Speaking Of Uninformed Supposition
Adding to Josh Marshall’s point here, the general idea of a national public option with a state opt-out option seems to me like a potentially fine idea.
Here is the deal. Even if only two-thirds of the States opt in, government should already have a big enough pool to swing most of the muscle that a national public option would offer. I cannot ignore that the deal will suck for people in Texas and the deep south. Temporarily setting aside that unfortunate minority, and assuming that conference negotiators can exorcise the devils that live in details, the plan could be a lifesaver.
The most encouraging point for me is that the system will likely work like a one-way ratchet. States can always opt out at the beginning, but pols in a state with a solid public option would eat nails and walk on glass before seriously trying to get rid of it. Over time positive press and occasional progressive wins in the state House would move holdout states towards accepting the public option as well, and at that point they’re in for good. Rising progressive candidates will certainly make opt-in a plank in every major race, and a powerful one if the plan doesn’t suck. If a few hardcore states hold out indefinitely, the issue will have grown a lot less controversial and the Federal government can finally take the decision out of their hands.
Look at it this way. Even if states could opt out of Social Security, Medicare or Medicaid, do you think that any would?
Naturally this model takes for granted that the President will sign a bill that delivers affordable, non-discriminating healthcare. If Democrats pass some dynfunctional compromise cooked up by Susan Collins then they might as well let he whole thing fail and start over whenever voters give Congress back to them.
Warren Terra
Almost certainly would never happen, but we have heard noises of precisely this sort from the Wingers, the Tenthers, etcetera – even including some loudmouths in elected office, though they’d never have the guts to try to go through with it.
Zifnab
That’s awfully sweet of you. Now excuse me while a take a giant steaming dump on the hood of your car.
Just Some Fuckhead
I think it’s a great idea too. And not just because it will give people an affordable health care coverage option, but because it will get more progressives elected in red states that deny their citizens affordable solid health care coverage.
And that is why it’ll never pass.
Bailey
I’m not sure I trust the Opt in/Opt out development. We’re already seeing on a national/Congressional level how much pressure the insurance industry is applying to our representatives. Even a 60 seat majority can’t seem to muster up enough votes to get something decent passed. How would that change if the decision was then just thrown to all the bankrupt states? How much pressure would the state representatives then be put under from the insurance industry?
It sounds like a good idea, but it just seems to me like kicking the ball down the field.
Cain
There are other advantageous. It will make the state more attractive to small businesses and people will probably gravitate towards such a state for work since there would be some kind of safety net. The states that don’t have a public option will probably start bleeding until they are forced to do it in order to compete.
Overall I like this idea. On that same note, have people looked at Wyden’s plan? He wanted states to offer as good or better than the federal public option in order to get single payer system or at least figure out better ways to do the public option. Wyden was one of the guys who was on the fence about voting for the public option in the senate.
Some links:
Ron’s Healthcare Plan
Free Option addition to Baucus plan
Anyways, he has some interesting ideas I thought.
sri
Xecky Gilchrist
@Zifnab: Ditto.
I live in Utah.
Just Some Fuckhead
@Zifnab:
Right there is why you can’t have anything nice.
Warren Terra
I feel your pain, Zifnab, but it’s hardly Tim F’s fault that the majority of your elected representatives are so resolutely awful. If, in the context of an otherwise decent health care bill, the only way we can get the sane parts of the country a public option is to let the insane parts opt out of it, that’s still better than letting the insane parts of the country deny it to the whole country.
Sloegin
1. States can’t afford the healthcare obligations they’re stuck with now, much less new ones without federal kickbacks.
2. The sick will move from states that don’t have healthcare to those that do, quickly bankrupting them.
BB
Tim- This. A thousand times this.
This approach will take patience, and I do feel for the states who will not immediately benefit from the public option, but if we absolutely have to compromise the get it, it’s the only good option.
Gradually, the public option will spread. The issue will in some ways look like the stimulus funds uproar where even the wingnuttiest legislative bodies refused to turn down funds. As long as the largess comes from Washington, everyone wants on the gravy train.
Not only that, but the public option as a standalone issue polls surprisingly well. We can move the debate outside of the Village echo chamber, use it is a cudgel to win some statehouses and in the long term get health care to a heck of a lot of Americans.
Bnad
Sounds like a cop out. Philosophically wrong, stingy, sets up a slave state/free state system. And will turn the state legislatures into the insurance companies’ bitches.
Brian Griffin
as a southerner, I support the idea.
precisely because it will force our state pols to be honest about this. after most states opt in, they will have to back it or watch businesses leave, and stop demagoguing the issue.
this will create a collision between reality and ideology. which is why this is the last scenario the wingers would want to see.
Tony J
So the states that are still firmly in the Republican camp refuse to take advantage of the public option, leaving the majority of the country to see how it works without the South sucking on the teat for all it’s worth?
Or some of them do, and those who flip to accepting the public option hand challengers further to their Right a big old cudgel to use against them with the Base come the Primaries?
And as time goes by, the voters in those states who don’t have a public option get to see the rest of the country enjoying a benefit they can’t recieve if they continue to vote Republican?
Is this one of those “How realignments happen” thingybobs?
dr. bloor
@Zifnab:
That’s awfully sweet of you. Now excuse me while a take a giant steaming dump on the hood of your car.
As much as I might prefer it, there’s no federal regulation preventing Texans or any other red-staters from moving to a more citizen-friendly state.
More to the point, your neighbors hate the idea of gummit-run-healthcare-complete-with-death-panels. Once they see citizens of other states getting something they’re not—greater competition and more affordable plans—Texans will be on board in no time.
Joel
The opt-out has the added benefit of putting the nails to the republicans on the state level. If they’re serious about opposition they’ll have to stand against what will presumably a popular program. It’s a clever play by the democrats, if they’re united here.
