I am sure that Reid can garner many votes for a "trigger" that have conditions that cause it never to be pulled. People agreeing to a "trigger" might have very different ideas about the amount of "pull" required, and those votes would change when in came down to criteria that might actually invoke the public option.

Not THE PRIOR steve--the former, or the latter, but never "the prior."

aimai

Very thoughtful analysis, Steve. It explains the shadow theater of the last 24 hours... . One thing I'm not clear on: if the opt-out provision is merely that, could it not be added as an amendment to a "robust" option (rates tied to Medicare)? Or is that basically the substance of the proposal? You write as if they are separate bills...

If the trigger hadn't already been pulled, we wouldn't be having this discussion.
If a state decides to opt-out, is there a way for them to opt-back in?

angling for dilution and/or perversion of the public option is disgusting simply because they have not made anyone - republican or democrat - make the case as to what downside the public option has. All the opposition has ever given is empty platitudes: 'government run health care, blah, blah, blah' - ooooohhhhh the horrors, what the hell does that mean in terms of something bad and especially in light of Medicare and the VA healthcare there isn't one single thing wrong with government run health care.

So I say: screw opt out until someone makes a solid case that there is some down side to a robust public option. (As usual, the Vichy dems aren't debating the issue, they're debating against the American people).

If a state decides to opt-out, is there a way for them to opt-back in?

I believe the answer is yes. However, once they have opted in, the only way to get out of it is if the whole program fails.

lock down 60 votes in the Senate, and get this thing done.

Or forget Olympia Snow, and pass it through reconciliation. Aside from getting a better bill, this would also start to strangle the idiotic notion that we can run the country when 41 senators (representing some tiny fraction of the population) can stop any piece of legislation.

kabuki on opt-out and trigger is distressing. the goodness is in that it isn't still public option-is-dead.

but this kabuki is usually not what really clinches the legislation. there is more evil approaching from the corporations -- "trigger vs, opt-out" is probably just the bright and shiny...

neill said:
. . . there is more evil approaching from the corporations -- "trigger vs, opt-out" is probably just the bright and shiny...

Right. An issue that's just as important is -- Who will be permitted to chose the public option?

If most Americans can't join, then a "public option" is pretty meaningless. In the end, the only people in the public option will be the ones that need so much health care that the insurance corporations don't want to insure them. A guaranteed failure for government-run health insurance and a big win for Republicans and the corporations.

I'm remaining cynical about this whole thing until I see the bill Obama signs. I've spent too many decades watching the Democrats snatch defeat from the jaws of victory.

I wonder if Pelosi's instructions to the CBO were to report on:

--cost savings of the 'robust' public option.
--cost savings of the 'trigger', beginning at X, Y, and Z years out.
--cost savings of the 'opt in' idea, with X, Y, and Z examples (numbers) of states and costs starting 'out' at the gate.
--cost savings of the 'opt out' idea with cost examples of states opting 'out' at years X, Y, and Z.
--cost savings of a true, single-payer program.

I think we all know what the last one will show. But, for purposes of appearing 'bipartisan' and to essentially make the oligarchs feel better about having to give up something to fend off the masses of pitchfork-wielding serfs if nothing is done, we cannot expect single payer now, if ever.

Opt-out leaves some Americans uninsured, which means some of them will suffer and die, especially in states where there is no political will to fight for those who most need it.

Going with opt-out may be what's possible, but I hope to hockey sticks they're using that capitulation to push back and get the best damn public option for everyone who opts in.

We already lost the "deficit-neutral" battle over something that apparently costs us 40,000 American citizens -- fathers, mothers, daughters, sons -- every year.

What better thing to spend a little of our hard-earned GDP on? How much have we given private military contractors in Iraq? Could we at least spend that much? And what's the correlation between Congressional holdouts and lobbyist dollars?

They've already groveled *plenty*. Time to suck it up and say "This is happening. You've had your say. We're standing up for our fellow Americans now. Get on board or live with it."

Harry & Nancy: We Red State Progressives will help support opponents of Dems who vote to exclude us from health insurance reform, you can bank on it.

Right on the mark, Melior.

As all the news becomes "increasingly optimistic" about a public option with an opt-out clause, progressives from Arizona to Texas straight through to Georgia are feeling increasingly like we're in the process of being thrown to the wolves.

Try to imagine the shape that this nation would be in if Social Security had featured a state-based opt-out clause. Medicare/Medicaid, too.

This "compromise" is insanity.

Don't let it happen.

"Both prefer the robust public option, of course, but like some other progressive reform leaders -- Jay Rockefeller, Howard Dean, even Rep. Anthony Weiner (D-N.Y.) -- they've come to see the opt-out compromise as tolerable."

I'm a little confused by your wording here and other places in the article. You word it as if opt-out is a compromise to the robust PO.

Isn't robust or not-robust more about rates being tied to Medicare? Wouldn't it be possible to have the most robust type of public option (one based on Medicare rates and available to all), and an opt-out for states?

In fact, wasn't that kind of the plan before?

