‘Opt Out’ Public Option Gaining Momentum

Posted on 10/08/2009 at 11:16 am by Bob Cesca

Josh Marshall:

…just on the face of it, this sounds like a compromise reformers could embrace because I suspect many, probably most states would opt in, providing a plenty large enough pool to get to the bargaining power that is essential to make a public option work.

Part of my assumption here is that you’d have relatively few states opting out and they’d tend toward lower population states, likely clustered in the South and mountain states. So I suspect that a substantial majority of the population would be in opt-in states, providing the bargaining power that would make the public option threshold viable. And if the public option works, one would think the people in opt-out states would quickly become pretty envious of the folks in states who had the option.

Think of it this way. A robust national public plan with nitwits like Rick Perry refusing to participate in the plan (even though Texas really could benefit from it). Put another way: they could, in a figurative sense, invoke the 10th Amendment. This, of course, wouldn’t be very popular and I suspect that anyone who opts out won’t be in office very long once voters get a whiff of how much money voters in other states are saving.

My question remains: will this public plan be available to everyone, or just the uninsured, small businesses and the self-employed?

Oh, and by the way, before we go any further, can we shit-can the “Opt-out Public Option” name? “Public option” is ambiguous enough — now we’re looking at the added awkwardness of the term “opt-out.”

Give us Freedomcare!

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  • Jan

    It’s simple.States with rethug governors- no po EVER as they continue to take $ from BCBS et al. If they also have a rethug legislature for get it.States with a dem governor MAYBE something would get done UNLESS they have a rethug legislature.And what would a trigger be? Who’s gonna decide that the ins. companies are still screwing people? Who the hell will monitor this fiasco?This is obviously gaining momentum because it gets the monkey off Congress’s back and throws it to the states.THIS. SUCKS.

  • Eric

    I can see a worst-case scenario, like the one Jan posited above, coming to be, but I think the chances for it seem pretty slim.All of this, no matter what the final form, isn’t going into effect into 2013, right? Has that changed at all?Say legislation passed with this opt-out provision, and it still has an individual mandate. From the polling I’m aware of, the public option has overwhelming support just about everywhere.What governor/state legislature, no matter what political affiliation, is going to make noises, prior to 2013, about opting out? Wouldn’t they be committing political suicide? And I’m pretty sure their constituents will be pressuring them for a position on the matter in the time between now and then.

  • J

    @Eric, Jan: I can see it going badly to. But for one thing, if states can and do opt out, then quite frankly those places are no worse off than they would be without reform, so if it comes down to it, this would be the better option. Second, I really really doubt that any state would actually opt out. I mentioned it earlier, but how many states actually refused stimulus funds–no matter how their leadership blustered? I think the only one who stuck to his guns was Sanford and it clearly cost him even before the scandal broke.The opt-out sounds to me to be more of political cover (Look! We like states’ rights!) than something that anyone would take you up on. I’m much more curious as to how permananent opting in or out would be.

  • http://www.beinggomez.blogspot.com BeingGomez

    Oooooh. If Rick Perry denies Texas FreedomCare and decides to Opt Out….he’s gonna find many a disgruntled Texan Opt In his arse!The demographic in TX is shifting and the Perry is not as popular as he once was. I think the more he continues with his all and out LOON crusade, the more evident that becomes. He’s slowly and quietly losing supporters. He will have to be voted out though before TX Opts in. GO FREEDOMCARE!

  • roxsteady

    I posted this exact same thing yesterd Bob and you’re right. I think other states that don’t get it will kick out their congressmen and senators if they don’t opt in. However, I still would prefer to call it the PIP, Public Insurance Plan!

  • Jan

    Rest assured, rethug governors would rather screw their citizens than take anything from the guvmint.What worries me is who is going to monitor this? Governors and legislators taking money from the insurance companies? And do we think that Anthem or WellPoint is going to be brought to their knees and start offering a good product all of a sudden? No. They’ll just keep paying off the politicians to not have a po.it’s still 2013-2015. About 200,000 will die while waiting for??……….

  • Jan

    I did see that 1000 state legislators are going to DC tomorrow to call for reform.So that is promising.

  • Irish Girl

    I think this state opt out thing would work for most states but not in mine–AZ is a wasteland of commen sense. I’d bet good money my state will opt out…

  • Irish Girl

    oops, common, I meant

  • Eric

    What worries me is who is going to monitor this? Governors and legislators taking money from the insurance companies?

