The Return Of The Blue State Public Option

A good news post from Ezra, reporting by Politico:

Sen. Tom Carper (D-Del.) is quietly talking with the Senate Democratic leadership and Finance Committee members about an alternative to both the government insurance option and the nonprofit insurance cooperative. In a one-page document he began circulating last week, Carper suggests giving states the option of creating a competitor to private insurers, which could include a government plan, a network of co-ops, or a large purchasing pool modeled after the revered Federal Employees Health Benefits Plan.

So long as states can band together, this could work. In fact, we can make this "Federalist Option" robust (Medicare +5) and open to everyone in the participating states. Imagine California, New York, Illinois, etc. banding together in a robust public option open to everyone. This works for me. Let Blanche Lincoln explain to Arkansans why they do not have that option. No interloping please.

Speaking for me only

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    No deal (5.00 / 4) (#2)
    by andgarden on Wed Sep 30, 2009 at 01:25:49 PM EST
    It has to be national, and not optional to the states, or I'm not interested.

    Unless, of course, we make the states (none / 0) (#8)
    by andgarden on Wed Sep 30, 2009 at 01:34:47 PM EST
    an offer they can't refuse, a la medicaid.

    How are mandates going to work? (none / 0) (#10)
    by lilburro on Wed Sep 30, 2009 at 01:35:55 PM EST
    No mandates?

    Mandates follow the public option (none / 0) (#12)
    by Big Tent Democrat on Wed Sep 30, 2009 at 01:37:33 PM EST
    so mandates are state by state (none / 0) (#18)
    by lilburro on Wed Sep 30, 2009 at 01:41:58 PM EST

    It's never going to pass anyway.  


    Well (5.00 / 1) (#25)
    by Big Tent Democrat on Wed Sep 30, 2009 at 01:45:57 PM EST
    If I were King, no public option means no mandates.

    To wit, the state opt in means opting into mandates/public option.


    I would think (none / 0) (#28)
    by lilburro on Wed Sep 30, 2009 at 01:50:20 PM EST
    that would further complicate the debate (imagine doing the mandate battle on top of the public option battle state by state).  Might as well punish everyone with a mandate until they wake up and choose the public option.  So I agree with andgarden below.

    This already can happen (none / 0) (#65)
    by BobTinKY on Wed Sep 30, 2009 at 02:54:59 PM EST
    as it did in Massachusetts.  What would be new about this plan?

    I think you could have a national mandate (none / 0) (#13)
    by andgarden on Wed Sep 30, 2009 at 01:37:35 PM EST
    and state public plans tied to Medicare rates.

    Yep. I agree. (5.00 / 2) (#37)
    by shoephone on Wed Sep 30, 2009 at 02:05:14 PM EST
    Although Poor Kent Conrad wouldn't like it because the Medicare reimbursements in his state are "too low."

    On the other hand, I think Kent Conrad's idea for co-ops stinks to high heaven. We already have co-ops in my state, and they do not work for everyone. I have list of friends with horror stories about their experience with Group Health.


    A so-called "budget hawk" who wants (none / 0) (#38)
    by andgarden on Wed Sep 30, 2009 at 02:06:32 PM EST
    more largesse for his state. Ach, they're all the same.

    I don't feel that secure with Cantwell either (none / 0) (#44)
    by shoephone on Wed Sep 30, 2009 at 02:17:46 PM EST
    She talks a good game, and voted for Rocky's PO amendment yesterday, but she's also been making lots of noises about how great co-ops are. And she never tips her hand until the very last minute and then sometimes votes like a Republican. (I will forever vilify her for her IWR vote.) There is no way of sussing out where she really stands on the PO.

    At least Patty Murray signed on to the HELP committtee bill.

    If the TV news media had any balls at all, they'd have video of the Senators being interviewed, with their campaign contribution numbers running in the crawl below. The amount of Conrad's insurance and pharma money might make some people think twice about his silly ideas.

    All hail opensecrets.org!


    Or they write the check, (none / 0) (#92)
    by ChiTownDenny on Wed Sep 30, 2009 at 05:04:11 PM EST
    which no state is positioned to do.

    I don't think California or New York can afford (5.00 / 1) (#3)
    by me only on Wed Sep 30, 2009 at 01:25:54 PM EST
    it.  As two of the states that have the biggest budget crisis at the moment.  This strikes me as TennCare, which has been dramatically cut by a Democrat Governor.  One of the biggest expenses was lawyers.  The other was people moving across state lines to get better coverage without having to pay for it.

    I think this plans works well on paper, but not so well in reality.

    At Medicare +5 (5.00 / 1) (#5)
    by Big Tent Democrat on Wed Sep 30, 2009 at 01:31:13 PM EST
    I guarantee you they can afford it more than what they have now.