Bubblegum Tate
@Warren Terra:
My guess is that they’d largely accept it, but try to find some small provisions they could opt out of and then talk about how they stopped the soshulist takeover of health care. You know, like how jackasses like Jindal accepted stimulus funds, but turned down a small portion of their state’s allotment so they could make a big show about how they turned down the stimulus.
El Cruzado
@Sloegin:
The vast majority of “the sick” aren’t in any position to pick up their things and move to another state.
anonevent
I think Gov. Goodhair should have to explain to the six employees who just got laid off at my job in Texas why they can’t get in on this (yes, I know that the bill doesn’t take effect until 2013). As more and more Republicans in Texas are laid off, they can start experiencing the way they want other people to be treated, and watch states that actually want to take care of each other. If Texas opts out, I’ll find some Republican in another state to swap houses with.
Fwiffo
Expecting 2/3 of the states to join is unreasonably sanguine. There are a lot of big states that would opt out, leaving a lot of people out in the cold. It’s not just Texas. I’m actually presently getting fucked in the ass by insurers here in Florida and don’t want to be denied the choices given to people elsewhere. Florida is a big state, and it’s one likely to join the opt-out crowd with our wingnuttiest of state legislatures. And don’t forget the utterly dysfunctional situation in California – that’s one state that can single-handedly fuck us all.
If I could afford to give up my job and drop everything to move to a more progressive locale, I would have already done it. This “opt-out” boondoggle seems to be motivated by the same spiteful “I’ve got mine” attitude that drives the tea-baggers.
BFR
I wouldn’t count on that. If this passes and gets implemented in most of the states, then I would expect to start seeing messaging popping up portraying TX as the “last bastion of true murican freedom.”
On another note, I’ve read the TPM article and I’m not seeing that this is picking up any momentum from conservative Democrats. Is there any actual evidence that they’re biting?
geg6
@Sloegin:
Um, have you even kept up with the debate on this? This isn’t a state-by-state plan. It’s a national public option. With federal funding for those at some multiple of the poverty level, along with small employers and individuals. It’s only that the states decide if their citizens get this choice.
Since it’s the feds, employers, and individuals paying for the plan, I really don’t see how this would bankrupt any state. In fact, it would probably move some employers and industries into the states that have the public option, increasing state tax revenues.
Jeez Louise.
geg6
@BFR:
I don’t think they even need the Blue Dogs to actually vote for the bill. All they would need is for them to commit to not supporting a GOP filibuster. And that, my folks, is how you get to a filibuster proof majority. Not to mention that, yes, this is how realignments happen.
JGabriel
Tim F. @ Top:
The are several problems I see with this option. The first is that it will receive no Republican votes — not that I care, but why have it then? Does it make it easier for Blue Dogs? If so, again, why?
I think a lot more states than expected would opt out. Insurance industry lobbying to opt out would skyrocket at the state level. Criticisms of the program will dominate the debate, with many states choosing to “wait” until the flaws are corrected, which they won’t be without a majority of states enrolled. Efforts to get states to not opt out will be split 50 ways, rather than a single, nationwide effort.
Sure, it looks doable initially, until you think about why the insurance lobby might support it. They’re desperate for a way to fracture the debate and the resources to oppose them.
Finally, it sucks morally — letting people in regressive states suffer until they elect more progressive leaders.
And I say this as someone from a state, NY, that would be pretty likely to opt in.
.
Steve Balboni
This is such a fucking terrible idea.
States are populated with actual people with actual healthcare needs and creating a system whereby one state’s wingnut governor can deprive his citizens of the public plan is bullshit. Plain and simple.
What happens if a Republican governor of California opts out? There are over 6 million uninsured in California right now, are they less deserving of a public option than the uninsured in Washington or Oregon? What about when Rick Perry opts Texas out? There are 5.5 million uninsured there.
If there is a right to access to healthcare then that right exists no matter who your governor is or who the head of your state legislature is or, frankly, no matter what a majority of the citizens of your state prefer.
I strenuously object to establishing a system whereby a citizens access to various benefits and rights are not enjoyed generally but rather depend on the specific circumstances of the individual’s residency. This compromise would ghettoize our nation’s healthcare system.
BFR
Right, but is there evidence that this is going to keep Ben Nelson & company in check?
Corner Stone
@dr. bloor:
The main issue here is that I believe Harris County (Houston) has a ratio of something like 1/3rd of the population does not have health insurance.
Care to guess the skin color of most of those folks? Even if the crackers themselves are dying due to lack of coverage they will look over and see a brown or a black getting coverage too and freak the fuck out.
I’m just tired and worn the fuck out by trying to explain to these ninny heads that my health and well being SHOULD NOT BE tied to employment. Who the fuck thinks that makes sense?!
The Grand Panjandrum
I love this idea if this is the way to get the bill passed. Let the liberal v. conservative policy battle be fought out in the real world. We’ll plenty of data to determine who was right and who was wrong.
BFR
We don’t know the details but I’m pretty confident that it would require legislative action, so Governors Goodhair and Governator wouldn’t be able to opt out by fiat.
So, yeah, Texas would be hosed but if you follow CA politics then you’d know the chance of CA opting out is somewhere between 0% and 0%.
LD50
@Warren Terra:
Absofuckinlutely. Texas has fucked up the rest of the country for quite long enough, thankyouverymuch.
JGabriel
@Sloegin:
That’s probably not a valid argument: a public option will be paid for from federal taxes and user premiums. It shouldn’t affect state budgets. Though, as always, the devil is in the details — and certainly Republicans will make the claim of statement 1, despite the truth.
.
