The public health care plan is the major lightening rod of the health care reform "debate" (which, thus far, has not been about health care or reform!). It provides the radical right "evidence" to engineer fear of "socialism" and "a government takeover" that make seemingly rational people scream for the government to "stay out of Medicare (!)." It allows irrational people, e.g., Sarah, with apparent backing from Newtie, to proclaim that the government is setting up "death panels." [Whereas tobacco companies, whose business is, literally, selling death -- needing to recruit 15,000 children per month to become nicotine addicts -- seem not to be objects of Sarah-Newtie's outrage].
By making the public plan optional for each state, the hot air is let out of the disinformation balloon. "The public plan is socialism." Okay, if that's what people in your state believe, disallow it in your state. The wingnuts could even declare victory. Who cares?
If Alaska believes their quitter's twitters that the public plan establishes "death panels", then they can refuse to allow that plan to be offered in that state as one of the competing health plans. If Kentucky believes that its people "win" on health care by defeating a public plan, then let them defeat it, for Kentucky.
My state (Washington) would certainly adopt it. If Montana (our neighbor and home of Max Baucus) does not want it, then several years later we can see what the health care is like in Montana compared to Washington. And, if it is better in Montana without the public plan, why should the rest of us get exercised about it?
Consider this: suppose Medicare had been, similarly, optional. In states that did not adopt it, insurance premiums would have to skyrocket to account for the very high costs of seniors' medical care. Business would have suffered a competitive disadvantage, and many families would have to go into massive debt to pay for Granny's care -- something Granny would have felt terrible about. Who would want to live in that state, and how long before the political forces in the state decided, however reluctantly, to adopt Medicare?
Adoption of the public plan, if optional, will become a major campaign issue in most states. I suspect that it will be nearly universally adopted -- or the private insurers, in an effort to prove it is unnecessary, will keep their premiums from rising at such drastic rates.
I will go a step further. This was first suggested ("An Offer on a 'Public Option' Republicans Can't Refuse: Let States Determine Whether to Adopt It", June 25, 2009) purely as a political strategy. But, making the public plan optional is not only better political strategy, it is better public policy in our federal system. Federal authority really should be exercised only when necessary, and the burden of proof ought to be on those who assert its necessity. Those states not wishing to partake of the public plan ought not to be provided any additional benefits as compensation, but ought not be treated as pariahs.
The optional public plan can pass. There will no longer be any excuse for a member of the Democratic caucus to vote against cloture (and, if they do, they should be stripped of their seniority). We now know that Senator Byrd can make it to the Senate to cast a vote. That provides 59 votes for cloture. If Senator Kennedy cannot make it for the cloture vote, making the public plan optional ought to attract the Maine Senators to vote to allow a vote on health care reform.
Deference to federalism is also good 21st century progressive politics. One does not have to subscribe to the Republicans' nonsense of government-as-ogre to prefer individual control over one's life choices. Progressives who assume that millennials, who shun the rightwing because of their lies and divisiveness, are naturally attuned to federal power do so at their electoral peril. Today's progressivism is not yesterday's.
Progressives make a fundamental error, therefore, when they do not take advantage of opportunities to create policies that do not require the assertion of federal authority. On energy and the environment, for example, no such opportunity exists -- indeed, even federal authority is inadequate, world action is required.
Health care reform, however, is different. It provides an opportunity for accomplishing the goals of reform, while enjoying the benefits of federalism. And, in so doing, enabling the reform to be enacted in the first place.
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