The Opt Out
Posted on Thu Nov 19, 2009 at 10:07:26 AM EST
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Firedoglake is against it:
It is encouraging that Senator Reid respected the will of the American people and included a public option in the merged Senate bill. However, the addition of a state opt-out provision threatens to leave millions of Americans at the mercy of private insurance monopolies, with the federal government acting as enforcers for a product with no competition to keep prices down. [. . .] [W]hile people struggling with crippling health care costs and pre-existing conditions may have to wait until 2014 for relief, states can begin opting out immediately. That means for the next four years, health care will become a partisan football at the state level, easily gamed by the same insurance company lobbyist dollars that flooded on to Capitol Hill this year.
If you can get a public option passed without an opt out, then let's do it. But if we can not, then I believe an opt out that requires enactment of a state law through regular procedure is acceptable. My view remains that the only real reform in this bill (as I have stated, there are other good features in the proposal - specifically the expansion of Medicaid coverage, but they are not meaningful reform imo) is the public option. Indeed, if given a choice I would rather have an opt out Medicare +5 public option available to more persons with an opt out than a level playing field national public option without an opt out. Neither seems politically possible at this time, even through reconciliation. More . . .
Firedoglake writes:
If Harry Reid truly cares about fighting for the good of the country over the good of Wellpoint, he will immediately dispense with the opt-out and move to reconciliation and allow a majority in the Senate to deliver to Americans what they want and desperately need.
I think this assumes a non-opt out public option can be passed through reconciliation. I do not believe that is true. A whip count is in order on this issue.
Assuming, for the moment, I am correct about the non-opt out public option not having 50 votes for reconciliation, the question becomes, as always, is it better to have this proposal or to not have it? I still fall on the side of favoring the proposal. To me the question is does this proposal create a program that can be built upon to improve health care in our country. In my view, it does - specifically, it creates a public option untethered by profit motives and tethered by the desire for cost control that does not impinge on the coverage of its beneficiaries.
Many Village Wonks hold the view that excise taxes on health insurance and the exchanges will function as cost control mechanisms. I disagree. Indeed, there is no evidence to support their views. Conversely, there is a mountain of evidence that demonstrates that government run health insurance has more effectively held down health care costs than private insurance.
It is for this reason that it is my view that the public option is the only meaningful reform that has been proposed to date. The opt out provision does not challenge that view.
Finally, with regard to the concern expressed by FireDogLake about insurance company lobbying at the state level, this seems to me to be better seen as a call for state level activism, as opposed to a lament about our broken political system. It appears to presuppose that the only political battles worth fighting are at the national level. I believe that lamenting the need for local activism is wrongheaded. The challenge should be welcomed and accepted state by state.
The public option is worth fighting for - state by state.
Speaking for me only
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