South of I-10
@Zifnab: No joke. I’m at the mercy of Bobby freakin Jindal and the idiots in the state legislature?
geg6
@BFR:
There was also talk (Rachel Maddow and HuffPo both reported it) that the whips are telling them that if they vote with a GOP filibuster, they will lose their committee seats. And that, my friend, is how you whip a Blue Dog.
4tehlulz
This image captures my feelings.
I haven’t figured out for who though.
LD50
Hard to imagine the Democratic leaders in Congress showing that much spine, frankly.
BFR
Yeah, that’s unfortunate. I also don’t think we should assume that the deep south will eventually come on board. Slavery & Jim Crow were economically ruinous to the south but they sure didn’t want to give them up.
Corner Stone
People please! If weight of public opinion, or logic, or rational decision making had ANY ability to move the voting populace in wingnut territory then WE WOULD NOT BE IN THIS MESS.
But it simply does not. For those that think this “opt-out” solution would somehow put Republican officials backs to the wall, or some shit like that, you are utterly clueless about living in a ingnut environment.
Gov. Perry, or whomever the FL Gov will be or Georgia or South Carolina – they’ll all demagogue the fuck out of this, play to their nutters, rile up the idiots and spam disinformation the absolute fudge outta the place – and never pay any price for it. Nothing has ever happened to Perry for his treatment of the stimulus bullshit, or the secession shit or anything else. Sure he’s got Kay Bailey challenging him but she’s making all the same damn nutter noises he does! She’s tacked even further right then one could’ve imagined.
All this “opt-out” will do is fuck the people who need it the most and who can’t fight back effectively for themselves. The poor, sick, weak, etc don’t really organize very well. For some strange reason.
BFR
Yeah, I saw the segment. But that’s a hammer of a different sort – the question is whether this compromise helps to whip Nelson, Landrieu, etc. Any indications?
geg6
@LD50:
Well, miracles DO happen!
It was hilarious on Rachel. When she reported the story, the graphic showed Harry Reid with one of those Devo flower pot hats on his head. I LOLed.
Corner Stone
@LD50: It’s bluff. Pure and simple. And a GD transparent one at that. Who do you think put Reid in the leadership? And why did they do that?
Things like this right here. Kabuki.
ETA - not yelling at you, agreeing with you. Just cheesed off that any media would repeat this farce as possible.
LD50
@BFR: It would be amusing to watch wealthy Southern GOP politicians running for re-election by telling poor people how much better off they are without health care. I predict that at least 27% of them will believe it completely.
gbear
Hate to say this, but the thing I’d most look forward to if this bill were to pass is watching Tim Pawlenty’s head explode as he tries to maintain his fake ‘moderate’ face.
Also hope that this plan is acceptable (‘safe’) enough for all the pro-public option democrats that Olympia Snowe’s ‘concerns’ get dumped. She needs to be made inconsequential.
Tsulagi
You would think this would appeal to “states rights” Republicans. They could opt out in their states further encouraging free market forces in health care to continue to work their magic. Maybe even push for state tax breaks and complete deregulation of the industry within their states. Surely they would do so welcoming the opportunity to showcase how a totally non-taxed, non-regulated health delivery system would lead to THE MOST GREATEST HEALTHCARE EVER causing even the French to weep in envy.
Yeah, right. R-pols won’t support this anymore than they’ll support any form of HCR. Last thing they’d want is voters to see a solid public option program working in opt-in states contrasted with opt-out in theirs given their usual level of competence in actually running something. They aren’t going to put their money, or careers, where their mouth is.
geg6
@BFR:
Um, if they will lose their chairmanships, etc., they may as well just kill themselves. That’s like losing the keys to the kingdom. Congresscritters will do anything not to lose their committee kingdoms. They don’t have to vote for the bill. Just not for a filibuster.
BFR
Sorry if I wasn’t being clear. Yeah, revoking a chairmanship is a big giant hammer. But the opt-out is a different tool – my question is whether or not the opt-out (independent of revoking chairmanships) is moving the needle at all.
Roger Moore
@Warren Terra:
This. I’m tired of being pushed around by a bunch of know nothings elected by know nothings. If they want to eat a shit sandwich that’s fine, but don’t let them put it on the menu for everyone.
geg6
@BFR:
Well, we don’t know yet. Schumer is saying it is, but that doesn’t mean much. It’s only been out there for less than 24 hours, so let’s see.
Corner Stone
@LD50:
God. Not more of this poopyheaded nonsense please.
mattH
Sorry to pick on Texas, but I’m sure that if you let them, they’d drop Medicaid the first chance they got.
flavortext
So “Yes we can!”, unless you have the unfortunate luck to live in a state controlled by Republicans? Why would the South wake up to reality when they see the public option work in other states? Opting-out of Obama’s socialist healthcare scheme will play enormously well in wingnuttia, reality be damned, and the Dems will have screwed over the more sane people who managed to turn out in such high numbers that Obama won Virginia, North Carolina, and Florida in 2008. Think they’ll have as enthusiastic a turnout in 2012, when half the country takes care of its sick and the other half is on the “don’t get sick, and if you do get sick, die quickly” plan because Democrats were too timid to govern like a national party?
LD50
@Corner Stone: Naw, we really love Texas and all they’ve done for us.
Hey, everyone, how about a big hand for Texas for being such good sports!
gbear
@Corner Stone:
Governors can rally the wingnuts all they want and still only have 27% of the population on their side. I don’t see that as being enough of a wall to keep them from all the uninsured or insured-and-still-screwed people in their states. If it comes to this, politicians who want to keep health care out of their states shouldn’t make any plans beyond their current term. They’ll be gone.
Just Some Fuckhead
Virginia is nominally blue, with two Democratic senators and a democratic governor. Republicans have about a 50-40 advantage in the state legislature and there is a good chance we’ll have a Repubican governor for the next four years.
