Opt-Out Public Option
When I first heard of the plan to allow states (Red States) to opt-out of the Public Option my initial response was let them. Kinda the same reaction I had to the threats of Texas seceding. It is past time to call these obstructionists on their empty rhetoric. Let them Go Galt. A diary on kos spells out the advantages. (Read the whole thing)
Here are the main points:
- It forces GOP legislators to put up or shut up, leaving them in a very uncomfortable position.
- It leaves the rest of us with a strong public option, even after it’s watered down.
- It hampers the ability of Republicans to lie about healthcare issues.
- Businesses will have an incentive to move to blue states.
Don’t get me wrong. This is not an ideal solution for healthcare. It is, however, a perfect solution to make Republicans put their money where their mouth is. So far they’ve been given a political pass. They bitch and moan while they cash their stimulus checks. Basically, they score their political points by spewing rhetoric they have no intention of turning into reality. It’s past time to give them what they claim they want.
Giving props to Carper will be almost too much to bear.
Once Carper realizes what he has done, there will no doubt be some kind of amendment to benefit the insurance companies.
http://www.msnbc.msn.com/id/33213245/ns/msnbc_tv-countdown_with_keith_olbermann
that is worth a look. It is also worth it to participate. Let the red states die on the vine, but we need to stand up. Bring the full weight of liberal America down on these pansy ass senators and force them to do their damn jobs.
I feel like Carper is about to have a Darth Vader in Return of the Jedi moment. The insurance companies are the Palpatine we are Luke…. someone is about to get thrown into a pit.
Here’s my issue with the state option, and please tell me if I’m wrong.
Delaware, for instance, if given the opportunity to do an internal “public option”…. who would sign up?
The people who need it, obviously, or the people who are unable to be insured in the private market. Essentially, you’re creating a high risk pool.
With a national public option, you’re spreading the risk over millions of people. You allow for certain competitive advantages due to volume when dealing with providers. In a state as small as we are, you’d have a very small, very expensive group of generally uninsurable people.
Now, if we partnered with NJ or PA into a “regional plan” then you’re spreading the risk a bit more.
If you allowed individuals to opt in to the state worker’s benefits, then probably everyone would jump on board because they have such a rich benefits plan. I imagine those benefits would have to be diminished or we’d simply go bankrupt.
I’m all for a public option, I’m just concerned with how a small-state like Delaware would be able to pull it off.
The people who need it, obviously, or the people who are unable to be insured in the private market. Essentially, you’re creating a high risk pool.
Yes… but grasping at straws here: once that pool becomes unmanagable, we will be faced with another political decision to either raise taxes to fund it, or to broaden the pool, or both.
It sucks to have to cling to the hope of a two-stage process, and if we do I will not consider it a victory for health care reform; it is more of a sideways step than forward progress.
The risk for Dems is when the high-risk pool inevitably develops funding problems, Dems will be seen as responsible and will face it as a negative campaign issue.
Your concerns are valid, JTF. I don’t think this is an ideal solution, other than it forces Red State politicians to walk their talk.
It seems like the whole game revolves around how to pass a bill that doesn’t require new taxes.
Whatever happened to the concept of taxing the rich to pay for health care? When the hell are we going to have THAT debate? That is what should be on the table now.
And tax-cut wingnuts, please remember: A tax increase is a lot easier to bear if you don’t have to pay private health insurance premiums anymore.
As for JTF’s concerns about the size of state plans, here is my understanding (feel free to correct if needed). That concern is a valid one for Carpers’s plan. It would set up individual state plans, with states having the option of banding together to form regional plans. This new compromise coming out today is different — it would form a national public option with states enrolled by default, but allowing states to opt out if they so choose. The important part is that the plan itself is national, not state-by-state.
“It seems like the whole game revolves around how to pass a bill that doesn’t require new taxes.”
Wouldn’t it be nice if that standard were applied to troop buildups in ASia?
Should be the standard for any bill.
This new compromise coming out today is different — it would form a national public option with states enrolled by default, but allowing states to opt out if they so choose.
Oohh, I am starting to warm up to that.
Still not tied to Medicare rates though, I bet.
Geezer,
Bush paid for his war just fine while cutting taxes. I think we probably mean a bill that doesn’t raise the deficit.
I don’t like the opt-out option. For one, it reduces the pool of people in the P.O. and the fewer there are, the less the plans can compete with mega-insurance companies. I hope Congress will pass the Wyden amendment, which will allow people to opt out of their employer-based plans and will allow them to buy into the exchange or the public option. The bill as written right now won’t allow that. I don’t think we want the P.O. to turn into the place where the sickest people are.
I think a lot of blue states won’t do the P.O. if it costs them money.
