The Public Option "Opt-Out" Compromise Is Reasonable

A new compromise has been floated for the public health insurance option: it's not co-ops, it's not a trigger; it's a provision that allows defiant states to opt out of offering the program to consumers. This idea has its problems (namely the millions who will be excluded) but as far as public plan compromises go, it's the best one anyone has come up with.

Most of America should have the option of a plan it has strongly and consistently supported throughout this dramatic debate. Blue states like California and New York will undoubtedly go for it, and millions will see an immediate improvement in their lives. Red states like Utah and Wyoming will probably strike it down. Either way, allowing states to offer a public plan seems like the bare minimum that should result from this legislation.

After all, this isn't simply a government entitlement or a handout to the poor; it's a "self-sustaining, independent, self-financed entity," as Senator Robert Menendez called it, designed primarily to meet people's health care needs, rather than make a profit. Thus the argument that it'll drive up the debt is irrelevant to what's actually being discussed.

So let it happen. Let Red America whine about big government while Blue America gets quality health care people can afford. Let conservatives rant about socialism, communism, fascism and Nazism while more of them die and go bankrupt due to a lack of health insurance. Let them turn to Rush Limbaugh and Glenn Beck, who will likely blame gays, immigrants, and European socialists while more lose their jobs as businesses migrate to blue states, where they can afford health care for their employees.

Let Michael Steele, John Boehner and Mitch McConnell (or whoever the GOP leaders are in 2016) explain to their constituents why their insurance premiums have doubled while blue-staters are relatively unburdened of their health care woes after embracing Socialized Medicine.

If the GOP really believed its rhetoric about how awful and Socialistic the public plan (or nearly any other government program) is, the smart response would be to welcome the opt-out compromise, trusting that its failure over time will prove their point. But my prediction is that won't happen, because the smarter Republicans know their cynical antics are about political posturing -- just as when they defamed Medicare the same way.

That's why Republican lawmakers will still fight this compromise tooth and nail, as they would any kind of a public option for anyone, because they fear having to justify the eventual discrepancies to their base. But considering how close the Finance Committee vote on Schumer's amendment was, 13-10, this concession could pick up the crucial few flips necessary to turn the tables.

Of course, this isn't as good as offering a strong Medicare-like insurance option opposite private plans to everyone in America. But the advantage of the opt-out provision is not merely that it's more politically feasible; it would also offer a real-life juxtaposition of an America with a public option and an America without one.

The impacts of the compromised provision would offer a revelatory perspective, divulging the Republican Party's propaganda and lies, such as they've been. It would strip their ability to later vilify the public option as the source of all the nation's ensuing problems, as Exhibit B would reveal how much worse things are without the program.

Despite the far-reaching horrors of the failed health care system, Republicans (and some conservative Democrats) continue to treat the issue as a petty, point-scoring political game. Not only will the opt-out compromise expose today's conservative movement for the vacuous farce it has become, it'll serve as a critical step to helping America understand public health insurance for what it really is. The states that waver today will come around tomorrow after seeing the results, and it'll soon be a dead issue.

And years from now, during the next health care debate, some tea-bagger will barge into a town hall and yell at his Congressman to "Keep your government hands off my public option!"

Follow Sahil Kapur on Twitter: www.twitter.com/Sahil_Kapur

Comments

[zoelithos]

Dear Mr. Kapur,

While I initially cringed at the opt-out, after reading your article I have come to agree with your point that this may be the best political compromise on the table, as a “lesser of evils.”

Krugman and Wells, in “Health Care Crisis and What to Do About It” (The New York Review of Books, March 2006) argue that public health insurance saves money in two ways: by lowering administration costs, and by bargaining with suppliers for lower prices. Having the public option split among state lines will weaken both advantages of the public option, and thus the control in spending in the US may not be as spectacular as we’ve seen in Taiwan after they adopted a national health insurance. In addition, states that have an aging population, or states with a higher prevalence of ill health will have a version of the public option with higher premiums, compared to states with younger, healthier populations Inequalities in health among individuals will directly translate to a state level. This should not become the status quo.

