66)

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Comments

If a state opts out, is it obliged to provide an alternative, or do the residents of that state get to be sucker punched by the insurance industry?

Posted by: Carol on October 8, 2009 at 10:52 AM | PERMALINK

" and conservative Democrats who are worried about what a public plan would mean for insurers in their states."

Notice they aren't worried about the uninsured and underinsured constituents in their states. They are worried about the poor insurance companies and their profits?! We should know which "Conservative Democrats" are more worried about the well being of insurance companies than the people who put them in office so that they can all get primary opponents. Can people in those states choose to get insurance through another state's public option if their own state cares more about insurance company profits than their own people's well being?

Posted by: atlliberal on October 8, 2009 at 10:53 AM | PERMALINK

First off, one good thing about this is that states already run medicaid and SCHIP. They have lots of experience in this area. But some states are better at it. Washington state runs a Basic Health Care system for people who don't qualify for medicaid or SCHIP. My daughter got great health care for $15/month when her mom had income of over $40k. Eventually her income went up too much to qualify.

Posted by: tomj on October 8, 2009 at 10:53 AM | PERMALINK

Hmmm. This should put some Democrat Senators who are actually Health Care Corporate slaves in a bit of a bind.

Let's see how creatively they frame their opposition.

Posted by: manfred on October 8, 2009 at 10:53 AM | PERMALINK

Carol,

Well the details are still in the works but I suppose it would be the latter. There is no point to this compromise if not to protect the right of insurance companies to profit off illness to whatever extent it is politically possible

Posted by: brent on October 8, 2009 at 10:54 AM | PERMALINK

exactly what manfred sez...

health care reform is a front -- a battle -- in a war -- let's see what the enemy does next, Dim and Repugnant...

Posted by: neill on October 8, 2009 at 10:56 AM | PERMALINK

Whatever it is, they will come up with objections to it. Or do you really think that logical consistency makes any difference to health-care-reform opponents?

Posted by: Chris S. on October 8, 2009 at 10:58 AM | PERMALINK

What a great idea for how to depopulate the South. The old Confederate Traitor States will opt out, and then everyone with brains will leave for better, more sane life elsewhere, leaving the place to the idiots - who will lose representation in Congress as they lose population, and eventually become the truly irrelevant-to-the-rest-of-us wasteland it's always been.

Posted by: TCinLA on October 8, 2009 at 10:58 AM | PERMALINK

I still don't see how it's much better.

We already know which states will be most likely to "opt out" and they are the states with the lowest per capita incomes and the highest numbers of uninsured people. So what happens in those states? Private insurers continue to charge whatever they like - only now the citizens of those states are under a mandate to purchase over-priced insurance. So how does that work? Does the federal government increase the subsidy (and further increase federal tax welfare for the red states) so that the morans can afford to comply with the mandate and buy the only insurance available to them - the over-priced private plans offered by the insurer who holds the monopoly in their state?

As nutty as the Republicans in Congress are, the Republicans at the state level are nuttier. You really think it's a good idea to leave it up to them to decide whether or not to allow a public option to compete in their state? Particularly when there is no cost to the state for protecting the private insurer monopoly?

This is not only a recipe for disaster for the cost of reform, but also for the political future: those Republicans who are staunchest in their opposition to allowing public-private competition in their states will be the ones who receive the health-insurer largesse needed to finance their campaigns for congress. Our tax dollars will, in effect, be going to subsidize not only grossly over-priced medical coverage, but also to promote the wingnuttiest of the wingnutty to national office.

Posted by: Jennifer on October 8, 2009 at 11:00 AM | PERMALINK

no no No No NO NO!

Do we live in Bizarro World version of the US where the 1964 Voting Rights Act becomes law..."except where individual states opt out?"

This is a stupid idea, people. If health care is a right, if the role of the federal government is to provide a defense of the people (including defense against illness and disease) then there is not "opting out."

I live in Louisiana; I am in the minority who believes in health care reform with a roboust public option. I will get screwed by Bobby Jindal and the state legislature. Knowing that, are you really going to throw me under the bus?

Really?

A previous commenter called it "a sucker punch." That's putting it mildly.

Posted by: Ara on October 8, 2009 at 11:03 AM | PERMALINK

The Republican nuts at the state level who opt out will risk being replaced, as people find out how much better their relatives in other states have it.

I think that if we go this route, the opt-out states will gradually opt back in.

Posted by: Joe Buck on October 8, 2009 at 11:06 AM | PERMALINK

This may force the conservaDems and repubs to consider voting for the bill. Because when their constituents realize they've been shafted, they'll vote for someone else next time.

Posted by: Hmmmmm on October 8, 2009 at 11:08 AM | PERMALINK

This is pretty inspired. It forces state legislators to explain to people at the state level why they can't have the same choice that their neighbors do. "Because I am bought and paid for by Blue Cross and Blue Shield of Arkansas" is not going to be much of an answer.

Posted by: Barbara on October 8, 2009 at 11:11 AM | PERMALINK

I live in Louisiana; I am in the minority who believes in health care reform with a roboust public option. I will get screwed by Bobby Jindal and the state legislature. Knowing that, are you really going to throw me under the bus?