    It had better not be set up that way, and I’d be surprised if it was. I’ve heard this described elsewhere as, still, a federally administered program, even if individual states have the ability to opt out. That would be essential to gain the economies-of-scale/bargaining power.

  • Raphael Kearns

    Commented on this on yesterday’s thread. As one who lives in Texas, I think this is a BAD idea. If you look across the South and Southwest there are majorities of poor white voters who have voted against their own interests since the 1970′s.What is going to turn this demographic around? I have no idea. It is something that I have spent hours pondering. Where did the real Tea Baggers come from? My guess is that the majority were white voters from the South. They are not going to vote against the Republicans when the “threat” of Socialism/Nazism/Communism that we on the left are trying to “jam” down their throats.Take a look today at the comments on this article from today’s Dallas Morning News:http://www.dallasnews.com/sharedcontent/dws/dn/latestnews/stories/100809dnbustexashealth.3dd0fce.htmlThat is if you can read them without wanting to gouge your eyes out.

  • eve

    I am so upset about the opt-out thing. I feel like the Democrats in DC have slapped me in the face.

  • eve

    It is not the least bit reassuring to be told that the opt-out won’t be used. It would be used in some states like Texas where the insurance companies give the legislators so much money.This is very different from the stimulus package. They took the stimulus package because it gave them money. The same states will opt-out because it will mean a lot of money to legislators personally to do so.

  • cjo30080

    I’m extremely disappointed that Cesca isn’t outraged about this.If an opt-out passes and is signed, it would be blue state Dems telling red state Dems, who helped elect Obama and majorities in the Congress, to fuck off. It would be the death of the 50 state strategy. It would be bait and switch of the highest order. Dems ran on a platform of quality, affordable health care for ALL, not just people living in blue states.As one who lives in the south, those who rationalize this proposal as being a good compromise by telling themselves that states wouldn’t dare opt out for this reason or that doesn’t know the south. We don’t have budget disputes down here. When revenues fall, we just slash spending on “government” schools.Those claiming that this wouldn’t leave people in the south any worse off even if they do opt-out should remember that states couldn’t opt out of the mandates. People would be forced to by insurance from the crooks without cost controls. Either way, monopoly and oligopoly insurers would continue their practice of gouging insureds.Affordable, quality health care is a moral issue of life and death on par with civil rights. The opt-out proposal is akin to an Emancipation Proclamation with an opt-out, woman’s suffrage legislation with an opt-out, civil rights with an opt-out, or Medicare with an opt-out.This opt-out proposal is trash on so many levels, and I’m pissed at any so-called progressives who believe otherwise.

  • Jan

    I live in VA.Need I say more?This is just another compromise by the dumbocrats.I’m sick of this shit.

  • Eric

    cjo30080 makes some very good points.

  • J

    cjo30080: “Affordable, quality health care is a moral issue of life and death on par with civil rights. The opt-out proposal is akin to an Emancipation Proclamation with an opt-out, woman’s suffrage legislation with an opt-out, civil rights with an opt-out, or Medicare with an opt-out.”Every single one of those things came with an opt-out–real or implicit–when they first passed. Every one.

  • jjasonham

    Look at the big picture people. This “compromise” will probably be used as political cover and a way to get even more into the bill than would otherwise be in it (earlier kick in times for instance). More than likely there would also be a required amount of time to be in before you could opt out. If you have not read the TIME article discussing the behavioralists that Obama has on his team, I HIGHLY recommend it. It is very well known in behavioral science that it is much more difficult to get individuals and groups to opt-out of a benefit, than to opt-in. In fact, in that article I believe it specifically mentions those research conclusions. Since the devil is in the details, things that would be critical in this process would be it’s permanency.As an added bonus, it is highly likely that most of this “opt-out” debate amongst state legislators will be happening around re-election period. If this isn’t a one-issue vote heavily in favor of the democrats, I don’t know what is. Expect GOP civil war.