Your argument hinges on the hope that once red states see the “error of their ways”, they will give. My concern is in the interim, when people migrate from red states to blue states, leaving America more fractured along party lines. Our consideration should be “how long will it take for the red states to give in, and what can we do to shorten it?”

Stone Cha
-St. Paul, MN

[klondiker]

I'm sorry - this is not acceptable to me.

The states that are most likely to reject it are the ones who need it most. In Mississippi, one insurance company controls 90% of the market. If any state needs the public option, it's Mississippi.

And, by the way, why do people keep forgetting that the public option IS the compromise!! Most of us wanted single-payer, but instead settled for a robust public option. You can't act like this was the starting point! This is what they do, okay: you concede and concede, and they'll still want more.

The compromise has already been made at the public option. You can't move the line any further.

[ncmom54]

Bravo! co-signed & fanned

[tgriffy]

Living in another state likely to reject it, I have to agree this proposal is not acceptable. Maybe it would eventually come around, maybe it wouldn't. That doesn't do me much good in the here and now, and I can't afford to move to a blue state.

[Woopie]

Wrong again!

Individuals should opt out not State Governments. After all it is I who pay the taxes, not the State, that supports the plan. It I who for the last 40 yeard have supported liberal policies, not the red state that I live in.

[DinkSinger]

The public option will not be tax supported. Taxes will be used to decrease the cost of insurance for those who can't afford it, but that money will go to private as well as public insurers.

[COPerez]

If there were any way to structure the opt-out law so that each state legislature must debate the option in public, then perhaps this might be a good compromise. These politicians would be forced to stand up - in front of their constituents - and debate and then vote - on the record - to allow or deny them this option.

I think you'd see some very uncomfortable conservatives all over the country and a lot of red states opting in.

But that's the ONLY way I'd be in favor of this option.

[balmora]

The fact that it'll drive up the debt is never "irrelevant".

[creo13]

He said the argument is irrelevant. It's not a fact that it will drive up the debt.

[DinkSinger]

The fact is it will reduce the debt. The Republican argument against the public option, which must cover all its own costs through premiums (and income from investing those premiums), has been that its premiums will be too low and drive private insurers out of the market. Lower premiums will mean lower subsidies from the taxpayers for families that need assistance to obtain insurance.

[Ladyrantsalot]

I think you have a point here. It may be the only way to get the public option started. I would prefer dividing things up by congressional districts (or even counties) rather than by states. There are a lot of people in, say, urban areas of the south who support health care reform and need it. But that's probably unrealistic. It would be interesting to see how this would affect politics within ostensibly Red States. After all, Red States are almost invariably "beneficiary states." They are the biggest welfare queens in America and it's hard to imagine them moving beyond conservative rhetoric to actually rejecting federal help.

[Sahil Kapur - Huffpost Blogger]

A lot of you seem angry at this idea, and at me for defending it.

Let me be clear: it would of course be ideal to give everyone the choice of a public insurance plan right away -- I mention that explicitly in the piece. It would indeed be unfair to red-staters (especially red-state progressives who have done their part) if their legislatures turn it down. But the point is that even though some states may initially opt out, they'll almost certainly embrace the provision eventually, after seeing its benefits.

I hate to sound cynical, but the only reason I bring this up is that it may be the only chance of a public option surviving in the debate at all. We still don't know if that's the case, and I hope it isn't, but it's looking more and more likely. Is this compromise better or worse than killing the whole concept in the bill?

Governors like Rick Perry drop the word secession at the prospect of stimulus money -- what will be their reaction to this? The entire GOP is dead set against it, and some of the most powerful Democrats (Baucus, Conrad) are determined to strike it down. The point here is not to make anyone suffer but to lay the foundation for the skeptics to understand -- and eventually embrace -- the choice of public health insurance. Not to mention, it's a far better compromise than co-ops or the trigger.