Serious question: are all your neighbors who are opposed to the gummint takeover of health care in principle going to be as enthusiastic about their positions when they see that the residents of other states getting tangible benefits that they've been deprived of because Governor Jindal wants to be President when he grows up?

Posted by: dr. bloor on October 8, 2009 at 11:18 AM | PERMALINK

Does the federal government increase the subsidy (and further increase federal tax welfare for the red states) so that the morans can afford to comply with the mandate and buy the only insurance available to them - the over-priced private plans offered by the insurer who holds the monopoly in their state?

You make a strong argument against this compromise. I think I mostly agree that its not a great idea. However I would offer two caveats to that.

Depending upon how strong the public option will be in this bill, it might be better than the alternative. That is, I will take a strong public option where states can opt out over the very watered down public option that is being discussed in all of the bills now where States have to participate.

The second point is that it is possible that a public option in say, 30 States, would create enough competition that it might lower costs for both premiums and health care even in States that opt out. Insurance companies still need to keep a customer base. I realize that a lot of people are fairly well stuck in the States where they live but that is not universally true. Insurance companies can very quickly lose a significant portion of their customer base if they can't compete on the cost of their premium and if they are paying out more to health care providers because they lack bargaining power.

Also, businesses are still the primary purchasers of health care and if they can move to a State where their health care costs are going to be 20-25 percent less, that is pretty strong incentive to either move or lobby their State to opt back in.

There are still strong reasons not to go this route but, in my mind, it does have a few things to recommend it.

Posted by: brent on October 8, 2009 at 11:19 AM | PERMALINK

Do we really want to go there? A business here in Charlotte just relocated three miles across the border to South Carolina due to favorable tax treatment.

Repubs in certain states will sell the opt-out as "creating a favorable business climate" and we'll be left with a huge gap in coverage. With a 60-seat majority in the Senate, can't we do better than this?

Posted by: Dave Munger on October 8, 2009 at 11:20 AM | PERMALINK

I think this idea of States opting out is just political gamesmanship. While it may have a certain appeal at first blush to those who would like nothing better than to see the obstructionist Republicans in Red States stew in their own juices, it should be remembered that everyone in Red States are not Republicans and it would leave a great number of Americans in need of health care still in need. The idea of universal health care is just that. It is universal for all Americans.

Posted by: sparrow on October 8, 2009 at 11:22 AM | PERMALINK

Abandoning the most vulnerable to the whims of their states' boneheaded majorities. Not what I had in mind when I worked for a Democratic House, Senate and White House.

Posted by: shortstop on October 8, 2009 at 11:24 AM | PERMALINK

I love this idea. Let the States decide. Then those poor bastards living in Texas, South Carolina, Alabama, and the other so-called red states can see real close up who is presently running the "real death panels". The Insurance companies. This approach will also expose these astonishingly stupid Senators for what they are : Shills for Corporate America. If the bill ever pases and goes to the States, once placed onto a ballot initiative these GOP deadenders will be laced by their constituents. What fun.

Posted by: Stevio on October 8, 2009 at 11:29 AM | PERMALINK

This will never fly. It's the equivalent to repelling prohibition and letting the states decide. Who is going to opt out ? No one, and Big Insurance knows it, therefore Blue Dogs will be persuaded to vote no.

With the latest round of republican support for reform the best option IMO is reconciliation.

Posted by: ScottW on October 8, 2009 at 11:30 AM | PERMALINK

Repubs in certain states will sell the opt-out as "creating a favorable business climate" and we'll be left with a huge gap in coverage.

How? Depending upon how robust it is, a public option is either unrelated or lowers the costs for businesses. Even if one argues that the public option will have to be paid for by new Federal taxes, than for a business, that is already a sunken cost. If the public option exists and they are already being forced to pay for it, they might as well take advantage of it.

Repubs can fool a lot of the people a lot of the time but business people are not so easily fooled about their costs.

Posted by: brent on October 8, 2009 at 11:30 AM | PERMALINK

WE DON'T NEED 60 VOTES TO PASS THE REFORM BILL!!!

Why does the MSM never challenge Democrats who keep insisting this is the case? Every time a democrat invokes the 60 vote conflation, they need to be challenged!

We need 60 votes to stop a filibuster. We need 51 votes to pass a bill!

Posted by: pirate wench on October 8, 2009 at 11:33 AM | PERMALINK

It's a good compromise that would be even better if the states would be required to put the "opt out" option in a voter referendum.

Posted by: Howey on October 8, 2009 at 11:36 AM | PERMALINK

"...if states didn't want to participate, they wouldn't have to...if a compromise has to be part of the mix, this one has real promise"

Thinking back, we could have avoided the Civil War if Lincoln had just included an opt-out in the Emancipation Proclamation.

We could have achieved woman's suffrage and the civil rights act rather painlessly if we had just allowed states to opt-out.

What about Medicare? Much of the contention around elections has to do with this issue. Let's end the disputes and simply allow states to opt-out.