Even so, I support a state opt-in plan. No reason the rest of the country should suffer needlessly because The South is still fighting the Civil War. Of course, I also support repealing Medicare YESTERDAY. Old people are the most affluent segment of our society and should be able to afford their own insurance. The ones who can’t afford coverage can try to qualify for Medicaid and then start voting Democratic and praying for single-payer like the rest of us.
BombIranForChrist
A lot of Southern states elect their officials on a platform of anti-government, but the truth is that the South gets a whole shit ton of cash from the federal government.
The mean side of me says, fuck ‘em. Survival of the fittest. The biggest punishment you can give to a Southern state is to force it to live according to its own beliefs, rather than letting it spout off on beliefs while all the time engaging in behavior that is antithetical to them.
But man, that’s just not what I’m about. Even bible-thumping hypocritical idiots need healthcare.
I am also worried about this assumption: “Even if only 2/3rds” ... what is to say 2/3rds will go for this? How much will this cost the states? Is this how the plan will be balanced? Shove the cost to the states?
Anyway, I’m totally open to the idea, but I am definitely still a little skeptical.
LD50
An interesting theory. Can you offer more evidence?
rumpole
Wow. Those states that don’t have one will see flight like you would not believe. They’ll be empty, except for the people that either (a) make a tone of $; or (b) absolutely have to live there for one reason or another.
LD50
I assume the states that opt in will all institute residency requirements.
JGabriel
Corner Stone: LD50:
God. Not more of this poopyheaded nonsense please.
Yes, I too would be happy if Texas stopped with its poopyheaded nonsense.
.
ThatLeftTurnInABQ
If the threshold for passing this plan is about the same as passing a constitutional amendment, why don’t we just go the latter route and dissolve the Union. Let the Confederate states go their own way. Let’s face it – the geopolitical logic behind keeping the US together as a single nation which held in Lincoln’s day when democratic republics were scarce and the US was a minor player in the global balance of military and economic power has long since passed its sell-by date. If the Soviet Union can split up without WW3 breaking out, so can we. Break up the US; we aren’t united, so let’s stop lying to ourselves about it. The cost of resettling the inevitable refugees would be less than the cost of the bullshit we have to put up with now.
JGabriel
BombIranForChrist:
You mean God won’t answer their prayers? Shame on you, you commie unbeliever! Shame!
.
anonymoose
It sounds like a good idea, but I think they need to go whole hog with the idea:
1) Provide for a ROBUST public option which states can opt-out.
2) If a state opts-out, then they MUST provide an alternative to the status quo. ...in other words they must roll their own health care reform. Want an exchange, fine, do that…..but…
3) There will be triggers set up in that if the state’s roll their own option does not help reduce costs or if they dont cover the uninsured enough, that state will be forced into the robust public option plan.
For those who feel left out, the state will be forced to change to something better than the status quo, and if they don’t succeed, then they will be forced into the public option.
Bill H
Given that no such bill is under consideration, I’d say that is unlikely. Several health insurance bills are being considered, but most of them fail the “affordable” test and will require subsidies.
Rekster
Tim F. said:
“unfortunate minority”. You are nuts. We in Texas and the deep south along with the Southwest are Americans just like you. Unfortunately, we live among the wingnuts for whatever reasons. We donate to progressive causes, we vote for Democrats, and we deserve the same as you “fortunate” ones who live in other areas of this country.
TexasMike
This is why Democrats can’t seem to get shit done anymore. This is Triangulation 2.0. Sell out the millions of dems in Texas and the south who busted their asses to get Obama elected and expanded majorities in both houses. 50 state strategy…Fuck it. Just so “bluer” states can get a public option. I got news for you. Dems in the south won’t only pressure the local pols but the national ones who vote for this shit in the first place. I’ll send money to primary any pol who votes for a piece of shit like this.
Rekster
Take a look at some of the comments from wingnuts about this article in today’s Dallas Morning News:
http://www.dallasnews.com/shar.....d0fce.html
You will see what the thought pattern is like here in Wingnuttia.
zzyzx
@TexasMike: I understand your pain, but it is the representatives of the states who are likely to opt out who made it so we couldn’t just give this to everyone in the first place. It’s better to have 2/3 of the country have this option than none, especially when the barrier to rejoin is so low.
Sentient Puddle
Yes, it sucks for those of us living in places like Texas, but this may well be the best way to play the bill. I don’t know about the rest of you, but I’m still pretty uneasy about congress going all or nothing on the public option. I’ll settle for “in the near future” over a reasonable chance of “whenever the Democrats sweep in on another wave.” And besides that, it could also cultivate a blue grassroots uprising in these states, which could have longer-term political implications beyond just health care.
Beyond the assumptions already listed, I’d also add as an assumption the fact that this sort of compromise could get an Olympia Snowe or two on board. If they’re just playing coy while our side whittles away reform to oblivion, I’d just say fuck ‘em.
LD50
@Rekster: Well and good, but if John Cornyn is the only thing keeping the rest of the US from getting some kind of national health care, well, then, fuck John Cornyn.
robertdsc
@Rekster: @TexasMike:
These.
LD50
@TexasMike:
No, that’s not the reason at all. The Democrats have a supermajority in Congress with almost no help from the South. The reason is that the leaders of the Democratic Party are fucking spineless and seem to believe the mid-’90s propaganda that they’re unpatriotic unless they do everything the GOP tells them.
Dean Wormer
@LD50:
Give it back to Mexico, already!
(Though I would vote for a federal district in Austin, even if we have to airlift in Peet’s and require a UN escort for SXSW.)
Xecky Gilchrist
@Rekster: Unfortunately, we live among the wingnuts for whatever reasons.