[BLBass]

Apparently I'm late to the party, but I think what makes me angry about this proposal is that it is inherently decentralized. This means that for all the expenditure of political capital involved in getting moderate/c­onservativ­e votes in favor of such a compromise, the plan would be so weakened as to be nearly useless. States can't be the ones to offer this opt-in/opt-out option. It must be instituted at the Federal level -- if the cost is allowing (mostly red) states to opt out of providing a service to their citizens, that must be an affirmative choice made by the state legislature to refuse the funds and the benefits, with full knowledge of the political risks such a vote would entail. This formulation would be the only one that 1) gained any chance at cost savings from being on a large scale, 2) provided any political incentive for the opt-out states to change their minds -- as you put it forward the plan would not likely be successful enough to gain converts down the line, or 3) provided sufficient political pressure for red state citizens to convince their states not to opt out in the first place. I have a feeling that if the votes are there for your formulation (I'm not at all convinced they would be), they would also be there for this one.

[balmora]

"Despite the far-reaching horrors of the failed health care system..." How can you make such a statement when polls show that 85% of Americans are happy with their current health insurance?

[JDReign]

Wrong thats 85% of INSURED Americans are happy with it

[creo13]

Ask them if they would like cheaper insurance that can't be taken away. That they can get insurance despite a pre-existing condition. I think the would be even happier, don't you?

[tybris]

I completely agree. Its time we progressives started standing up to our state governments instead of letting people like Rick Perry push their ideas like they are speaking for us. I love this idea. It will force conservatives to really decide if their ideals are practical. Right now all they are complaining about is saving the "ideal" of capitalism.

[huff-fan]

The citizens of those states that opt out would let their states get away opting out.

[OzzieTonto]

The right wing whine has always been: 'freedom of choice." Look at this stooge, preaching to take away choice in right-wing (or is it 'redneck?) states. It's a losers' cop-out!
As if the USA can't afford to provide health care for its poor. every other developed country on earth does it: what's the problem here? The money's there: Obama's just donated 14 trillion and counting to the fat cats of Wall St, but this is what passes for public policy?

[tybris]

um..yeah Bush did that.

[TommyMcCarthy]

Mr. Kapur could not possibly be more wrong here....

From the piece "This idea has it's problems (namely the millions who will be excluded)"­........we­ll ..yeah??

A public plan that excludes millions is no plan at all, ...and a public plan that allows the states to "opt out" based on POLITICAL IDEOLOGY?....well the concept would be laughable if it wasn't so obscene.Not only that, it's patently un-American.

Mr. Kapur seems to think it would be a positive to "offer a real-life juxtaposition of an America with a public option and an America without one." Sounds chillingly like Reganomics: "vote with your feet".

One need only re-word Kapurs specious argument slightly to see what is being proposed:

"So let it happen...
Blue states like N.Y. and Cal. will probably go for it ...And states like Wyoming and Utah " ( and here I insert) ...." would be allowed to condemn a portion of THEIR populations to continue to suffer and die unecessarily because of the idealogical makeup of their state legislature." Sound o.k. to you?

150 years ago about 500,000 Americans, among them Abraham Lincoln ,lost thier lives in a little dust-up that established that there was not a Redstate America, and a Bluestate America....there is only the United States of America

We're not about to go back on THAT anytime soon; not for heartless and greedy Pols on the right or wise guy pundits on the left.
tm

[Kevins]

How many do you think will be excluded?
And if they are, why?

Almost all the states are blue states.
All the states with the highest populations are blue.

Red states that decline a public option will likely see jobs drain to blue states, medical bankruptcies rise, and insurance monopolies concentrate in their states--creating crisis.

Any red state that continue in that line--self­-destructi­ve line--for any length of time, while watching blue states sigh a breath of relief, will have to be quite determined to hurt themselves.

And will undoubtedly face voter revolt.

Everyone will end up getting the public option.

[soisay]

I think this reaction is a gross overstatement, bordering on the tea-baggers. I have never heard this idea, but it has some advantages. It may offer some idea threads that can be used to a more generalized solution.

Any Red-States that would refuse to participate in a budget-neutral public option will be forcing their citizens to remain in the current private system. As ins prices or unemployment rise, their citizens will demand more S/Chp, Medicaid, and other med security net; each the responsibility of the state. Citizens priced out of insurance, but not covered with state subsidies (assuming public option indeed does drive costs down) will force political pressure on local red legislatures. Eventually, it may even become a Supreme court issue if it is not accepted for ideology. The ins companies may match their rates in Red-States (to avoid being proved liars). Or the Repubs may be right and it will be a budget buster or creeping cost. Like I said, there may be a solution in here somewhere. This is not a "death panel", please lighten up.