Steve Benen lives in Vermont. He'll be fine. The millions living in SC, GA, AL, LA, MS, TX, among others, will be fucked.

Considering the hard fought political progress we've made toward a strong public option, this proposal is despicable, and I'm deeply disappointed in anybody who believes otherwise.

Posted by: Chris on October 8, 2009 at 11:43 AM | PERMALINK

I live in Florida and our state legislature (Republican dominated) is already preparing some version of the "opt-out" thing. I have insurance from my previous employer, but my son has nothing. He is 26 years old, employed part-time, and in no way can either of us afford health insurance coverage for him. Largely due to preexisting conditions. I'm furious that the Dems don't have the courage to pass a strong bill with a federal public option via reconciliation. If THIS opt-out option passes, I will have to leave Florida for a state that is sane. Ridiculous!!

Posted by: winddancer on October 8, 2009 at 11:45 AM | PERMALINK

I think it's an interesting idea and it's to give cover to the conservaDems. They can vote yes to overcome the filibuster with a pure heart. It is also a way for them to not take any stand at all and let the fight go to the states.

We've seen with Sanford and the stimulus that state legislators can enact policies even with crazy governors. I think state legislators are probably easier to talk to and influence as well.

Posted by: Unstable Isotope on October 8, 2009 at 11:53 AM | PERMALINK

I personally don't care for the states opt out option. I live in TX - the state with the highest number of uninsured - with (wingnut) republican leadership. Do you honestly think that Rick Secede Perry is going to go with a public option? Hell no, he'll just ignore the issue like he has all along. The southern state will suffer because health care is a political issue to republicans, not a moral or economic one.

Posted by: Jilli on October 8, 2009 at 11:55 AM | PERMALINK

Considering the hard fought political progress we've made toward a strong public option, this proposal is despicable, and I'm deeply disappointed in anybody who believes otherwise.

I guess what I would say Chris is that it is not at all clear to me that we have made much progress toward a strong public option. The only versions of the public option that are on the table are really pretty weak versions that will not allow most businesses or individuals to participate. The details of this new compromise have not been made clear, but risking your disappointment, I would take a much stronger public option with the opt out clause rather than the very weak public option that is being offered without the opt out. We'll see, probably over the next few days how this compromise is structured.

I happen to live in Nevada where, although it is not a foregone conclusion, I can very easily see this State opting out. That would suck but if we end up with a public option that spans say 30 states and tens of millions of users, I still think I will probably be better off than with the public option that is being floated now that will probably only cover a few million within the next 10 years.

Posted by: brent on October 8, 2009 at 11:55 AM | PERMALINK

States opting out is a bad idea.

But why the heck are we even debating the quality of the compromise? Why not say no to any compromise?

We are citizens, not politicians, as Howard Zinn says often. We should give a resounding NO to mandates without a robust public option. And let the politicians take it from there.

Posted by: Ohioan on October 8, 2009 at 11:58 AM | PERMALINK

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Posted by: Earth on October 8, 2009 at 12:00 PM | PERMALINK

"if we end up with a public option that spans say 30 states and tens of millions of users, I still think I will probably be better off than with the public option that is being floated now that will probably only cover a few million within the next 10 years."

I appreciate brent's offer to sacrifice himself for the good of others (something tells me that brent is going to be just fine), but he's asserting that an opt-out version would be stronger and cover more people than any non-opt-out version proposed. He might have a point worth considering if there were any evidence to back that up. But there isn't. As far as I can tell, this is pure fantasy.

As others have pointed out, this opt-out proposal would leave people in the red states, not in the same position, but worse off. Mandates forcing people to buy insurance from crooks with no cost controls of any kind are a recipe for disaster.

With regard to brent's statement it's "not at all clear to me that we have made much progress toward a strong public option", brent hasn't been paying attention. We have 51 votes in the Senate for HELP's version. That's all we need for reconciliation.

The political risk for Dems isn't passing a strong national public option through reconciliation or other means. The risk for Dems is not doing so.

Posted by: Chris on October 8, 2009 at 12:14 PM | PERMALINK

The "opt-out" compromise is intriguing from a strategic standpoint and would be acceptable as a last resort, but I have to agree with those who say we can do better.

It's Crunch Time, folks. I reiterate my call for a mass demonstration demanding a public option.

Let's fill the Mall in DC and other similar areas in major cities across the country.

The teabaggers brought 100,000, tops. LETS ASSEMBLE TWO MILLION people demanding a public option. A strong physical statement is needed and there is nothing more persuasive than a massive throng crying "Public Option Now!! in unison.

Posted by: bdop4 on October 8, 2009 at 12:17 PM | PERMALINK

I agree with many others above, including Jennifer and Ara. People in the red states would be locked out of the system by their legislators. I live in Alaska - we already have a state legislator preparing "tenther" legislation to declare that the state doesn't have to abide by federal laws that it doesn't like. All Americans should have equal access to health care. Amy compromise of that principle is unacceptable.

Posted by: ghillie on October 8, 2009 at 12:19 PM | PERMALINK

If the states get to opt out, we will finally see if the legislators for those states are doing the will of the people, if they are not they will not last very long.