Yup. This sort of “abandon the red state allies” thing is almost, but not quite, as bad as the poorly-thought-out “Boycott Utah!” BS that popped up after Prop Hate was passed. At least this one doesn’t explicitly punish red state progressives, but it’s still pretty dumb.
gbear
@Rekster: @TexasMike:
Umm, we’re talking about a healthcare option that, on it’s face, treats every state equally. It doesn’t discriminate against any state. Every state an equal chance to opt in.
Bob (Not B.o.B.)
Marshall:
In other words, the healthier states with less poverty would leave, driving up the costs for the rest that stay. See: Wyoming and Idaho.
Corner Stone
@zzyzx:
Hmmm…fractions…where have I heard a compromise with fractions that involved the states?...
Oh yeah! I gotst it! 3/5ths!
Will
The politics of this possibility are vicious for the Dems—in all the good ways. Reverse pressure. Instead of “forcing” the country into a public option, thereby taking all the heat and none of the light immediately, they present a “choice” that GOPers will have to sign onto, or risk political annihilation. Torn between their vaunted “principles”, and political survival, which path do we think the modern GOP will take?
This kind of massive arm-twisting is probably so politically tempting to the Dems right now—especially after the hell of August—that they might even see “opt-out” as preferable to mandatory. Hopefully, it would end up being good policy too.
LD50
Forgive me if I’m less than enthusiastic about giving up national health care just so that the politicians representing Texas can feel ‘included’.
gbear
@Corner Stone: weak.
Comrade Sock Puppet of the Great Satan
“So, yeah, Texas would be hosed but if you follow CA politics then you’d know the chance of CA opting out is somewhere between 0% and 0%.”
Yes, if it’s a majority vote.
If it affects the budget, then the CA Central Valley anti-tax GOP Taliban can nix it with their slightly-over-one-third of the legislature.
Dusty
Given that each participating state would be contributing proportionally rather than equally, the departure of a state like Wyoming or Idaho won’t matter all that much.
Dusty
If it’s federal money, it won’t affect the state’s budget.
Nick
How are they going to fund the increased costs associated with the exodus of the poor from southern states?
You can’t survive here in Minnesota in a tar paper shack in the winter, the kind I saw in North Carolina while in the Army. We either provide services to people or they freeze to death. Who is going to pay for that?
matoko_chan
Tough titty.
They voted for the Hip-brains.
gbear
...and then go out in two years and try to get re-elected.
BFR
Yeah, but if it’s an opt-out then the same rules should apply in reverse. In order for the state to pass legislation to opt out then they’d need at least a simple majority who wanted to opt out and perhaps as much as 2/3rds depending on how the legislation is crafted.
I agree though in the sense that if it’s opt-in, it would be difficult to get CA to participate.
BFR
@gbear
These legislators are from the reddest districts in the country (not just CA) – central valley, Orange County etc. Losing their seat because they’re too conservative isn’t real likely at this point.
mai naem
The only problem with this option is that it wouldn’t help the people that it really needs to help. From what I remember from the statistics, the deep blue states had high insured rates and the nutcase states are the ones with the lower insured rates.
Meyer
You won’t see the poor in exodus. They have medicaid everywhere. You will see the middle class shift around, which is exactly the group the states want to see moving in. You will see jobs shift as companies move to take advantage of lower costs, probably offsetting any influx of sick people.
You will see more immigrants – very desirable.
The states with the PO get richer.
This is absolute political dynamite
Corner Stone
@BFR:
Trying to explain this to people who don’t want to understand it is fun.
Will
Maybe the more they think about it, the Opt-In proposal starts to dawn on GOPers as a really, really bad idea for them politically. Maybe they realize just including everyone at the federal level is far less dangerous to their political survival than this Opt-In idea. Maybe they realize that the Blue Dogs and Olympia Snowe like this Opt-In idea because it gives them political cover. Maybe they then realize they no longer have the Blue Dogs and Olympia Snowe to provide them the political cover needed to vote against this thing, or to at least filibuster it.
Maybe Opt-In is just the Dems way of holding a loaded gun up to the GOP’s head and saying “You better not f*cking filibuster the federal deal, or it’s Opt-In, with the 60 votes we need to say f*ck you.”
Though I’m probably just getting carried away.
Dr.BDH
Vast inequality between states’ Medicaid enrollment rules and benefits (all to the detriment of poor Southerners vs the rest of us) has not produced a leftward shift in Southern politics and I doubt this opt-out would either. I would rather expect that uniform institution of an affordable public option in all 50 states would result in increased support for other liberal ideas, but then the numbers of illiberal Medicare beheficiaries in the South probably prove me wrong.
skeptic
@BombIranForChrist:
no kidding. as an “annoyin’ Illinoisan” it’s pretty ridiculous to hear the people benefiting most from federal largesse to complain about “big gubmint.”
see here:
http://www.taxfoundation.org/r.....22685.html
more the evidence.
LD50
@BFR: Not so sure. There are PLENTY of uninsured people in the Central Valley. If GOP State Representative Jesus McWingnut from Turlock smacks down health care for the whole state, all the Dems have to do in 2 years is point to him and say “Hey! Don’t have health insurance? It’s all thanks to THIS GUY!” Not all of said dirtbags would lose re-election, but a lot of them would.
BeccaM
It is a fact that people are dying because they don’t have health insurance. One every 12 minutes.
Thus I find it morally indefensible to support this ‘opt-out’ scheme.
How do you tell some kid in Louisiana or a family in Texas or some pregnant woman in Montana that they don’t deserve medical treatment because, unfortunately, their state government is dominated by regressive GOP neanderthals?
I thought our federal government was there to protect the rights, health, and welfare of ALL Americans, not just those whose state governments ‘opt-in’.
By the way, the last time we went for this kind of “let each state go its own way” compromise, the result was civil war.
Will
@Will:
I should probably be calling this “Opt-Out”, not “Opt-In”.