So there’s nothing in the world worth paying for, and we’ve reached the maximum possible level of taxes? I think the standard should be, “If it does require more taxes, is it worth the cost?” If “yes”, then impliment the taxes in the fairest way possible, and if “no”, then find another way to pay for it or it’s not worth doing. (I realize this is a pretty basic progressive tenet, but I thought it was worth mentioning.)
Anon, the HuffPo article describes it as a “robust, national public option”. Although I have not seen any details, the “robust” leads me to believe it would be tied to Medicare rates, unlike the Carper plans. We’ll have to wait and see, but this would be an important point.
UI, again, no details yet, but I’m not sure that would be a problem with this idea. Since the plan would be a national one, unless the states need to kick in matching funds or something like that, I don’t see why it would casts states more to participate. I think opting out would be purely an idealogical decision, made on principles, not state funding. (Or I could be completely wrong. It happens.)
To keep in the spirit of lovely Medicare prescription drug Part D (where D stands for Donut Hole), I propose that states that opt out of the national public option be charged a penalty if down the road they wish to join, and that the premium be 1% per month for the first three years. Waddayathink?
One thing I do like about the plan is that it would push some decisions to states. Even states with really conservative governors like SC and Texas were forced by their legislators to take the stimulus money. I think state legislators are much easier to influence than Congress.
I read the dKos diary, and agree with it. 1st choice–single payer ala Medicare for all. 2nd choice–nationwide availability to public health insurance option. 3rd choice–opt-out public option. 4th choice–state-by-state POs. 5th choice–nothing (aka the Republican plan).
I think that the 3rd choice is the most that we can get through the current senate.
Not so impressed is mcjoan -today on Kos ~
The “states” option, forwarded by Carper, is gaining ground among the usual suspect ConservaDems, according to a WSJ report:
“Conceptually, having the states take responsibility makes a great deal of sense,” said Nebraska Sen. Ben Nelson, a key voice for moderate Democrats. “It is important that we really take a close look at this.” He noted that states are already in the health-insurance business because they administer Medicaid and other federal-state programs. Mr. Nelson said state health plans could compete alongside the nonprofit cooperatives. Another Democratic centrist, Sen. Kent Conrad of North Dakota, said the Carper proposal was “very constructive.”
It’s very constructive if you want to kill an effective public option, and in that sense is just as constructive as the Snowe trigger. It creates 50 different ways to deliver health care, and maintains a splintered system that cannot effectively reduce costs. In face, as Igor Volksy at the Wonk Room points out, “in the 30 states that already provide their employees with coverage through so-called mini public options or co-operative options, health care costs have not decreased. They’ve increased.”
http://www.dailykos.com/storyonly/2009/10/7/790636/-State-Based-Public-Options-Gaining-Steam
Nancy,
This new trial balloon is newer. The Carper compromise was a big subject yesterday but this looks better although still week. In this case it’s a national P.O. with a state opt-out.
Carper’s plan was 50 state P.O.s (all opt in) with regional coalitions.
Actually, mcjoan thinks that this opt-out plan that Pandora wrote about has some promise. Certainly way more promise than the very weak Carper plan.
If this option means a fairly strong Public Option included in the exchange and individual states can decide to exclude that option by whatever means is legal in that state, I think that this might be a great compromise. For all of the benefits that Pandora noted above — it effectively gets the Public Option and the opposing insurance interests having to fight with state governors. And, as McJoan notes — how many of those governors actually sent back their stimulus checks?
One thing they could do to encourage states to stay in is to tie the changes in the Medicaid funding to staying in the national P.O.
yes, mcjoan is favorable to the opt-out. I didn’t mean to imply otherwise.
The Cantwell amendment that passed seemed to lead in this direction but the Wyden amendment that was summarily and sneakily scuttled was all about state’s opting in to a public option I thought.
They are going to have to satisfy Wyden to get his vote and this may be the way to do it.
I realize I am backtracking here, but I feel a need to try to clarify the ideas being debated for the public option. Time Magazine has provided a decent review of the health care debate, which you will find right here.
The public option, as I understand it, is designed to provide coverage of basic services plus preventative care. For catastrophic care, supplemental insurance plans would be available from private insurers.
The public option seams to have two versions, weak and strong.
The weak version has fees negotiated with service providers and optional participation by providers, thus little influence in lowering premium costs.
The strong version has fees tied to medicare fees and mandated participation by providers, thus strong influence on lowering premium costs. However, obviously, providers would not favor this.
To either of these two versions, as discussed in this thread, there is the option being considered of opting out by states, or the option of state control of the public plan.
I favor a strong version, but with fees negotiated with providers on a yearly basis like the Swiss system, and with mandated participation. Providers than have a say in the fees for service provision.