Posted by: JS on October 8, 2009 at 12:22 PM | PERMALINK

"I will get screwed by Bobby Jindal and the state legislature. Knowing that, are you really going to throw me under the bus?"

Yep!

look, I’m against State opt-outs (or opt-ins)
Soc Sec, New Deal, Fair Labor Act, Civil Rights Act, ect, ect have no state opt-outs
I’m generally happy whenever Federal power protects individual citizens from State & Local gov

But Im damn sick and tired of having the minority of the country who live in the ex-confederacy dictating to the rest of the country what we can and cannot do

So do I care if non-wingnuts in LA suffer because of Bobby Jindal? No, not any more, not if it means the north east, midwest and pacific coast , residents get a federally run robust public option

Don’t like your state gov? then change it or move. But stop trying to make the whole country into mississippi

Posted by: jefft452 on October 8, 2009 at 12:26 PM | PERMALINK

Those who followed the election know about the Rahm Emmanuel/Hillary Clinton swing state strategy vs. the Howard Dean/Barak Obama 50 state strategy.

Passing an opt-out version would be perceived as blue state Dems telling red state Dems to stay home on election day. They'd be telling blue state Dems that they don't need their money, their efforts, or their votes because when things are ever-so-slightly challenging, blue state Dems will throw the red state Dems to the wolves.

If an opt-out version of a public option passes, there's going to be big electoral trouble for all Dems moving forward. It's a bad idea on so many levels.

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Posted by: plupt on October 8, 2009 at 12:30 PM | PERMALINK

Writing from the absolute reddest state in the Union - Utah - I doubt we would opt out. The reason is simple, businesses will move out or not relocate in the state. Under any of the plans, business will still be footing the major costs of health care. Now they do it through premiums that they pay the majority of, but employees do not truly see - I am a business owner and have been a non-profit ED for many years paying these premiums. As a business owner if I can save 25% of my health care costs by moving to a different state, I'm gone yesterday. Any "business-savvy" state will not opt-out. The poorer South, which politically is a cesspool of populist pissers, will be the ones who do. I cannot see Georgia with the multiple economic engines it has pulling out, Alabama, Mississippi, Lousiana and possibly South Carolina - they may try. Even states with large health care organizations will choose to stay, because it will be less expensive for them to operate in those states - bottom line they win bunches. They have been playing a Brer Rabbit game all along. The funny question I have is who is going to run the public option? It will not be government bureaucrats, it will be health care industry professional who have experience. "Don't throw me in the briar patch!"

Posted by: henryedward on October 8, 2009 at 12:34 PM | PERMALINK

All these proposed compromises sound complicated and sub-optimal. Because they are complex and sub-optimal, they will be easy to attack.

The Democrats would be far better off proposing something simple. For example, extending Medicare is simple and clear. Extend Medicare to cover all children (everyone under 18 now has Medicare, regardless of other coverage, regardless of income), allow people to buy into Medicare, and create a Medicare Lite single-payer system that everyone has that pays for a small set of preventative services (regardless of other coverage, regardless of income).

That is simple. It would provide basic preventative care to everyone, full coverage for all children, and contains a robust public option in allowing people to buy into Medicare. It would have widespread public support. It would be hard for people to attack or vote against.

Of course, if we wanted to be extremely simple, we could just go full single payer. That would mean extending Medicare coverage to everyone, regardless of income, age, or other coverage, and switch all employer-based insurance coverage to being supplemental (like in France, providing for additional or premium services).

Either of these would be better than what the Democrats are doing.

Posted by: Greg on October 8, 2009 at 12:34 PM | PERMALINK

If the states get to opt out, we will finally see if the legislators for those states are doing the will of the people, if they are not they will not last very long.

Yeah, I loved Jimmy Stewart in that movie, too.

Look, let's get real about what red-state legislators, especially those with presidential aspirations, will do to keep in the good graces of the GOP and big business (most of which, brent's rosy scenario of a totally robust opt-out public option notwithstanding, is not likely to suddenly begin showing leadership in HC reform)...and the interests of their constituents be damned.

Meanwhile, do we not yet have enough evidence that the undereducated and overhating are willing to vote against their own self-interests when pressing social principles -- like preventing the two guys next door from getting married, or hating on the "socialists," or getting rid of that dangerous usurper from Kenya -- are dangled in from of them by the media and their party leadership? Until they personally get the "cancellation of policy" letter or Aunt Kate goes into medical bankruptcy or the uninsured guy at church dies from a preventable illness, the majorities of voters in some of these states simply will not believe we need reform.

It is probably true that many or most of these states would eventually get with the program. But it could take decades, and I'm not willing to watch the deaths and misery mount in the meantime. If you believe that healthcare is a human right, then you don't throw the minority to the savagery of the majority in these states. You just don't.

