America-stan: The Progressive Movement Neuters Itself by Supporting "States' Rights" to Opt Out of the Public Option

It's starting to amaze me how far some so-called "progressives" are willing to bend over to get something called "health care reform" passed, no matter how compromised and feeble.

Here's how they've proceeded:

First, take the progressive goal for the past 70 years--universal single payer for all--off the table from day one, even as a negotiating position.

Second, put in its place a mandate that the uninsured must buy health insurance or be fined by the federal government, but combine it with the right to buy a so-called "Public Option" instead of private insurance. Present this "Public Option" to progressives as a robust alternative to single payer that would insure over 125 million Americans and have the market-power to lower health care costs. By taking single payer off the table, make this the default left-wing of the health care debate against which insurance companies and their right-wing allies can focus the brunt of their attacks.

Third, in the face of these attacks, allow the Public Option to be watered down to a point where, according to the Congressional Budget Office, in its most "robust" form (as proposed by House "progressives" and Sen. Jay Rockefeller) it will only cover 5 million to 10 million Americans, and in its less robust form (as in the current House bill and the Senate HELP Committee bill) will cover exactly Zero Americans, and, in either case, will have no material effect in lowering health insurance costs. (For more details on how we arrived at this "Public Option in Name Only," see the Postcript at the end of this article.)

Finally, some "progressives" are supporting a proposal that any state that wants to may opt out of this "Public Option in Name Only," thus denying its citizens the modest benefits that Public Option supporters argue it will serve. "Progressives" like Howard Dean and former Move On leader Tom Matzzie are supporting this approach.

This last idea is the most pathetic of all, caving into conservative "states rights" framing of social and economic issues, taking us back to the pre-New Deal era when corporate interests tried to block federal regulation of the economy and the establishment of a social safety net by claiming it violated the Constitution; or the 1950s and '60s when Southern states claimed the right to ignore Federal civil rights laws.

The states and the federal government each have their rightful place. But this is not America-stan, ruled by a collection of local war lords, like Texas Gov. Rick Perry who hints at secession, or Mark Sanford who tries to turn down Federal stimulus money when he's not busy "hiking the Appalachian Trail." In a modern society, certain economic regulations, social safety net provisions, and basic civil rights protections must be national in scope to be effective.

If progressives accept the idea that states can opt out of the Public Option, Republicans will soon be proposing that states can opt out of Medicare, Social Security, the minimum wage, and civil rights laws. This is really bad precedent.

How low can "progressives" sink? Progressives have to stop being so desperate that they will accept almost anything, no matter how bad, even Republican "states rights" framing of issues, to pass something called "health care reform".

Otherwise, not only will we get a really bad health reform bill. We'll lose the argument to fight for other progressive reforms.

POSTSCRIPT: HOW THE "PUBLIC OPTION" BECAME THE "PUBLIC OPTION IN NAME ONLY":
...with a debt of gratitude to Dr. Kip Sullivan, a long-time fighter of universal health care, whose article "Bait and Switch: How the Public Option Was Sold" is a must-read for anyone who wants to understand how the "Public Option" became the "Public Option in Name Only."

The "Public Option" was initially proposed by Yale political scientist Jacob Hacker and Campaign for America's Future leader Roger Hickey as a more politically "pragmatic" alternative to the long-time progressive goal of establishing universal single payer health care (as though insurance companies and their paid-for Congressional allies wouldn't fight against a robust Public Option as hard as they would fight against Medicare for All).

Hacker and Hickey laid out 5 criteria that they argued were essential to the success of the Public Option.

1. The PO had to be pre-populated with tens of millions of people by shifting all or most uninsured people, as well as Medicaid and SCHIP enrollees, into the PO, so like Medicare it would represent a huge pool of enrollees on day one.

2. Only enrollees in the PO, not in private insurance, would be eligible for government subsidies.

3. The PO and its subsidies would be available to all nonelderly Americans (not just the uninsured and employees of small businesses).

4. The PO would pay Medicare reimbursement rates.

5. The insurance industry had to offer the same minimum level of benefits that the PO offered.

If these criteria were met, the Lewin Group (a subsidiary of health insurance giant United Health) projected that the Public Option would enroll 129 million Americans, have overhead of 3%, pay hospitals 26% less and doctors 17% less than the private insurance industry, and have premiums 23% below the private insurance industry average.