Corner Stone
@gbear: Last time I checked we were having a debate on “National Healthcare Reform”. Not sure how having a supermajority benefits anyone if when doing the right thing for the nation gets too hard they compromise away the health and well being of some of the people who didn’t happen to vote for them. And along the way punish those who did happen to vote, work, and contribute to get that supermajority.
It just seems real damn easy for a lot of people here to convince themselves that rational decision making will take hold at some future point and everybody affected will be just fine and dandy til that outcome appears.
That’s not going to happen, not in the next generational era anyway. And what are those people to do who will pay with their health and wellbeing in the meantime?
Fuck ‘em if they’s in TX? That’s the answer when someone needs help? They shouldn’t have been so fucking stupid as to live in TX, and they should high themselves on up to Minnesota?
I just don’t see how this so called “compromise” is in any way a less disgusting appeasement than other betrayals done in ode to “compromise”.
It’s not going to work the way people keep suggesting.
Dean Wormer
@BeccaM:
And there is a decent argument to be made that a rump CSA which eventually drifted into 3rd-worldness would have resulted in less overall suffering than 150 years of race-baiting and “Southern Strategies”
LD50
@BeccaM: Of course the opt-out option isn’t best. The question remains, is it defensible for the whole country to be held hostage by the minority of people who are trying to block it? That doesn’t help people who are dying because they don’t have health insurance, either.
That’s already the case, remember?
This analogy means what? That the states opting out will start shooting people in the states that didn’t? Or the reverse?
Dusty
How do you tell some kid in New York or a family in Illinois that they don’t deserve treatment that they don’t deserve medical treatment because, unfortunately, the United States Senate has too many moderates?
If a robust public option for all can get past the Senate, I’m all for it. But if this Schumer compromise is the best we can do right now, then, fine. The battle can move to whatever holdout states opt out of the plan.
It’s an “opt out,” not an “opt in,” and, as Nate Silver notes:
Sentient Puddle
@BeccaM:
OK, but what if we go to war for the full public option and lose? Then we’re worse off than the opt-out compromise because the whole country now has nothing.
If you feel quite comfortable that congress can get the full public option in the bill and pass it, then great, we don’t need to talk about this compromise. But I’m not feeling it. It may not be right, but we need to take what we can get now. And right now, I think the thumbscrews may well be the most politically savvy compromise.
kay
@TexasMike:
Dean’s 50 state strategy was much more than a scheme to get Democrats elected at the national level. It was a bottom-up approach.
The 50 state strategy centers on state level government, leading to and in conjunction with a push for a federal majority, and that was the intent. We started here at the county level.
Texas had some catching up to do. It stands to reason that you’re organized now (what you referred to) but don’t have state government gains yet. 50 state moves the needle in the right direction everywhere, but accrued gains aren’t going to be the same.
BFR
So, I haven’t lived in CA for a few years, but my sense on how this would play out would be:
Dem: “Hey! Don’t have health insurance? It’s all thanks to THIS GUY”
Republican: “If you vote for my opponent, he’ll take ur gunz, let the mexicans take over and turn your son ghey like they do in SF
1!!”
Yeah, it’s possible that you could squeeze a couple out and get over the 2/3 hurdle but by no means is it a guarantee.
Corner Stone
I see alot of false choices going on here. Are we saying we have only TWO outcomes?
The Opt-Out choice or Status Quo?
When did this happen? When did the Opt-Out-or-Nothing Coalition take the other options out back and execute them?
I think we’re still too deep into the mire here to say that these are the only two possible outcomes, much less falsely argue that that is the factual case.
Tsulagi
Don’t think Texans or many in red states would have to worry much about their states opting out of a solid public option plan.
Oh yeah, R-pols and pundits would beat their chests, cry their Beckian tears, and endlessly talk the shit out of their talk. But when it came time to walk, strong guess they’d act as they have with federal stimulus money for the states.
Take the highly principled governor of Texas. Perry was strongly opposed. Then quietly took all of the stimulus money for Texas except loudly and publicly that for unemployment benefits. He had his principles. Well, except later quietly asked for a federal loan to cover unemployment benefits.
R-govs and legislatures would opt in. They just don’t want to be put in the same position as with the stimulus package where publicly they ditto-echo their loonies, but then quietly try to do the sane opposite without too much notice. They have no problem with hypocrisy, just others noticing and calling them on it makes their inner Jesus weep.
Will
Dean is on board:
http://www.huffingtonpost.com/.....14118.html
kay
@Corner Stone:
I think it’s great if the whole discussion turns to “what will the public option look like?”
Despite best efforts of media and Republicans.
That, all by itself, is good.
kay
If liberals want a concession for opt out (and they should get one) they should trade opt out for the leeway to have a true public option in the states that opt in, where anyone (employers) could choose the public option.
Then they’d be getting somewhere.
Dusty
Possibly, but, again, as Nate Silver notes:
Ezra Klein also argued that:
Look at it like an experimental drug. We don’t let everyone have it, even if we think it’ll work. We do test runs in smaller populations. The “opt-out” is a test run. If it works, it’ll be increasingly difficult for nonparticipating states to hold out. If it doesn’t, it’ll be easy to scuttle.
Martin
My sense is that the opt-out option might allow progressives to fight for far more in the bill. And it gives Democrats in red states – like Nelson, Conrad, Lincoln etc. cover to vote for the bill by simply justifying that their state can choose accordingly whether or not to participate, they aren’t forcing the issue.
This seems to give everyone on the left a lot of breathing room, and takes away a lot of the ammunition from the right, and maybe now a better bill can come from it.
Martin
I will officially predict that if this passes, ‘Opt out of social!zed medicine’ will be an annual voter initiative in every state that allows voter initiative. I’m pretty sure that’ll at least be true in CA.
