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.
Single-payer.
That said, I think MR. Abrams makes an excellent point and hope that this idea is considered by people such as Mr. Durbin.
Without the public option, with respect to calling this health care REFORM, there's no there there.
This way the states that want it, can have it, and pay for it, and the states that don't, won't. Of course there would need to be some guarantee that the system was paid for only from this plan (and perhaps with whatever premiums might be charged to people under the Plan), so that it would not add to the deficit.
I know that a sales tax hits the lowest income people the hardest, but free healthcare benefits them the most, so again, it sounds fair to me. Plus, we would all be able to see exactly how much of a societal cost healthcare has, by the annual adjustment of the sales tax rate.
This appeals to conservatives because it respects states' rights, independents and conservatives because it's cost-transparent and deficit-neutral, and bleeding-heart types (literally and figuratively) appreciate the free healthcare, so what's not to like?
I say install the pubic plan and let the private industry rise or fall on its own merits. Isnt that free market principals at work?
Do we have to profit off of EVERYTHING? Should we be capitalizing off of basic human needs?
Maybe there should be a few areas in life where we just do what's best for everybody... like treating the sick and educating the young... i.e. things people need in order to survive.
Save all the free market competition for luxuries.
Everything doesn't have to be left or right .We should care enough about each other to find common ground and make our country more fit for the world market. As it is we are not able to.
Thirty seven countries have a head start on us.
I really wish everyone was able to put aside partisan differences and look at the big picture. Do not blame the other party, work with them to bring about a change that will make the greatest country in the world even greater. We are all Americans and need to use our heads to make the best decisions.
Thank you for your paid endorsement.
I often ask this same question about single payer. I don't believe there is anything stopping a state from adopting (contrary to the popular progressive belief that Kucinich put in an amendment that made it legal. He only put in language that would exempt single payer from possible federal intervention under another law.)
I applaud your attempt to get progressives to try some of these things at the state level. (I agree with medicare example, except I think it would have had just the opposite affect). Let states decide for themselves. I'd even go a little further and have the federal government make sure that residents of one state could purchase the public option from another state. This would lesson the probability of states subsidizing the option, since residents may not want their tax dollars used to benefit residents of other states.
No, I would rather the crisis comes into being and we tar and feather Republicans for their utter stupidity at that time so we can get what we need then. Better that than to let them gain face and blame us for the crisis too.
Abrams argues that this would take the 'government takeover' argument away from the right, and that states that those that do approve a public option will have a competitive advantage over states that don't, thus putting pressure on those states to adopt it, or to pressure private insurers to lower their costs.
This is sort of the Gay Marriage approach. It forces not one unified political decision, but 50 state-by-state contests from now until who-knows-when. That approach might make sense for Gay marriage, as the general population is fairly divided on that issue. But nationally most Americans want a public option. And in addition to 50 political fights, what's to prevent different states from adopting or rejecting different plans? Talk about a confusing patchwork. And where is the most widespread poverty? The South. Where is the least amount of unionization that might negotiate for private insurance? The South.
Abrams says "Deference to federalism is also good 21st century progressive politics."
It seems to me that it is more divisive than progressive.
You are quite right about civil rights. But, e.g., the Voting Rights Act's triggering mechanism applies only to states in the South with a history of discrimination. Here's the analogy: both the triggering mechanism in the Voting Rights Act, and the public plan, are mechanisms to achieve a certain end. They are not the end in themselves.
A healthcare reform bill that achieves the desired end (which, IMO, ought to be improved health outcomes, at lower costs with universal coverage) is what we should be about. Allowing states different mechanisms to make that happen is good policy.