Liberal Values Defending Liberty and Enlightened Thought

The public option has probably received more attention than any other aspect of health care reform even though it will only affect a minority of people who are eligible to select it. Harry Reid announced today the Senate bill will include a public option with an opt-out provision for states.

The public option would be a government-run health insurance plan similar to the Medicare program except that it would be paid out of premiums from those who choose the plan. Different proposals under consideration would either have the public option pay health care providers at five percent above the Medicare fee schedule or would have the public plan negotiate payment as other insurance companies do. Those receiving insurance coverage from their employers would not be eligible to choose the plan. The opt-out provision would allow individual states to choose not to have the public option offered in their state. They would have until 2014 to exercise this option.

Considering the politics of the situation this probably makes the most sense. Reid does not currently have the votes for including a public option. A public option with trigger, as Olympia Snowe as well as some conservative Democrats want, would not be satisfactory. Including the opt-out option might make conservative Democrats who oppose the public option more willing to vote for it, or least refrain from joining a filibuster. The majority of voters support a public option (even if many do not understand it), but if Senators from conservative states fear opposition from their constituents they would have a better shot of not antagonizing opponents if they can offer the ability to opt out. If worse comes to worse and there are still not enough votes for the public option, putting this out for a vote will result in those voting against the public option, as opposed to Harry Reid, feeling the wrath from he left.

If the public option passes with an opt-out option it is far more likely that most states will actually have the public option compared to the more conservative alternative of a public option which only comes into existence if certain triggers are met. If the default situation is to have the public option, most states will go along as opposed to taking action to block it.

The need to actively opt out of the public option creates an interesting political situation. The red states, where politicians might be most vocal against a public option, tend to have the highest percentages of uninsured. Uninsured voters in the red states might not go along with being denied this choice, especially if they see it being offered in other states.

Starting out with the public option in place and requiring action to opt out could also lessen opposition from those who now oppose it based upon misconceptions as to what the public option really means. They will have less reason to protest the public option once they see that this is just one more choice and not a step towards socialized medicine. Finding that they can avoid the public option simply by signing up for a different plan if they choose, right wingers might be less concerned about this and could go back to questioning Barack Obama’s citizenship or exposing fluoridation of water as a Communist plot.