"Now, Nelson's concerns about the main drawback of the opt-out compromise are entirely fair. If you're in, say, South Carolina, it's likely state policymakers would remove your state from the national public plan, and South Carolina's consumers would be at a serious disadvantage."

So be it. Then the good people of south Carolina better take stock in the decisions they made in the voting booth...and that's exactly why the opt out is a good idea. Put up or shut up time and live with the consequences. I'm sure the few states who would opt out wouldn't do so for long and the people responsible would pay a heavy price come election day.

Richard Kirsch, executive director of the group Health Care For Americans Now, said, "It is clearly much better than triggers."

I dunno.

It might be cheaper for the insurance corporations to bribe key people 20 or 30 state legislatures to opt out of a public option than it would be to bribe members of Congress to kill it. Maybe someone can do a study.

I can imagine a number of trigger mechanisms that I could get on board with:

-- The insurance corporations have six months to cut the number of uninsured by 50 percent, presumably by offering big discounts to get people to sign up. If they don't meet the deadline, then a public option begins and people can get 25 percent of the subsidy they would have been eligible for to buy private insurance and use it to buy into the public option. If after another six months, the insurance corporations haven't cut the number of uninsured by 60 percent, then people would get 50 percent of their subsidy to buy into the public option. After 18 months, 70 percent of the uninsured would have to be covered or the subsidy goes up to 75 percent.

Another idea:
-- After one year, every month that there are more than 10 million Americans who aren't covered by health insurance, an insurance corporation executive who earns more than $1 million in compensation will be chosen at random and executed.

Just some food for thought . . . .

I prefer the opt-out public option to all others. Give the right wing ideologues running the asshat states a chance to show the courage of their convictions.

Illinois would surely welcome some of the many businesses and taxpayers that would flee these states.

I really don't think any states are going to opt out. When all's said and done it won't be that big a deal.

Bill Nelson is my Senator and I just did let him know. Now all you other Floridians out there join in and help me out. Bill Nelson.senate.gov

Benen: "But if a compromise measure is necessary,..."

But A compromise measure is not necessary.

The solution is simple. The Senate leadership need only give conserva-Dems and Olympia Snowe two choices. Vote for cloture to get a strong national public option (no opt-out) akin to the plan that came out of the H.E.L.P. committee, OR vote against cloture to get an even stronger national public option (something akin to Medicare for all) via reconciliation.

LOVE Steve T's plan! Unfortunately, that ruthless edge disappears when one enters politics and gets on the go-along-get-along carousel.

If, say, South Carolina were to opt out of a public plan and allow its citizens to be preyed upon by big insurance companies, wouldn't a large portion of the working middle class simply fold their tents and move to the closest state that offered it? Nothing like seeing your tax base melt away to make you see reason.

With the trigger, it's definite that everyone would be denied a choice between competing public and private plans for some indefinite period of time.

No Steve. The time period will not be indefinite at all. It will be forever. Nelson knows full well that no public option will ever be "triggered." They will set weak and purposefully vague benchmarks and when, inevitably, the industry fails to meet even those pathetic benchmarks, we will simply start this fight over the public option all over again. This is about kicking the can down the road a few years and I doubt there is a single legislator in either chamber, least of all Snowe, who believes that it is anything other than that.

Lets see, all the bloviating notwithstanding, how many states finally opted out of the stimulus?
If opt-out can secure conservative and/or moderate votes, I would opt-in for opt-out in a flash.
hs

SaintZak : "So be it. Then the good people of south Carolina better take stock in the decisions they made in the voting booth...Put up or shut up time and live with the consequences.

Two things--

First, it's not appropriate for us to determine policy having life or death ramifications based upon how people vote. If we did, then that would make us shit holes, and everything talk radio says about us would be true. Health care is more than a right. It's an obligation that we have to one another.

Second, there are millions in the red states who couldn't deliver the electoral votes from their states, but they did deliver votes to give Obama and the Democratic Congress their mandate plus provided financial contributions, canvassing, long distance phones call, and the like, in part, to achieve health care for all. What SaintZak is trying to say here is, "Thanks for your help. Now, go fuck yourselves".

Here's a blog where SaintZak will fit in nicely: http://www.RedState.com.

South Carolina is going to tell its citizens they will not have the right to choose a less expensive plan because it is operated by the Federal government? Uh, no way. Possibly lots of bluster at the beginning, but it will die a quick death because local debate will cause more people to understand that a right people in other states have to get the cheapest possible plan will be taken away. Somewhere around 40% in the reddest of red states will be utterly dead-set against opt-out even before such a debate. The whole "government takeover" argument will disappear when the opt-out proponents have to try to make it.