Posted by: shortstop on October 8, 2009 at 12:36 PM | PERMALINK

I am not seeing a lot of strong arguments against the opt-out plan in these comments. The plan seems to be a way of giving Blue Dogs an excuse for a cloture vote. While political compromises are irritating, and I agree that the 60 vote threshold shouldn't be the shibboleth it has become, I also believe that if health care reform fails because a Democrat votes against cloture it will be extremely hard to get any political momentum behind it again for a very long time. Opposing a foot-in-the-door measure like this just because universal coverage is a moral imperative is like opposing a plan to feed refugees in Sudan because it doesn't also feed refugees in Kenya. And the analogies to the Voting Rights Act, the Emancipation Proclamation, women's suffrage, etc. are strained at best. If you think you have enough votes for a constitutional amendment creating a right to equal health care, have at it. I think getting legislation through Congress is difficult enough.

If there were likely to be long-term bad consequences from an opt-out, though, I would be against it. But that's the argument I'm not seeing here. People in Alabama will be fucked by BC/BS? Right, but they're fucked now. At least with a public option out there driving down prices in 30-40% of the country, there will be some political and market pressure for change in the states where the insurance lobbies have a stranglehold on the legislatures.

Posted by: Toad on October 8, 2009 at 12:42 PM | PERMALINK

but he's asserting that an opt-out version would be stronger and cover more people than any non-opt-out version proposed.

Of course, I quite specifically did not assert anything of the sort. I suggested that if that was a result of the compromise that would be one I would support over what is being offered now even if I couldn't directly benefit. As an aside, since we are all discussing what any of us will or will not support, and since you know nothing about me or my situation your blithe assumption about my motives is a particularly unnecessary insult but whatever makes you happy I guess.

With regard to brent's statement it's "not at all clear to me that we have made much progress toward a strong public option", brent hasn't been paying attention. We have 51 votes in the Senate for HELP's version.

Since we are talking about evidence, there is no evidence that we have 51 votes for HELP's version as you state. There is also zero evidence that the HELP bill or any bill could make it into or out of the reconciliation process without significant compromise. To the contrary, there is more than ample evidence that there are few Senators who support the reconciliation process at all.

But most importantly, the public option in the HELP version of the bill is almost exactly as weak as every other version. It would only be available in the exchanges and the participation in the exchanges will be extremely limited. The CBO estimate puts participation in the public plan offered under HELP at around the same number, about 5-10 million over ten years, as with the House plans.

As I have said, we don't know the details of this compromise although you seem quite a bit more certain than I am, for some mysterious reason, about what we should assume it will entail. My point is that it is very easy to imagine a public plan and an exchange that would cover more people but would allow States to opt out. I believe that would be a better deal and would have more impact across the health care industry than what is being offered now, which despite your expectations, offers very little evidence that it will impact the health care system as it exists now.

Posted by: brent on October 8, 2009 at 12:46 PM | PERMALINK

Any insurance reform legislation that guarantees coverage of pre-existing conditions will eventually lead to a single payer system. Insurers will shift risk models from the application/underwriting process to the marketing/acquisition process. Insurers will find ways to discourage high-risk consumers from choosing their plans. Low risk consumers will choose the most basic coverages (as prescribed by law) and the high risk consumers will choose the most comprehensive policies. High risk consumers will likely migrate to the same plan (or insurer) -- most likely a public option sooner rather than later.

And, without some form of rationing device to discourage poor health choices (higher premium, higher deductible, longer queues, etal.) costs will continue to spiral out of control.

Posted by: m on October 8, 2009 at 12:53 PM | PERMALINK

"I cannot see Georgia with the multiple economic engines it has pulling out,..."

henryedward doesn't know Georgia very well.

Georgia is consistently ranked in the bottom five of public education. In addition, the Atlanta area has among the longest commutes in the country (poor road system and poor public transportation), has among the worst air quality in the country, and recently came within 90 days of running out of water during a drought that wouldn't have been vary serious to most metro areas (Georgia legislators solution was to reclaim 200 year old land from Tennessee that contained a river to be redirected toward Atlanta).

Georgia doesn't attract business with such things. Georgia attracts business with low taxes, weak employment laws and enforcement, a major national and international air hub, and strip joints.

Read about the recent budget disputes in California and Michigan? Georgia doesn't have budget disputes. When revenues fall, they cut corporate taxes more and slash spending for "government" schools (Georgia recently had a slew of layoffs of teachers and teacher aides).

I'm sorry, but anybody who would make themselves feel better by insisting that Georgia and the rest of the south wouldn't dare opt-out is only fooling themselves.

Posted by: Chris on October 8, 2009 at 12:53 PM | PERMALINK

"the analogies to the Voting Rights Act, the Emancipation Proclamation, women's suffrage, etc. are strained at best. If you think you have enough votes for a constitutional amendment creating a right to equal health care, have at it."

Strained at best? Some of us don't need a constitutional amendment to tell us the difference between right or wrong. Health care is a moral issue, and some of us happen to believe that quality health care and issues of life and death are up there with voting rights, among others.

Aside from that, this constitutional amendment nonsense is bait and switch. Southern Dems helped toad, among others, to elect a Democratic president and Democratic Congress--all of whom (including Max Baucus) ran on a platform that included quality, affordable health insurance for all, not just those living in blue states. Again, this attitude is a big "screw you" to red state Dems and might mean death to the 50 state electoral strategy that succeeded in giving Dems the majority that they hold today.