That was the "bait." Then came the "switch." (I'm not saying that the initial supporters of the Public Option intended to pull a bait and switch. They honestly believed they were following the best strategy. I'm saying the effect of their strategy was a bait and switch, and now they're not owning up to it.)

The so-called "robust" Public Options that are still under consideration in Congress (i.e. the Senate HELP Committee bill and the tri-committee House Bill) only meet the last of the 5 criteria for an effective and robust Public Option and reject the first four criteria. The puny Public Option proposals that are still on the table are not pre-populated; subsidies go to both the Public Option and private insurance; large employers are barred from buying into the Public Option; and the Public Option is not allowed to use Medicare rates but must instead negotiate rates on a provider-by-provider basis. (Sen. Rockefeller's Amendment, which was voted down in the Senate Finance Committee, and the proposals by the House Progressive Caucus which are not in the bill reported out of the House Committee, propose that the Public Option could pay Medicare rates plus 5% for the first 2 years of its existence).

As a result, contrary to the Lewin Group's projections for the original "robust" Public Option proposals, the Congressional Budget Office projects that the Medicare plus 5% version of the Public Option would enroll less than 5% of the non-elderly population, while the version that doesn't use Medicare rates at all would enroll exactly 0 members, and in either case, would have a negligible effect on insurance premiums.

This isn't a "robust" Public Option. It's a puny and neutered Public Option. It's a Public Option in Name Only.

Leaders of the Public Option movement are failing to level with their constituents, who are still hoping for a robust Public Option. There is no "robust" Public Option left on the table. If they want to argue that this small public option is better than nothing, that's fine. But it's intellectually dishonest to continue to claim that it's "robust"

Now some of these "leaders" want to take this puny Public Option in Name Only and reinforce the conservative "states rights" framing of issues by allowing states to opt out, just so they can claim a victory for the Public Option. This is truly sad.

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POSTSCRIPT 2: A CHALLENGE TO ROGER HICKEY, RICHARD KIRSCH OR TOM MATTZIE FOR A FRIENDLY DEBATE ON WHETHER A "ROBUST" PUBLIC OPTION IS STILL POSSIBLE: I'd like to challenge my progressive colleagues who proposed taking single payer off the table and substituting a a "robust" public option (and who also write for Huffpo) to explain in Huffpo how there's any possibility left for a "robust" public option to be passed, and how any of the "public option" proposals still barely alive in Congress meet the criteria they themselves set out several years ago for what would constitute a robust and and effective public option. Better yet, let's go on "Countdown" or "The Rachel Maddow Show" and debate this.

 

Comments

[profproof]

you're right about one thing...pr­ogressives neuter themselves.

[Palito]

let's see. The current cycle is going fast but it is clear where it is headed.

* Reid says they are not "bound by any deadline" and theyre going to take it slowly...
* the MSM announcing the return of the gop and that it;s over for the democrats.­..
* deranged gop officials set up a circus in DC to "kill the bill" with wide media coverage.
* multiple reports of conservative dems "afraid" that health care will end their political careers.
* the House vote is postponed because they don't have the votes...
* reports of the President making personal appeals to save the bill.
* reports of progressives capitulating and giving up ground.
* nationwide flood of tv and radio ads agains health care reform, funded by the chamber of commerce and its multiple astroturf groups, blaming unemployment on HCR.

They are close to derailing this whole thing... I think HC reform in overall is on life support at this point.

[RZoroaster]

Oh please. Progressives haven't "neutered the movement" Its just that most members of the democratic party aren't nearly as progressive as you are. You're no different than Rush or the Tea Partiers mocking the RINOs. Most democrats do not want a single-payer system. Thus they didn't introduce a single-payer system. This was an appropriate decision.

Its also a practical one. A single payer system would have zero chance of passing in the legislature. I say this as a former organizer for Physicians for a National Healthcare Program, the premiere SP promotion group in the US. They like to advertise how many co-sponsors they have on HR676, but when I spoke with those legislators, each one I spoke with told me that they were only supporting it because they knew it couldn't pass and they were just showing their support for the concept of universal healthcare. I don't know if there is anyone in the House besides Conyers who actually things single payer is the best option for the country.