The way I viewed this type of compromise when they first began talking about it was that it would allow states to opt-out, but in return for that, it would make room for a much stronger public option - because why water it down when states that don't like it can opt out anyway?

to red state folks:

I hear you and I would feel the same way.

I think it comes down to how this is structured. If it's an opt-in plan then you're absolutely right. Your wing nut Governors/Senators/Reps would never opt-in. But if the plan is set up so that it is implemented nationally and then, only after the program has been in place for a few years states can opt out... that's a lot different. As far as I know, that is how they are talking about doing it.

All of your wing nut rulers hate Medicare and Medicaid too but they wouldn't dare - it would be political suicide. If it is implemented in the right way, it will be the same for the PO. They won't dare opt-out. It will be too late.

So I think it depends a lot on how they set it up. How many years before they can opt-out, etc. As always, the devil is in the details.

I'm having trouble finding a good explanation of the 'opt out'. Who decides to opt out? The governor or the state population (a vote) or the state legislature? Or are all these details 'to follow'?
Also who is eligible for the public option: I'd go in a second because I have United Health and I hate them on principle AND I want to support 'Medicare Part E'. Does anyone have a good source of this kind of information? I don't seem to be able to get at it.
Thanks in advance.

IF there's a "robust" public option that is universally available (big if). And IF there's a real opt-out. Then the Dems are going to have several years of beating state Rep politicians over the head for trying to take away their constituents' health coverage. How's that going to play, Repubs? Especially if the states that are covered do well and rates stay lower.

progressives from Arizona to Texas straight through to Georgia are feeling increasingly like we're in the process of being thrown to the wolves.

I'm a progressive in Tennessee (and originally from Mississippi, so I know from backward states), and I'm just not that inclined to blame blue-staters for not always rescuing us from our more conservative peers. The wingnuts have more political power here than we do; that's just a fact, and while it would be nice if we could rely on sweeping actions from the feds to improve our lives on every level, there's also a very good argument against letting HCR be sunk or hopelessly weakened just to soothe the more provincial types in our areas, too. It's unpleasant, but we have to tip the scales in our own states on issues like this (basic questions of citizenship & individual rights like race/gender are more appropriate for federal intervention IMNSHO), and letting local/state pols be the ones to deny the most effective & inexpensive option could be to our political advantage if we used it against right instead of resenting the left.

That said, I think there will be very few states that actually do opt out-- most of the very conservative ones are also the poorest and most dependent on the federal government, and the cardinal sin is to turn down money or benefits from the feds. Remember, the reason the GOP is fighting this so hard is that they fear its success.

Pardon my reposting this from above thread, but it belongs here:

I got one of those emergency emails from the progressives (forget which group, not seeing email right now) urging me to petition Obama not to vote for a crummy bill, just to get Olympia Snowe and "bipartisanship" on it. I sent it in - and recommend, please contact the WH etc. about this. Without the public option, "reform" is no reform.

IMHO that even applies to opt out, but we might try to insist that State opt out has to be from public referendum and not State legislature. That would make it harder, and force acceptance of public sentiment.

If we have to have anything less than a national robust public option on day one, the opt-out is by far the best compromise from a progressive point of view. It seems highly likely that public option would spread to even the reddest of states given its cost containment and coverage advantages (and its likely popularity with consumers). And if there are a few holdouts, that's just fine -- I for one would enjoy the spectacle of GOP politicians trying to defend to hard-working Oklahomans or Alabamans the decisoin to deny them the good coverage at low prices their "socialist" neighbors have access to.

Latts, I'm puzzled by your statement
"the cardinal sin is to turn down money or benefits from the feds."
That sounds as if red state officials would be very wary of turning down funds. How does that square with their opposition to stimulus funds?

Opt-out leaves some Americans uninsured, which means some of them will suffer and die, especially in states where there is no political will to fight for those who most need it.

I suspect few states would actually be willing to "opt-out" if the public option provided a decent alternative to expensive private insurance. As others have mentioned, a bigger issue may be limitations on which particular individuals get to "opt-in".

How does that square with their opposition to stimulus funds?

They made noises about opposing the funds, but were happy enough to actually accept them (all the time complaining about how the mean lib'ruls were making them do it). See Jindal, Bobby and Palin, Sarah.

I think some of the people making comments don't understand how very strange state legislatures are in hard core red states. Here in Arizona we have had Republican legislators contact Grover Norquist to determine if they could vote on certain budget measures this year. They didn't want to violate their "no tax" oaths. Maybe a grace period before opt out becomes effective would make a difference. I don't know.

"...Reid is also counting votes for a trigger, and probably has even more votes for that approach..."-Benen

He has more votes for a robust public option but not among moderate semi-dems who are holding the whole reform bill up in the senate. Reid is only trying to find a way to appease them.

Opt out and trigger are both give-aways to the ins companies. Reid is not dealing with senators...he's dealing with those senator's lobbyists.

Stupid dems fail to realize that if they can get a good reform bill passed without regard for private ins but with regard only for the good of the people, not only will they be popular for a decade winning elections everywhere but the private ins companies won't be throwing money at their opposition because they won't be profiteering recklessly off the people and won't be able to afford to.