For those arguing exclusively for cloture (the Senate can hold a reconciliation vote if cloture doesn't pass), the solution is to provide conserva-Dems with with two options, a strong public option through a normal floor vote (e.g., HELP) or a stronger public option (e.g., give everybody the option to buy into Medicare) via reconciliation. As was previously indicated, the votes are there for the latter.

Posted by: CJ on October 8, 2009 at 1:14 PM | PERMALINK

"People in Alabama will be fucked by BC/BS? Right, but they're fucked now"

Yes, bt as long as the rest of the country is fucked too they are ok with that

Posted by: jefft452 on October 8, 2009 at 1:32 PM | PERMALINK

the solution is to provide conserva-Dems with with two options, a strong public option through a normal floor vote (e.g., HELP) or a stronger public option (e.g., give everybody the option to buy into Medicare) via reconciliation. As was previously indicated, the votes are there for the latter.

What I have seen as far as "whip counts" is about 44-47 solid yes votes for some version of a public option which suggest to me that maybe if we manage reconciliation properly we might be able to get some type of public option. I haven't seen any whip counts that encouraging on the strongest versions or the public option or even on just getting to cloture. You and others seem confident that the votes are there to get a robust National version of this but I just don't see the evidence of that. The closest I have seen suggests that Schumer's weaker version which divorces the public option from Medicare rates might be able to get 51 votes but it is not entirely clear that that version would work under the rules of reconciliation.

Posted by: brent on October 8, 2009 at 1:33 PM | PERMALINK

Health care is a moral issue, and some of us happen to believe that quality health care and issues of life and death are up there with voting rights, among others. - CJ

I agree, health care is a "moral" issue and should be a "right". But the debate is backwards and morality cuts in more than one direction. What type of health care is "moral" and "right"? And, I'm not referring to abortion.

Is it moral for a neighbor to subsidize the extra cost of an elective c-section or certain cataract surgeries? Is it moral to continue smoking with the knowledge of the increased health care risks (and costs) that will likely be subsidized by a fellow tax payer. Should you subsidize the birth of your neighbors four children when your decision is none?

Again, I agree that providing health care to those in need is a moral issue. But I'm certain every person on this blog would have a different opinion of what that means to them.

I bet it would be substantially easier for Congress to act on a bill that first outlined the basket of "moral" and "right" health services before passing a financially open-ended piece of legislation.

Posted by: m on October 8, 2009 at 1:39 PM | PERMALINK

Chris,

When UPS, Delta, and Coca-Cola can increase their bottom-line through savings on health insurance premiums, they will demand the public option. You make my argument: "Georgia attracts business with low taxes, weak employment laws and enforcement, a major national and international air hub, and strip joints." The public option only makes it cheaper to do business. A public option is a tax break for business, portability strengthens not only the worker's hand, but converts every aspect of employment to at will, wages at the air hub can remain stagnant and employers increase their bottom line, and the strip joints have more revenue and healthier performers. What exactly is your disagreement?

Posted by: drewhyde.p@gmail.com on October 8, 2009 at 1:41 PM | PERMALINK

"Those who followed the election know about the Rahm Emmanuel/Hillary Clinton swing state strategy vs. the Howard Dean/Barak Obama 50 state strategy"

Oh Bullshit
The Rahm Emmanuel/Hillary Clinton strategy was the same thing we heard since '72
The north, east, and west were told to shut up while we try to appeal to southerners

the 50 state strategy (notice the 50, not 11) means not that we ignore the south, but that we stop bashing 3/4 of the country to please a handfull of goobers who will never vote for us anyway

Posted by: jefft452 on October 8, 2009 at 1:43 PM | PERMALINK

I live in a state (AZ) likely to opt out if given the choice. As a Univ. of AZ retiree, my health benefits are decent, but I'm concerned by the 1000s of people in this state who can't afford decent insurance.

One of the biggest advantages a nationwide public option could offer is economies of scale. The more people in a given insurance pool, the cheaper the cost can be, with expensive illness costs being spread over a larger population base. Also economies can be realized with computerizing all records, and sharing these with everyone in the plan. How many of us have had to undergo duplication of expensive and sometimes debilitating tests because of being referred to a specialist, for instance?

While such economies can still be present with those states who opt in, the advantages to a public option will be watered down by lack of participation of the states opting out.

But if the only way to get a public option enacted is to offer this compromise, so be it.

Posted by: Wolfdaughter on October 8, 2009 at 2:00 PM | PERMALINK

Drew,

You're assuming that Georgia legislators are intelligent and/or pragmatic. They're not. They're ideologues.

For example, despite offering huge tax incentives and lower overall state corporate taxes, Georgia recently lost a competition for a major German pharmaceutical manufacturer despite because of its poor quality education system (the drop-out rate hovers around 50% and those who stick to take SATs average among the lowest in the country). This happens continually, but it didn't stop legislators from dramatically slashing funding from public schools during the last session.