And I don't know where you got your public option figures but they're far different from anything I've read anywhere else. And I think you misunderstand the purpose of the public plan. It doesn't need to insure a third of the country to be a success, it only needs to remain an option to set a ceiling on private insurance prices. I seriously question your understanding of the economics of this issue.

[Palito]

the Public Option ( if it survives) won't be able to put a ceiling on private insurance prices because it is designed by the lobbyists to be a small pool for poor unemployed people or high risk people. It is not designed to compete or lower costs. In fact, it is highly likely that the public plan will be dismantled because it will be the dumping ground for poor sick people and it will go bankrupt.. it will be used for generations to come as an example of how govt run health care doesnt work.

The absurd employer based system will continue to be the only way to get health insurance for the vast majority of people. democrats keep saying " if you like your insurance, you can keep it" but they never say that, if you do not like your insurance, you have to stick with it because your options will continue to be limited

in anycase, Rome wasn't built in a day, this new system will blow up again due to skyrocketing costs in 10 years and we;ll be back to "reform".

[Dale Larson]

It's time to end our "risky experiment" of "For-profit health insurance". It's a proven failure.

HR676 http://hr676.orgg) Single Payer system that is proven, pro-business and pro-people:

* Slashes at least 30% of costs off the top by removing private insurance overhead.
* Companies take health care expenses off their books. Stock value increases. Better able to compete internationally.
* Small companies could have access to higher skilled workers because previously they couldn't compete in the labor market by offering similar benefits.
* More entrepreneurial ventures will launch since they have more money and less unrelated risk.
* Dramatic drop in bankruptcies.
* Dramatic drop in lawsuits. Most of these lawsuits are simply to obtain money to cover health care if something interrupts their coverage.
* Reduced system complexity. Greater efficiency due to fewer regulations.
* Savings from employees not having to fight with their insurers during work hours.
* HSA and MSA dollars redirected back into the economy for goods and services.
* Additional money to spend from not having to carry "uninsured motorist coverage" on your auto policy.
* Contract employment is more viable for workers since they are guaranteed access to health care.
* People are covered when unemployed. No chance of being wiped out financially if you lose your job.
* Health care providers (doctors, hospitals, therapists­...) see increase in business with much less administrative expense.

[MarsAmbassador]

Change in name only. What a ripoff.

Weiner/Grayson 2012!

[Fight4Freedom2008]

Thank you Mr. Mogulescu, it's nice to see a true thinker... that takes the time to contemplate the ramifications and validity of such a rash proposal. I entertained similar theories myself at crooks and Liars. It seem logic often takes a back seat to emotion and there in lies the error of our ways. From a mindset that has a distaste for "E pluribus unum" the chance to opt-out is a dream come true. Since there is other social discrepancies, what will the next opt-out issue be?

[Nonamnesiac]

Progressives have neutered the Movement by not insisting on immediate, safe withdrawal of all US troops and contractors from Iraq and Afghanistan. Its double-talk on immediate withdrawal has given Obama a wink-and-nod to escalate and continue spending depression-causing, depression­­-sustaini­n­g resources including, most tragically human resources, on a minor threat to U.S. interests at worst. The Taliban has experienced "shock and awe" and would not permit al Qaeda to plan attacks on the United States even if they drive out the corrupt drug pusherocracy we support there after we leave.

Additionally, the progressive movement's neutered state with respect to Afghainstan is at the core of its willingness to cave in on single-payer, universal, free, quality health care for all Americans -- something the electorate is open to. Obama talks loudly about not permitting health care reform to contribute anything to the deficit, meaning a fig leaf of a public option at best if he's not going to demand that Bush's tax cuts are ended immediately. His other option to control the deficit and provide first class health care is ending US involvement in Afghanistan and Iraq, including ending funding to contractors and using that money for deficit reduction, infrastructure improvement, health care and fixing what we broke.