General Winfield Stuck
If this hasn’t already been noted in comments thus far for this thread. The idea looks great on States Rights, and short sighted politics to get something passed. But, I can’t think of anything that will further divide the country than this idea, if it comes to pass. But then, maybe that’s something that is going to happen no matter, so bring it on as Massachusetts On the Rio Grande will go for it, I am sure.
Let the south drink Tea for health care, if they choose.
Dusty
Sure, but, if the public option is working the way it’s supposed to, there’ll be plenty of ammunition to oppose those voter initiatives. There will be voters on the public option, just as there are voters on Medicare. Voters will know someone on the public option. It won’t be some mysterious notion that voters don’t understand will benefit them.
Martin
Won’t stop the millions of dollars wasted on the initiatives every year, though. This will be right up there with the 80 gajillion efforts to stop gay marriage.
Martin
And it looks like Nelson is on board, with Conrad on the fence. Looks like the filibuster is almost certainly averted and they can go for a 50 vote proposal.
OniHanzo
How much of this speculation that Texas would even opt-out is based on anything of substance?
Rick Perry may shoot his guns in the air about secession but he’s not an ironclad fool. He knows how his federal dollars are buttered.
wrb
great line Sully just posted:
“Then public doesn’t want a Democrats-only health insurance bill, but they don’t like the GOP and love the public option. I think the Dems would be fools not to get a public option in the bill and brag about it. And Karl Rove, once again, is completely wrong about everything.”
Dusty
If private organizations want to spend millions of dollars on fruitless campaigns to abolish popular programs, that’s their lookout. It’ll give some work to printers.
Dusty
That last post was in reference to this:
Martin
Eats up a lot of taxpayer dollars, though. A ballot initiative booklet in CA regularly weighs in north of 100 pages. That times, what, 20M voters plus postage? It’s insane.
kay
@Martin:
I agree, Martin.
I was also worried about red states blocking enabling legislation (which I think is going to be needed) when the federal law passed.
I anticipated this huge legal battle, with Texas leading the charge, and gumming up the works for the whole country. I don’t want to do that. I don’t want to give conservative state legislators and governors something to litigate.
Dusty
This is, of course, based on polling that frames the question in a skewed way. Only the Research 2000 poll for the GOS gave respondents a choice between a Dem-only public option and a bipartisan bill without a public option and they took the Dem-only bill. It’s hard to believe, but they cared more about the policy than the process. Shocking.
Dusty
Sure, but that’s a bigger problem that this one proposal, so I’m not sure how it’s an argument against opt-out specifically.
General Winfield Stuck
@OniHanzo:
There is a good point in your comment.. While I think it would cause an initial orgy of states right wingnuttery with a lot of chest thumpin’ faux patriotism, in the long haul the states who don’t opt in right away will see a lot less personal health and financial disasters from those who do.
Like they say, there are no atheists in foxholes, probably holds true for those near death with no hc insurance in hospital ER’s and their friends and family. And I’m not talking about Dobson’s baby wingnut Jaysus religion. I’m talking about the “I’m going to die if I don’t get medical care kind”.
wrb
@Dusty:
The public option isn’t about the extent of coverage. It is a cost-cutting measure (in theory).
If it works in the way we non-Randians think it will the people in opt-out states will have to pay more.
If the amount is substantial they will soon opt in.
And possibility reevaluate their economic religion.
Ash Can
This is a case of the bad versus the worst. The worst is to have no public option at all. I have a serious problem with not extending the public option to all states. But if it means saving the PO altogether, I’m reluctantly in favor of it.
Of course, the political implications of Opt-In/Out favor the Dems, and the PO, overwhelmingly. Any state lawmakers foolish enough to sacrifice their populations on the altar of the Church of the Most Holy Insurance Industry will find themselves with a few bonus orifices in their backsides courtesy of the voters’ pitchforks, and it could very well engender wholesale changes in the political makeup of the red states. But, in all seriousness, I’d much, much rather it didn’t come to that.
PhoenixRising
Gosh, it’s interesting to eavesdrop on progressive straight people debate which kinds of compromises are appropriate on an issue you care deeply about.
As a professional gay activist, I’m fascinated. We’ve been wresting with the ethical and pragmatic questions about who to leave out in exchange for ‘something’, how to structure advances to include the most needy as well as the already-strong, and who to include in the conversation about the minimum acceptable solutions for…some time now.
Yep, this will divide the country into haves and have-nots, leading to migration for those who have choices and deem this the most important aspect of their lives. Yep, it will be divisive for the institutions that bridge regions (the Democratic Party, for example) whether they push for it or concede reluctantly.
Pass the popcorn.
tom c
To Hell to the deep South. If it offends their suthun honah to accept better health care as it abuses their state’s rights or whatever hell other idiot ideology they are abusing now, than really, I say the hell with them. The rust belt has been losing population and jobs to the south for the last since, well whenever it was air conditioning became affordable. If being able to get better health care convinces people that its not that hard to shovel freaking snow a few times a year and put on a sweater than I’m all for it.
BruceJ
In.
A.
Heartbeat.
The legislative leaders in my state are already on record saying they believe that Social Security, Medicare, etc is unconstitutional.
The only moral any of these scumbags hold is: “I got mine, jack, fuck off!”
The ONLY thing they would ever see is that the state would no longer have to cough up anything for these programs.
Who cares if poor folks die. Good riddance. At least we lowered taxes!
This ‘compromise’ condemns a huge number of people to second-class citizenship, and no real health care reform.
Martin
It’s opt out, not opt in. That makes a HUGE difference, btw.
States have to go out of their way to not participate and they need to then justify why they are going out of their way. We all know its far easier to stop bills than to pass them. This requires states to pass bills.
