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.
The opt-out provision really bothers me. Maybe it’s because I fall into the rather narrow category of people who would be eligible, live in a red state with the strong potential to opt-out, and am being selfish.
I understand the pragmatic arguments for the opt-out clause, but I don’t have the kind of faith that the state governments won’t willfully screw their people or that voters will necessarily understand how their states are screwing them. Mark Sanford didn’t take any hits in the polls for refusing stimulus money, he went down the tubes for the sex scandal.
It’s not that I ‘trust’ the federal government, necessarily, but the federal government can make sure the law is applied properly everywhere. Leaving this kind of leeway to state governments almost guarantees that some people will be denied the full benefits of reform.
It would be better not to have the opt-out provision, but if they can’t pass the public option without compromise, this is far better than the other compromises suggested (such as only a trigger for the public option or co-ops).
Considering that a few weeks ago the public option appeared dead, we are doing well to be at this point.
Well, they have not tried to pass a public option without a compromise yet. Nor am I certain they have totally explored the possibility of doing so, though that could just be my cynicism. The full resources of the Democratic Senate leadership have not been committed to any legislation at this point in the history of this Congress… with the possible exception of the farm subsidies bill it later came out contained errors that needed to be corrected.
I honestly believe that Harry Reid’s primary goal in compromise is compromise itself and not passage of reform. I can understand that and I can even respect the idea of ‘consensus governance’ in theory, but we’re not going to have consensus on issues in the current political climate and I am frustrated at the continued search for it at the expense of good governance.
Reid is said to have a pretty good eye for assessing what can get the necessary votes in the Senate and what can’t. Yes, the opt-out gives red-state governments the choice of keeping their populations as a captive market for the insurance companies; and yes, a public option with no opt-out would have been better than a public otion with one; but a public option with an opt-out is better than no public option at all, and given Obama’s refusal to give real leadership on the issue, it may be the best we can get. My guess is we’ll face a hell of a fight to get even that much.
If Reid’s plan succeeds, over time people in the red states will see the public option working and realize that the scare stories haven’t come true, and they’ll be able to pressure their own state governments to rescind the opt-out. It’s conceivable that the opt-out might even be found unconstitutional on the grounds that it denies some citizens a right that others have.
Yes, people will continue to die unnecessarily in opt-out states during the years while we’re waiting for some such resolution to happen. But if we can’t get some kind of real reform, even more people will continue to die unnecessarily in all fifty states for even longer.
We could probably have done better on this if we had a more committed and less bipartisanship-besotted President, but the Democratic party last year chose not to nominate one, and we are now stuck with the result. Under the circumstances, Reid’s plan is probably the best we can get.
Reid is also said to be a timid moderate who believes the Senate leadership’s job is to restrain the liberal zeal of the Democrats in the House. I’m not saying that the praise for his discernment is not warranted, but the evidence does suggest that the statement about his belief in the need for the Senate to damp down the enthusiasm of the House is a likely one. Where does discernment end and moderation begin? It’s a difficult question.
I’m not sure that this public option is so good as to be worth the opt-out clause. If it were a robust public alternative which anyone who wished could purchase and included the option of opting out of employee paid insurance, then maybe it would be worth the opt-out clause. The massive improvement in coverage combined with the significant economic benefits of lifting the health care burden from the shoulders of corporate America would rate some compromise and corporate America would suddenly be pro-health care reform. The reason they are against it now is because Democrats believe they can float the whole thing on the corporate dime to save red ink on the government budget.
That argument is naturally a whole other argument, but it goes to show just how unsatisfactory this public option is compared to the ambitious goal of ‘universal coverage.’ Is an opt-out worth it for this public option? I don’t think so.
I agree with you about the obsession with bi-partisanship and did not vote for President Obama in the primary. I have spent a lot of time chastizing liberals for believing he was a liberal when he promised to be conservative through the entire primary and much of the general election. That said, it is not just about his idee` fixe` with bipartisanship. The Senate leadership (from Reid himself to authors of horrible bills like Max Baucus and Ron Wyden) is equally obsessed with the idea. Many of them campaigned on ‘impeach Bush’ rhetoric and then promised bipartisanship once they took office.
So I think we can and should direct some ire their way.
“Well, they have not tried to pass a public option without a compromise yet.”
They clearly don’t have the votes for that. This is not something you can keep trying until you win. If health care reform is voted down on the first vote in the Senate there might not be a second chance. Compared to the prospects a few weeks ago of no public option, a public option with opt-out is a good compromise.
“Yes, people will continue to die unnecessarily in opt-out states during the years while we’re waiting for some such resolution to happen.”
Not necessarily. If the rest of the bill works, if there are opt-out states people will still have a choice of private insurance plans available through the exchanges.
“I honestly believe that Harry Reid’s primary goal in compromise is compromise itself and not passage of reform. ”
If he was primarily interested in compromise, the easy thing for Reid would be to accept Snowe’s compromise of triggers for a public option only. This is a compromise which has enough votes to pass. Reid deserves credit for going the more difficult route politically of a public option with opt-out provision.
And what’s with the criticism of Obama. If not for Obama pushing the Senate to include the public option the public option would be long gone. If not for Obama’s speech in August, all of health care reform would be dead. If the Democrats had nominated Clinton instead of Obama health care reform would have died by August if it had managed to stay alive that long.
Well, I can’t speak for anyone else with absolute certainty, but this is my take: partisan liberals who were obsessed with winning and saw Obama as the best chance to win decided that, because of his experience and his noble speeches, he was one of them. When he proved to be exactly what he said he was, someone with a genuinely unifying agenda who was going to strive for consensus at all costs, they believed they were sold out when they were the ones who deceived themselves.
So many of those on my end of the left-wing criticize him quite a bit for a wide range of ‘betrayals.’ I personally think he has worked miracles considering what Bush set on his table. I may even vote for him in the next primary… unless someone suitably fringe lefty for me runs I think he’s earned it. I do think it is important to recognize he is fundamentally a conservative, but I don’t think that is fundamentally a critical statement.
And I don’t think there’s a person in the Democratic Party more anti-Hillary than me. Preaching to the choir.
I was saying that even if one views President Obama’s actions in the most unfriendly light from the left, everything he’s done is pretty much what he told us to expect from him. I’m not talking about campaign promises, but about what he’s said about how he wants to govern and how he wants to change governing. He was all about the post-partisanship.
So I was saying that the oh-so-partisan Democratic legislative leadership is far more suspect on issues of ‘betrayal’ since most of them ran on very much NON-bipartisan agendas.
‘If he was primarily interested in compromise, the easy thing for Reid would be to accept Snowe’s compromise of triggers for a public option only. This is a compromise which has enough votes to pass. Reid deserves credit for going the more difficult route politically of a public option with opt-out provision.’
Well, in my view, the easy thing would be to tell Joe Lieberman that he can vote anyway he likes on the Senate floor when the bill is voted up or down but that his committee chairmanships are history if he doesn’t vote for cloture. Similar pressure should be applied to Ben Nelson, and all the Blue Dogs should be reminded that when the Democrats lost Congress in the mid-term of Clinton’s first term it was swing-district Democrats who sided with the Republicans who primarily lost their seats. Not hardcore liberal lions or even swing Democrats who stuck to their principles.