To maximize the spread of risks and keep costs down, there should be no opt out option, nor should the states control the public option.
So that’s where I stand on the public option.
A major problem with public options at the state level is increased cost due to duplication of resources. To have one public option administered at the federal level produces an economy of scale, and a national uniformity of the benefits as well. And don’t forget, the feds do a pretty good job of administrating Medicare, which can be transferred readily to administrating a public option.
Therefore, I don’t think it is wise to compromise with the red states on this particular issue of the structure of the public option.
Josh is there with Paul, and me for that matter:
http://www.talkingpointsmemo.com/archives/2009/10/latest_on_the_public_option.php#more?ref=fpblg
Nate agrees that Carper is onto something:
http://www.fivethirtyeight.com/2009/10/opt-me-out-of-public-option-purism.html
Like I posted earlier – once Carper realizes what he has done, there will be some amendment to weaken it for us, and strengthen it for the insurance companies.
Not bloody likely.
http://tpmdc.talkingpointsmemo.com/2009/10/conservative-and-liberal-democrats-warm-to-public-option-compromise.php
Texas probably will opt out — because there was precisely such a plan here in Texas that was passed in the early 1990s (under Democrat Ann Richards and the Democrat-controlled-since-Reconstruction Texas Legislature), and it failed miserably.
To quote The Who — we won’t get fooled again!
All the Texas experience proves is that a state P.O. is not big enough to help bend the cost curve. I believe Texas has the highest number of uninsured in the country so opting out will be a bit eyebrow raising.
Perry,
As far as I’m concerned, it the Senate is going to pass an opt-out P.O., there’s no reason not to make it a very strong one.
The man who ran the Texas exchange wrote about the failure of that in the NYT this week. The lesson is that you can’t do this well if you let the insurance companies cherry pick the insured.
Dr. Dean thinks the opt-out plan might work.
He’d still prefer a strong public option with no opt outs or opt ins, but as a political matter he does think that this could work.
It might bear mentioning that RWR is a teacher with all the benefits that entails. Just sayin’.
In other words, cassie, you don’t believe the public option can work if a private option is allowed to exist.
Comment by pandora on 8 October 2009 at 8:04 pm:
It might bear mentioning that RWR is a teacher with all the benefits that entails. Just sayin’.
Want to see how much gets held out of my check each pay period for my health insurance, which does not measure up to the insurance offered by most of the private companies in the area?
Guess you aren’t going Galt anytime soon, eh? Seriously, am I supposed to feel for you? How about I take a page out of your book and ask why you didn’t pull yourself up by your bootstraps?
In other words, cassie, you don’t believe the public option can work if a private option is allowed to exist.
And here you go again. With another completely dickish strawman. You can’t get to what I said without just making it up. You didn’t even read the link I provided — because if you did you would have been at least embarrassed by this new bit if idiocy. Just so that you have something to argue over.
You’d think that you would have gotten the clue by now. If you don’t understand what people here are saying, you ask us for clarification. If you don’t care about what they are saying in the first place because you’d rather indulge your peak wingnut imaginings of what liberals think –then get gone.
OMG, RWR is a teacher? Well, that explains a lot about Texas.
No, I understand what you are saying — the reality is that YOU don’t understand what you are advocating.
And the only “imaginings” I have is assuming that you liberals think at all.
The other ENORMOUS benefit to the opt out provision is that it puts the responsibility on the citizens of the red states. Until now, those citizens, when it comes to health care reform, have been either complacent or outright hostile. If they want to opt out, great, let them. But if they want instead to stay opted in, they’ll have to get off their damn butts and organize to throw out the Republican idiots who would opt them out. This will give an incredible, invaluable organizing tool to the Progressive Dems who happen to live in those states, because I’ll bet your bottom dollar that when people realize that people in OTHER states have the public option, they’ll be pissed that they don’t have it. I’m a little sick of the red state citizens benefiting from programs that they haven’t fought for, and that they get courtesy of us blue staters who have the good sense to elect officials who support things like the public option. No more free rides.
Me. I want a health insurance plan that I can trust. Especially if it’s cheaper.
Hang on a second. Wouldn’t state legislatures, including Blue State ones, be even EASIER to corrupt by the Health Insurance Lobbyists? Are we really going to entrust our opt-in to the likes of Harris McDowell?
X,
I think you have to opt out, not opt in. That should be more difficult.
“Want to see how much gets held out of my check each pay period for my health insurance, which does not measure up to the insurance offered by most of the private companies in the area”
The GOP prescription for this situation is for you to leave public employ, where you are a bloodsucking leech living off the work of others (I hear this every day where I work), and to go work in the private sector you’re so fond of. I imagine there are white flight, er, “Christian” academies in your part of the south — why don’t you take a job there, Greg?