I suppose its possible that states in the South would come around in decades, maybe less, after reform passes. But right now, Georgia Republican gubernatorial candidates, one of whom will win the next election, are campaigning on who is best able to lead the south in seceding from the union.

Brent,

You keep repeating the assertion that support doesn't exist in the country and in the Congress to pass a strong national public option. We can't read the news, blogs, and surveys to you. You'll just have to base your opinions on old information or misinformation, and we'll just have to accept it.

jefft452,

Bullshit? You proved the point when you said: "...do I care if non-wingnuts in [Louisiana] suffer because of Bobby Jindal? No, not any more,..."

Posted by: Chris on October 8, 2009 at 2:09 PM | PERMALINK

CJ, Toad IS a Southern Dem. And I'd love to see everybody get affordable health care. Nor do I need a constitutional amendment to tell me right from wrong. My point was just that the perfect shouldn't be the enemy of the good. On this issue, I think supply and demand might make up the difference as long as we get something passed that provides significant relief to a significant number of people. Maybe I'm wrong, but if so the error is one of economics or politics, not morality.

Posted by: Toad on October 8, 2009 at 2:13 PM | PERMALINK

Some of the people leaving comments on this article puzzel me. If its between having a strong public option with an opt out or a weak public option without an opt out, I want the stronger option. Medicare has an opt out claus but all states have medicare. Local governments are not going to shaft their citizens to please the national party. If the citizens are too STUPID stupid to vote them out of office, then they get what they deserve. You can't always get exactly what you want people...stop crying about it.

Posted by: Thebeanabong on October 8, 2009 at 2:28 PM | PERMALINK

From a cynical standpoint, I like this proposal as the majority of red states will likely opt out of the public plan and the yahoos in those states who continually elect Republican leadership will suffer because of their own electoral stupidity.
Survival of the fittest may in the long run make these people eventually think about the consequences of their ignorant choices!

Posted by: Tom on October 8, 2009 at 2:29 PM | PERMALINK

You keep repeating the assertion that support doesn't exist in the country and in the Congress to pass a strong national public option.

Chris,

I have stated nothing at all about public support of the public option but you do have a talent for making opinions up and attributing them to me. I applaud your imagination but I will do you the courtesy of responding to what you have actually written as opposed to what I imagine you believe. How about you extend me the same courtesy? Your choice of course.

Moreover, I have told you the facts on how the current public options are structured and what the whip counts are right now. As far as I can tell, you have not even attempted to dispute any of my assertions in that regard. You have merely asserted, apparently because you saw something in the news, that they are wrong. Indeed, its all relative of course, but your assertion that the HELP bill constitutes a "strong" public option and what seems to be your assumption that such a bill could very easily pass through reconciliation suggests to me that you are the one that could do with a closer reading of the actual information that exists.

There are not 51 Senators who have committed to a strong version of the public option even by your weak definition of what that would constitute (although if your fudge the whip count a bit and include Biden, you could theoretically and very tentatively have 51 votes). There are not 51 Senators who have even committed to the reconciliation process, which if one understands how the reconciliation process works, would not really be sufficient in any case. The only survey that matters at this point is the whip count of Senators and despite your confidence to the contrary, they have not, at any point committed to even the weakest version of the public option with sufficient numbers and in a way that would ensure passage. That is exactly why they are discussing a compromise. Your vague reference to what it says on blogs or in the news is an extremely unpersuasive response to that reality but if that is the best you can do, so be it.

Posted by: brent on October 8, 2009 at 2:31 PM | PERMALINK

I jailbroke my iphone 3g 2.2.1 with quickpwn and it froze. Now when I turn it on it shows and apple icon and a loading pinwheel but never goes any further. Is it possible to fix it without restoring it to its factory settings?

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Posted by: Raisy on October 8, 2009 at 2:33 PM | PERMALINK

now I'll be tuned..

Posted by: Virgin Mary Sculptures on October 8, 2009 at 3:08 PM | PERMALINK

brent: You and others seem confident that the votes are there to get a robust National version of this but I just don't see the evidence of that.

I'm not at all confident. I'm just horrified at the thought of sacrificing the toes to save the leg. Unlike jefft452, I recognize that there are significant numbers of Democrats, including hundreds of thousands of very low-income Democrats, in the poor Southern and lower Midwestern states who can't be conveniently blamed for their neighbors' ballot-box assholery.

Maybe we'll have to do this. But man, I wish we had better choices, and I'm not thrilled about the number of liberal bloggers who are sugarcoating the opt-out. I wish more people were honestly looking at what the cost will be to a lot of people whose accident of geography will trap them in an even worse healthcare situation than they're in now.

thebeanabong: If its between having a strong public option with an opt out or a weak public option without an opt out, I want the stronger option.

Not having heard any details, I don't think we have any reason to assert at this point that an opt-out public option will be stronger than what's already been proposed. Not saying it won't be -- just reminding you not to make that assumption.

General note to various people arguing that business will be all over the public option, rejoicing at the savings: For a couple of reasons, neither of them complimentary, big business has strenuously declined to lead or, for the most part, get on board the HC reform fight despite HC costs representing an overwhelming majority of business expenses. I'm a little skeptical that the implementation of a opt-out public option will act as an abrupt wake-up call to corporations that have failed to embrace reform up until now.