[TommyMcCarthy]

"Kevins" and "soisay" thank you both for your responses.....

To both:
You have missed a fundamental step in your thinking process.."voter revolts"... "citizen's demands" for this or that.... "political pressures on legislator­s"...."ins­urance companies being proved to be liars" and especially, "an eventual (I stress EVENTUAL) Supreme Court decision"......

Are abstract concepts which will fall on deaf ears to the 125 or so people (and their friends and families) who will die TODAY 10/6/09 of preventable diseases because they have no health coverage. Without belaboring the point...tomorrow is 10/7 (125 MORE Americans)...the day after that....10­/8....clea­rly I could go on...

Kevin.....just one thing: You ask: "how many would be excluded"?
I suggest to you......If it were your mother, or your child, or your SELF... That ONE person would be MORE than enough to focus your mind on the actual suffering and death of a real human being.....and we'd hear no more from you about abstract statistics or "red" and "blue" states.

"isayso" I don't know what a "teabagger" is.......no one mentioned a death panel...for the excellent reason that they don't (and never will) exist.
I suggest that if your own life or that of someone you loved hung in the balance....a suggestion that you "lighten up" would recieve the same consideration I have given yours,...which is none

There ARE no "red" or "blue" states...there is only the United States
tm

[ncmom54]

Public Option Nationwide - Single Payer option at the state level.

anything less is concession to a lower denominator. again.

[Kevins]

The other thing this would tend to do is concentrate medical monopolies in the red states--where they exclude competition from a public option.

That would tend to make the situation all the more intolerable for voters in the red states,
and probably hasten change there. Insurance company greed would likely help bring the crisis to a head--especially across the South.

But it wouldn't get to that--
Red States would take the public option. Just like they did the Federal Stimulus dollars that they said would dirty their hands. If they don't, they'll get voted out after one or two cycles no matter how much money insurance companies pay to keep their sweetheart deal--no competition--going.

[Awakenedcitizen]

This could end up to be like the governors who postured that they would not take stimulus dollars, and then did.

[Kevins]

This is basically what happened with Federal Stimulus money to the States.
Some states tried to use it as a political card: we won't take your money; we don't believe in it.

They believed in it once it got to their state legislatures for a vote.
And some of those red state congress-wipes ended up going so far as to BRAG to their constituents that they were able to secure all this government money for them--AFTER making a political stink about how it was all pork and they couldn't stand all this terrible government spending!

The red states will take the public option. They won't have a choice, their voters won't let them turn down something that will save them money--- and save their lives.

[Laws456]

This whole debate is actually quite depressing. We are stting here arguing for scraps. Most people know what REAL REFORM would look like, but since we're at the mercy of the corporate funded lawmakers, I guess we make do with what's available or not, in this case. No matter what bill passes, the Repubs won, the insurance companies won, other special interests won, and the majority of the people lose yet again. Think about it, when the reform bill passes and the public option isn't an option that all of us can choose, what's the point? Instead we'll be forced to buy into private health insurance companies that we know don't give a crap about people, as evidenced by the two latest articles posted on this site. This whole "debate" was just something to help the struggling media companies, which is why they covered the town hall mneetings so closely. The policy that comes out is crafted by industry insiders, and their purchased Congress members. All data shows that Single Payer is the best way to provide universal coverage and to keep costs down, but that wasn't even an option worth debating. Barack, your poll numbers are low because you have alienated a large chunk of your supporters by basically giving the insurance companies what they want. And it's really sad, considering that you watched your mother die fighting these same companies.

[Kevins]

If you think the Republicans won, look at their faces. Look at their clenched fists. Listen to their "NO!".

As long as they're twisting in knots to stop health care reform, and as long as insurance is spending--millions and millions--to stop this reform:

You should bet it's a good thing.

[ncmom54]

very well said! we've been sold out... They knew if they drug it out long enough the American People would be so worn down, sick & bankrupt from just trying to survive that we'd take whatever scraps their corporate allies are willing to conceed.