It's a win win all the way around but only if these dems don't start watering down their own bills. Guaranteed...the first state to option out will be the one which has the most un and under insured...Texas.

Republican states will try to opt out just to cause failure to the dems. Private ins will work the states legislatures to cause failure to the public option.

This is all dems now...they will be resonsible. Medicare for all is so much easier and effective...only bribery is preventing it.

Option this and trigger that. I imagine every piece of legislation ever created out of thin air has this boilerplate in it. NOT!

We have hired a bunch of dim bulbs to lead this country in its most vested interests. Collectively we should be ashamed of ourselves for not taking better care. Whoever is carrying water for this nonsense will be forever mocked.

I don't believe that the worries from residents of "red" states about this have any real substance to them. Remember, there would not only be pressure on the state legislators from their constituents, but also from their campaign contributors (not always the same (donchaknow?). While Businesses/leaders often oppose some measure that is being discussed for ideological reasons; rarely do they continue that opposition once the law is on the books. They most assuredly will take whatever financial advantages it brings them.
I would imagine the "opt out" would come somewhere between what occurred when Prohibition was repealed and Medicaid: states would have to pass regular legislation that specifically took the state out of the national program. Few states, if any, would probably do so.
I can see several governors talking up opposition, threatening vetos and what have you. Gotta keep their street cred! I can also see those governors heaving sighs of relief when their bloviating is ignored by their respective legislatures. Gotta keep their jobs!

One of the few "ideas" that GOPers trot out when they take a short break from sheer negativism is letting people bypass state regs and enroll in plans across state lines. Now this would in no way achieve any of the goals they usually suggest; unless one of the options (perhaps in DC) was a publicly run plan. I wonder if this was taken into account.

The opt-out needs to be at the individual level. To have a governor decide for everyone in his/her state that they can't have the national health system is just dead wrong.

I traveled a bit in Mexico. There, individuals have the choice of opting out, in which case they pay their own way - and they use private doctors. Plenty of wealthier people opted out, and thus there is a sizable market for the private doctors. Everybody wins.

And from what I understand, their national health system gives decent medical care, too. Especially for those tens of millions who otherwise wouldn't have health care. Now where have I heard that term - "tens of millions wouldn't have health care" - before?

How does that square with their opposition to stimulus funds?

Chris S., jimBOB and Doug basically answered that question-- the GOP tends to argue against funding ever being available, but once it is, only the ones with national ambitions even bother to make a show of rejecting it, because at the state & lower level they have to face their constituents' pain a lot more (which is why I used to say I could vote for an individual GOP candidate at those levels, until I realized it just encouraged them). They're only able to be truly vicious at the abstract level and still win elections, which is why the opt-out idea is such political genius by forcing them to either make deeply unpopular calls that will hurt some of their voters.

The Republicans have marginalized themselves unless we let them back onto the game by fucking up. The Democrats have straight up public support for a strong public option with no trigger or opt out.

Don't fuck up - push a strong PO bill to the floor and let those that vote against it get tarred for siding with big FAILED business over the American people.

The next big fight is real financial reform. We might as well get the SOLD OUT Senator's into the public's eye right now.

On a second thought, a triggered public option (PO) might not be a bad thing if the conditions that would trigger a full, robust public option could be made so strong that the it would simply kick in when those conditions are met. No watered down conditions. Why is this a potentially good solution? Because a health care reform bill without a strong PO would not be too different from the current system so that almost inevitably the inability to rein in costs or something else that's made the current system so catastrophic would quickly "conspire" to establish the conditions that would trigger the PO. Thus, if a triggered PO is the course of action, the key to ensuring that it wont' be a set back would be to clearly define and fortify the conditions that would cause the trigger to go in effect. Without knowing what those conditions are or would be, it is difficult to objectively assess whether or not a triggered PO would be good or bad thing.

" Harry & Nancy: We Red State Progressives will help support opponents of Dems who vote to exclude us from health insurance reform, you can bank on it."

So, you’re going to try to get rid of blue dogs in your state houses? Cool! I’ll help if I can

Oh, you mean us Damn Yankees, never mind

Weren't we told no one has to sign up with the PO if he/she is so inclined?
Doesn't that sort of makes it an opt-in deal from the get.

Why does anyone including Obama think this "trigger" bullshit can pass the Senate, much less the house??

I seem to recall something about a large progressive caucus that promised not to support anything weaker than the PO.

what Glen said at 18:32 only louder

Since I'm making the still-unrebutted claim of being the first to introduce this concept into the discourse back at the beginning of September, here's a new wrinkle for further isolating the opponents: put them both in, but in a different order from the one contemplated by the current (tiny handful) of "trigger" aficionados. A state by appropriate means (preferably a referendum) would have the right to opt out, the opt-out itself would be invalidated if a trigger of well-defined criteria of non-competitiveness is tripped. In other words, the trigger is not a method of introducing the public option in a state, but could defeat the opt-out.