Posted by: shortstop on October 8, 2009 at 3:22 PM | PERMALINK

”Bullshit? You proved the point when you said: "...do I care if non-wingnuts in [Louisiana] suffer because of Bobby Jindal? No, not any more,..."
Since 72 the goal of the DLC was to trim our agenda to meet the median voter of Cobb county GA
Gun control? Goober don’t like it so its out, who cares if a kid in NY get shot
Public Health? Goober wants abstinence only sex ed, who cares if a kid in Chicago gets an STD
Conservation based Energy Policy? Goober has a bumper sticker that says “freeze a Yankee, drive over 55” so we cant have that
Science Education? Goober don’t like no Evil-loution so we talk about giving kids uniforms instead
Public Ed in general? No Goober don’t want his tax $ going to integrated schools so we cut funding, who cares if some kid in LA cant afford collage any more

SO.. Dean comes along with something new. A FIFTY state strategy, and it works!
Now the same people who spent 30 yrs kicking the rest of the country in the teeth trying to recover Goobers vote and telling us that we were naïve fools for listening to a liberal yankee like Dean want us to believe that the 50 state strategy means …… trimming our agenda to meet the median voter of Cobb county GA

So no, I want a strong public option. Nation wide preferred, but if the only way I can get it is to let Jindal exclude LA then so be it
The rest of the country has already give up too much to keep trying to appease you

Posted by: jefft452 on October 8, 2009 at 3:24 PM | PERMALINK

”Unlike jefft452, I recognize that there are significant numbers of Democrats, including hundreds of thousands of very low-income Democrats, in the poor Southern and lower Midwestern states who can't be conveniently blamed for their neighbors' ballot-box assholery”

Oh, no, I recognize that also..
But your analogy of “sacrificing the toes to save the leg” is a good one. And Im not willing to loose the leg to save the toes

PS
you want to help "hundreds of thousands of very low-income Democrats, in the poor Southern and lower Midwestern states"?

Then pass Card-Check over Goober's objections

Posted by: jefft452 on October 8, 2009 at 3:34 PM | PERMALINK

My name is Jonn Pedro, http://jonpedrotralala.com

Posted by: jikopadrokolm on October 8, 2009 at 4:46 PM | PERMALINK
you want to help "hundreds of thousands of very low-income Democrats, in the poor Southern and lower Midwestern states"?

Then pass Card-Check over Goober's objections

Posted by: jefft452 on October 8, 2009

Ditto!!!!!!

Posted by: MarkH on October 8, 2009 at 7:11 PM | PERMALINK

"...big business has strenuously declined to lead or...get on board...despite HC costs representing an overwhelming majority of business expenses." shortstop @ 3:22 PM.

Of course it's a "what if", since HCR hasn't passed yet, but how much of that opposition would disappear once real, bottom-line figures showed what a company stood to lose by either remaining in an "opt-out" state or not lobbying the State legislature to opt-in? I have read (don't recall the article) that many CEOs oppose HCR for ideological reasons. Those reasons are quite sufficient for now as there isn't a public option actually up and running anywhere in the US and in most US companies what the CEO wants, the CEO gets. However, would that ideological opposition persist, even with the cozy relationships between CEOs and their Boards, once figures showed losses because of it?
I certainly don't mean to suggest that there would be a massive shift in support at the CEO level, simply a recognition that the rules have changed and there is no reason not to take advantage of those changes.
Hopefully this remains a "what if" and a nation-wide public option passes!

Posted by: Doug on October 8, 2009 at 8:52 PM | PERMALINK

Screw the 60-vote cloture requirement; just send the damned thing through via RECONCILIATION like Bush did with the 2001 tax breaks for the wealthy, and let's get it over and done with, and with a real system, not one the insurance lobby has dictated and which will funnel trillions into their pockets over the next few decades.

WE WANT A PUBLIC OPTION, AND WE WANT IT NOW!

And after this is over, let's get the Dem Committee Chairmen who are from Red states kicked down where they belong. To get things passed, the Chairmen need to be from BLUE states, so they don't have to be looking over their shoulders at then next election cycle and can do what is right for the country.

Posted by: SteveGinIL on October 8, 2009 at 10:37 PM | PERMALINK

I think this is more of a smart political strategy than anything else-- it's certainly a way for conservadems and even some GOPers to have a good excuse/cover to vote for reform. They can go back to their states and say that they voted for reform because they knew their state would op-out, therefore no "takeover" of health care by the evil government.

The thing is that if the House passes a bill with a robust public option and the Senate cannot pass a bill with any kind of public option then the bill reconiliation process will be pretty ugly. However, if BOTH bills have a public option then the "opt-out" portion could be dropped entirely during reconciliation. Even if it weren't then as someone pointed about above, a lot of the opt-out states would likely see a lot of businesses fleeing their state for nearby states that have it. Eventually everyone would be on board, just some states would have a few year lag time.

Posted by: zoe kentucky on October 9, 2009 at 2:47 AM | PERMALINK




 

 

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