[uncleT]

I don't think the author understands the point of allowing states to opt out. By going this route, the Democrats are setting a huge trap for elected state-level Republicans. Would a GOP legislature actually vote to opt out? If the stimulus fight is any indication, this group will fight for their share of federal dollars. And what about the GOP governors? Would they risk alienating their voters and stick to their conservative principles? Only the ones running for President.

The end result of the "opt out" bill will look exactly as the end result of a bill with no opt out. The only difference is that the former will make conservative Dems feel better about voting for it.

[upriser]

Based on many of the bloggers comments from conservative states, I don't think we can assume that state legislatures won't be pressured from big-time lobbyists from the health insurance industry to keep the public option out of their states. Also, by adopting an "opt-out" policy, we are basically selling-out the people in those states who really need a public option. I'm not willing to do this. Not only that, but it will alienate these people from the Democratic Party because it would send them the message that we don't really care about people in "red states". That's not a winning strategy. What kind of precedent does this set for future legislation?? Terrible idea.

[ZTB]

what is the sense to a public option is states can opt out? this is the worst idea i have heard.
in my state, florida, we might have alan grayson fighting for the people, but between nelson, who sits on the fence...an­d crist.....­eeeeesh...­clearly sitting on the opposing side......­what would the chances be in my state?
this opt out thing is just pure bs

[motodude]

Democrats cannot pass a health reform bill without a strong public option unless they want to lose their core support. After today's threat "report" from AHIP there can be no misunderstanding insurance cares nothing about their customers. Entrusting an entity which only wants your money with your life and death decisions is asking for trouble.
Today the health insurance companies showed their true colors proving health reform without a public option will not work. Pass health reform with the public option and the strongest possible insurance regulation.

[FirstShirt]

What is truly weird is that while on one hand democrats want this public option on the other hand they do not want to reduce or eliminate malpractice suits. Who will pay for the doctors malpractice insurance?

[socalgal38]

The needle is stuck on your record player, try changing it.

[chaya]

I think you're missing a basic point. Most Americans support a public option. A big majority wants to be able to afford health insurance. GOP politicians risk alienating their own voters by standing against real health reform. They know they can pretend to do so, though, because they know in the end they'll get to offer their voters great health care reform, even the public option--and no one will remember anything. (We saw the exact same thing with Obama's stimulus funding). That way they can have their cake (campaign contributions) and eat it too (re-election). If Democrats give red states the ability to opt out, their GOP politicians are going to get stuck between a rock and a hard place. If they opt out, they risk voter wrath. If they opt in, there will be infighting--and infighting is what brings down all movements in the end.

I think it's a pretty smart move.

[socalgal38]

i guess you didn't read the article. The public option is in name only.

With the insurance complany influence what makes you think your state won't opt out?

[iplaw]

The author is sounding like a member of the GOP in being self contradictory. If the "Public Option" is worthless as she claims then how does allowing states to opt out have any bearing on anything?

[thnk4selfagain]

Shame on Howard Dean. Does he want to be in the company of the Senator from Wall Street and now the big healthcare­/insurance­, Charles Schumer?

That this opt-in for public option is not progressive, agreed. But as further explained here, the debate and framing of healthcare reform has been so neutered, aided and abetted by so called progressives, that the American people are supposed to be grateful for the valiant fight by Dems for *exactly nothing.* Washington has made a joke of our democracy

[nogdon]

It is never an injustice to allow the states to choose how they want to do anything! It is is not and was never to be the FEDS that control the people of this nation. This Federal Government has become way to over-reaching in power as it is. Give the power back to the local and state governments.

[upriser]

Fine, but you are being too lenient. We need to ABOLISH THE UNITED STATES OF AMERICA and just have a loose confederation of states, who can join with other states and form their own countries. I'm sick of those states' righters half-way measures. Go full hog. We can divide up the nuclear weapons with some kind of formula. Either that or abolish the United States Senate and have a unicameral national legislature and abolish states' rights completely.

[jimmyjones22]

ABOLISH THE STATES.

Problem solved for everybody except for the postal system.

[Rog49Thomas]

The sad fact is that unlike most civilized countries, the political bandwidth in the USA is narrow and skewed to the right.

That is why the range of serious policy alternatives is so poor.

[upriser]

I couldn't agree with you more. It will destroy this country in the end.