Even though opt-out is unlikely, I could see a legal condition applied to it. Because system works only if everyone is covered by acceptable insurance -- can't opt out individually because you think you're healthy -- Feds have compelling interest to make sure people have access to affordable non-profit alternatives. It's simply seems unfair and, indeed, un-American to force people into choices between profit-making plans only.

There must be efforts to insure affordability. Therefore, state would have to certify before removing the Federal option from the exchange that it has a reasonable alternative -- either a statewide or regional, publicly-operated or sponsored ("public"), non-profit plan (operating on premiums, with Fed start-up loans) which is designed to provide affordability substantially comparable to that of the Federal option.

Some standard for an acceptable minimum pool for cost-savings would be necessary, perhaps, e.g. if it is assumed that 15% of a given universe would end up in whatever public option is available in the exchange, a population universe of no less than 20 million (2 million users). California, Texas, NY and Florida would be able to do state plans. Smaller states would have to band into regional compacts.

Of course, there's no reason in any case (other than practicality) why states could not set up such a plan as an alternative even with the Federal public option available. Many people might well be willing to spend a little more for the advantages of more localized administration and control.

The key is in any case is that it must be opt-in. It is not devolving the decision to the state level. The (strong) public option is in everywhere unless the state adopts affirmative measures to take it out of the state's exchange. It won't happen, but in case anyone wants to, they better offer a reasonable alternative "public option."

Never could tell Binbell Nelson from the Bellbin one... Each half-nelson seems to conspire to keep our necks wholly and firmly in a lock, so that we'll have to accept the yoke.

[...] wouldn't a large portion of the working middle class simply fold their tents and move to the closest state that offered it? -- Mark, @17:29

Not, if there were no decent jobs to be had in those states. A move is expensive, in more ways than one; not many people would be willing to do it on a gamble, that things might (rather than will) be better next door.

Pardon me: it must NOT be opt-in. The state must go through a full process of opting-out.

Remember, too, much of Republicanism in some of these states is cultural more than economic. Lyndon Johnson came from Texas, Gore from Tennessee, Carter from Georgia, Clinton from Arkansas. Populism is strong, too, and opting-out what would about as anti-populist as you can get.

"So be it. Then the good people of south Carolina better take stock in the decisions they made in the voting booth...and that's exactly why the opt out is a good idea. Put up or shut up time and live with the consequences"

Hear! Hear!

A straight medicare for all is preferred

but if we cant have that then mandate w/o public option is the worst, triggers or opt-in second worse

Opt-out is second best

"Pardon me: it must NOT be opt-in. The state must go through a full process of opting-out."

Yes, by default your in a Federally run program this way

If, say, South Carolina were to opt out of a public plan and allow its citizens to be preyed upon by big insurance companies, wouldn't a large portion of the working middle class simply fold their tents and move to the closest state that offered it?

More likely that entrepreneurs and small scale manufacturing might look at the total expense picture and decide on a blue state because they don't have to provide health care. This could mean employees both part time and full time are less expensive, which would mean hiring would be a lot quicker to recover after downturns.

The trigger option makes no sense whatsoever under any circumstances.

It seems to me that the "study" that AHIP just published has already automatically tripped any trigger you could name.

Ed

I propose out-out, subject to a trigger if consumers are getting shafted. There wasn't that easy.

South Carolina isn't the only state that might opt-out of any public option. Florida legislators (dominated by Republicans) are already working on a bill to refuse the public option for their own citizens based on "tentherism." As for a "trigger," there was also a trigger in the Medicare Prescription Act as well, which never got pulled, despite the fact that costs have far exceeded even the worst projections and the ever-expanding donut holes in those policies. The whole idea is a total cop-out to avoid EVER the creation of a public option. The Dems made a huge mistake at the beginning by taking the single-payer idea completely off the table. The ONE solution that would actually solve the problem.

"The trigger option makes no sense whatsoever under any circumstances."

Not quite. Include a trigger with a twenty-year timeline retroactive to 1989 and a provision that if health insurance accessibility and affordability are what they are on the date that the bill becomes law, a robust public option takes effect immediately. All done.

Facetiousness aside, health insurers have already had a long time to show good faith, or even enlightened self-interest, if they had any. This is like regulation of the financial industry. Half measures will not get the job done. It's going to take a big hammer. Sadly, there aren't many strong arms to wield one.