  • jjasonham

    This is a quote from the April ’09 Time article I alluded to in my previous comment:

    But the latest science suggests that yes, we can. Studies of all kinds of human frailties are revealing how to help people change — not only through mandates or financial incentives but also via subtler nudges that preserve our freedom to make choices while encouraging us to make better ones, from automatic-enrollment 401(k) plans that require us to opt out if we don’t want to save for retirement to smart meters that warn us about how much energy we’re using. These nudges can trigger huge changes; in a 2001 study, only 36% of women joined a 401(k) plan when they had to sign up for it, but when they had to opt out, 86% participated.It’s no coincidence that Obama’s budget proposes an ambitious program of automatic-enrollment pensions for workplaces that don’t offer 401(k)s or that his stimulus package has billions of dollars for smart meters. Behavioral science — especially the burgeoning field of behavioral economics that has been popularized by Freakonomics, The Wisdom of Crowds, Predictably Irrational, Nudge and Animal Spirits, which is the new must-read in Obamaworld — is already shaping dozens of Administration policies. “It really applies to all the big areas where we need change,” says Obama budget director Peter Orszag.

    It seems crazy, but this could work on a very large scale. I can readily think about the intended benefits. It’s much more interesting to think about the unintended benefits vs. the unintended negatives.

  • jjasonham

    Also, I’m not saying this is the absolute ideal! It’s just an option that we shouldn’t close off…whether we want to fully acknowledge it or not, we have some spineless Senators. We should continue to keep tabs on them in preparation for their next elections.

  • cjo30080

    First of all, j @2:16 is out of his mind.Expect GOP civil war? No. This opt-out proposal is the GOP’s wet dream. Expect a Democratic civil war.I had no hope of electing a Democratic governor, state legislature or U.S. Senators. I gave as much as I could to Obama’s campaign and Act Blue to elect Dems in other parts of the country. I made phone calls and wrote letters to help raise money for a Democratic administration and a Democratic majority in Congress. To this day, my credit card is automatically charged monthly by Organizing for America, specifically allocated to funds used to drum up support of a strong public option. And this opt-out proposal is a slap in my face.I live in Cobb County, Georgia, infamous for a Jewish man who was lynched for a crime he didn’t commit, and more recently, proclamations against homosexuals by the County Commission (sacrificing Olympic softball for the cause in ’96), electing Newt Gingrich to the U.S. House, spending hundreds of thousands defending its right to put stickers on textbooks insisting that evolution isn’t scientific fact, and selling Obama/Curious Georgia t-shirts. Cobb County is progressive compared to the rest of the state.I don’t give a rat’s ass what behavioral scientists say about 401(k)s, Georgia and the rest of the south WILL opt-out of the public option, and the Democratic party will wounded for a long time to come because of what it did to people like me and the people I care about.

  • Raphael Kearns

    cjo30080 @ 3:17 said:

    I don’t give a rat’s ass what behavioral scientists say about 401(k)s, Georgia and the rest of the south WILL opt-out of the public option, and the Democratic party will wounded for a long time to come because of what it did to people like me and the people I care about.

    I am with you. I grew up in Alabama and still have many friends and relatives who are still there and they are the GOP’s “wet dream” voters who continue to support these doofuses. Unfortunately, I now live in Texas and see the lunacy that goes on here day after day. I have seen commenters on other blogs that “believe” we will soon have a Democrat Governor, Legislature and Senator here.That is a pipe dream. Please look at the comments to the DMN article I linked in an earlier post. This state is overrun with loons.

  • jjasonham

    @cjNo insight or foresight. If you don’t give a rat’s ass about what behavioral scientists think about human behavior and how to influence it, then you’re ignoring a critical component of politics. You also must have missed all the polls that show a plurality (if not majority) of Republicans favor a public option. You REALLY think that southern legislators can opt out and not be held accountable by ALL of their constituents? How many of those same states DID NOT receive stimulus funds? How quickly were the ideologues in the state legislators silenced when they wanted to refuse the funds that their citizens needed? Why should this extremely important situation be any different? Think about it.

  • jjasonham

    I pretty much hold the same view on this issue as Dr. Dean. It’s on Huffpost. I view Health Care Reform as a civil rights and moral issue, which should never be compromised. But reality says that we have to deal with the Senate the best way we can until we get more progressive voices there (which will happen).

  • eve

    Ralph, we will go back blue in Texas but it won’t be anytime soon. The demographic changes are there and will continue. But that doesn’t help right now while we are one of the dumbest, crazy red states.

  • Raphael Kearns

    Eve:You’ve got that right. I comment often on articles on the DMN webpage and have been censured a couple of times but I pretty much stay off there because it hurts me to read some of the wingnut comments.I am not too hopeful for my congressional district, which is represented by Dr. Michael Burgess. Formerly Dick Armey’s district. I wish the Dem’s could find someone with a pulse to run against him but don’t see much hope there.