Martin
Well, if the have-nots are too fucking stupid or too stubborn to change their voting patterns, why is that a problem? Are we supposed to vote for them too, now?
General Winfield Stuck
Maybe you should read my comment in it’s entirety before responding.
@General Winfield Stuck:
HyperIon
@BeccaM wrote: By the way, the last time we went for this kind of “let each state go its own way” compromise, the result was civil war.
BS.
Isn’t that how gay marriage is getting tackled?
There have been many occasions when the policy has been “let each state go its own way” since the civil war.
Just because THAT manifestation of states rights was a big loser it does not follow that state rights should be abolished.
HyperIon
@Martin wrote: I will officially predict that if this passes, ‘Opt out of social!zed medicine’ will be an annual voter initiative in every state that allows voter initiative. I’m pretty sure that’ll at least be true in CA.
yeah, that’s what happens in a democracy sometimes.
then the people get to vote.
i never got to vote on the crappy employer based system we have now.
PanAmerican
Louisiana has a Democratic legislature. The Texas house is controlled by a coalition of non-wingnuts and Democrats. Montana has Brian Schweitzer and another coalition house.
General Winfield Stuck
@Martin:
I apologize, as I see you were responding to another commenter who said something similar to my comment, but not my comment.
Martin
I already voted for my representatives and my governor. I need to vote on every piece of legislation now too? Do we have a direct or a representative democracy? Pick one plz.
Bondo
Got tired of reading but two points.
1. States CAN opt out of Medicaid…it just wouldn’t lower their federal tax burden so they would be subsidizing other state’s poor uninsured and they would be hard pressed to do anything better with what remains.
2. Jesus fuck people get a sense of entitlement. People from Red(neck) States are whining about how opt-out would let their state deprive them of a public option and how horribly unjust that is. The alternative of course is a system where NO state gets a public option. Neither version has a public option in conservative states but somehow the liberals in those states find it appropriate to spite the blue states for finding a way to at least make sure those states can have a useful public option?
HyperIon
@Martin wrote: Do we have a direct or a representative democracy? Pick one plz.
I’m not for government by initiative but I do think that getting to express an opinion on a matter that effects every voter personally is not as problematic as letting everybody vote on gay marriage, which really is a civil rights issue.
I’m just saying that if a state did not opt out and then decided later to opt out, I’d probably be more comfortable with a direct vote rather than leaving up to a bunch of rather easily influenced legislators. But I share your general POV wrt government by initiative.
The Other Steve
Something is better then nothing. Something can be fixed if it doesn’t work.
Nothing doesn’t work from the get-go.
LindaH
Not passing a bill with a public option condemns even more. Look no one is going to tell Texas, or Wyoming or any of the Red states that they can’t have the public option. They get to pick it for themselves. We’re not saying f*off to the states that want to opt out, they are the ones saying f*off to their citizens. I’m sure some states will opt out. I think Ohio will not, even though we do have the distinction of re-electing John Boehner every time he runs. This is our best chance of health care reform in a long time and we will probably not see a better chance for an even longer time it this goes down in flames. I would love to see a public option for everyone, but the Dem’s don’t believe that they can pull it off. Maybe they are weak, but maybe they have counted the votes and are right. This is a start and can be built upon.
mattH
Not quite. It was only when they feared that they couldn’t enforce their will on other states that the southern states decided to secede.
Sloth
No, it doesn’t . IF they choose not to have one, that’s their choice.
Flip it around – if we do not get HCR, if there is no public option, how long until you start seeing the blue states start to band together to create their own public options? Or even full on single payer.
Less than a year, I bet.
And, interestingly enough, the state that is – IMO - one of the most likely to do so is at the absolute core of medical innovation in this country: Massachusetts. I wonder how McMegan will like that?
PTirebiter
Bondo,
I live in a Texas and I have all the insurance I need. Unfortunately, over 30% of my fellow “redneck state” dwellers do not. Their kids don’t know what the fuck a blue state is- so if I decide to take a steaming dump on the hood of your car, it’s on their behalf. If push does come to shove, very few of us will spite progressive states, but I find your cavalier attitude toward us to be ignorant bullshit. We don’t vote Democratic with an eye toward the day when it becomes more convenient for our Party to fight for everyone.
Robert Waldmann
States absolutely can opt out of medicaid. In fact, they had to opt in. Currently the count is 50 out of 50 say yes to medicaid (Arizona was the last to sign on).
Beefstick Platypus
@Just Some Fuckhead:
Teh Awesome.
Dream On
Let’s remember that Obama got 45% of the vote – in Texas. And I think I heard from someone somewhere – maybe it was Jim Hightower or Ann Richards – that Medicare was signed into law by LBJ, a Texan.
Let’s drop the tribalism.
Little Macayla's Friend
It’s an evil, broken political system when we’re reduced to arguing over which politically expedient scenario causes the fewest number of dead Americans after other countries have already provided empirical evidence for the ethical solution.
Res Ipsa Loquitor
@Cain:
Wyden’s plan stinks. And he is not on the fence about the Public Option; he wants to kill it. He thinks if it fails HIS plan will be the “sensible” fall back.
Your reference is, as those enamored with the Wyden plan, just to a press release or PR blurb. What is most interesting is his constant reference to
Res Ipsa Loquitor
Whoops, I screwed up a quote and it ate the rest.
Briefly: Wyden’s plan has ~ 6 cosponsors who are Repubs and the Dems are all Lieberman and Lincoln types. You know it has to be bad. It gets rid of employer based insurance and throws everyone into the private insurance industry’s tender hands. NO public Option. He’s again it. He’s for healthy competition. The only thing healthy will be the industry’s bottom line.Wyden is either a snake or dumber than a bunch or rocks.
bob h
Just how do you abandon the black and Hispanic populations of the Red States?