    Tie it to federal highway funding (5.00 / 2) (#9)
    by andgarden on Wed Sep 30, 2009 at 01:35:26 PM EST
    and we've got a deal.

    Perfect :) (none / 0) (#20)
    by Militarytracy on Wed Sep 30, 2009 at 01:42:30 PM EST
    You are going to have to (none / 0) (#24)
    by me only on Wed Sep 30, 2009 at 01:45:43 PM EST
    provide me some idea what Medicare +5 is.  Is it like a Holy Avenger +5 (+10 to CE)?

    Robust public option means (none / 0) (#26)
    by Big Tent Democrat on Wed Sep 30, 2009 at 01:47:10 PM EST
    Medicare reimbursement rates + 5% on top of that.

    Are you in favor of (none / 0) (#30)
    by me only on Wed Sep 30, 2009 at 01:51:41 PM EST
    increasing the payroll tax for Medicare to generate all the money required to pay for that?

    (I suspect the answer to this is no.)


    It has nothing to do with Medicare funding (5.00 / 1) (#33)
    by Big Tent Democrat on Wed Sep 30, 2009 at 01:54:09 PM EST
    It is just how the reimbursement rate is set.

    You need to understand the issues better.


    You still need the revenue to pay (none / 0) (#36)
    by me only on Wed Sep 30, 2009 at 01:57:36 PM EST
    for this.

    Two points (5.00 / 1) (#39)
    by Big Tent Democrat on Wed Sep 30, 2009 at 02:09:12 PM EST
    (1) Premiums first.

    (2) Income tax surtax on the wealthiest Americans.


    You mean the highest paid (none / 0) (#43)
    by me only on Wed Sep 30, 2009 at 02:16:53 PM EST
    Americans.  Even the Democrats aren't going to try to enact a wealth tax.

    I doubt that will pass unless almost all of the states are willing to participate.  Unless of course the tax was enacted only on the states that are participating.  Hmm, sounds like a state choice that could be enacted now, without the federal government.  Real Federalism.  Wonder why IL, NY, CA haven't already enacted this??????????


    Some states don't have a state income tax (5.00 / 2) (#54)
    by shoephone on Wed Sep 30, 2009 at 02:36:17 PM EST
    Mine, for instance. There is vehement opposition to taxes, per the anti-goverment Tim Eyman, who comes out with a new/same old intiative every two years to force a cap on property taxes and bleed the state government of revenues. So, the prospect of taxing the wealthy is irrelevant here. For god's sakes, Microsoft gets billions of dollars in high-tech tax breaks every year, just so they can turn around and whine about how the B&O tax is still too high and they HAD to go to a no-business-tax state like Nevada to register dozens of MS related companies there. Meanwhile, back at the Redmond ranch, Microsoft execs just gave themselves big salary raises and bonuses.

    In the real world of Washington's citizens, thousands of low-income people are being cut from the rolls of the Basic Health Plan (our only safety net). Now the governor is sending out trial balloons about closing down the BHP altogether! And the counties, suffering from lack of revenues, are cutting millions of dollars from public health services.

    The states -- which must, by law, balance their budgets -- are dealing with billions of dollars in deficits.

    There are too many variables from state to state that make this federalist health care idea a huge risk.


    WY no state income tax (none / 0) (#94)
    by Militarytracy on Wed Sep 30, 2009 at 05:57:56 PM EST

    NV...nope, not them either.  And my husband joined the military when he was a Florida resident and has no reason whatsoever to change that residency status!

    All the while (none / 0) (#97)
    by TeresaInSnow2 on Wed Sep 30, 2009 at 09:59:58 PM EST
    Cantwell is tauting the BHP....you know that it covers 75% of the uninsured, or so she says.



    Cantwell is, um... fibbing like a madwoman (none / 0) (#98)
    by shoephone on Wed Sep 30, 2009 at 10:54:07 PM EST
    There are curently about 700,000 uninsured people in Washington State. There are roughly 100,00 enrolled in the BHP, a number that is dropping by at least 17,000 in the next year because of forced cuts by the state government.

    If she is really claiming that 75% figure then she is using "fuzzy numbers".


    Errata: Ahem, that's 100,000 (none / 0) (#99)
    by shoephone on Wed Sep 30, 2009 at 10:55:54 PM EST
    (not 100,00) covered by BHP.

    Um, Baucus' bill taxes platinum (none / 0) (#68)
    by inclusiveheart on Wed Sep 30, 2009 at 03:06:03 PM EST
    health insurance coverage which is really only carried by the wealthiest among us.  Of course, I am pretty sure that if we really examined their definition of that insurance, since the insurance companies wrote his legislation, there is a nice loop hole through which most if not all could escape that tax.  Still, they are targeting wealth already - in a twisted and probably corrupt way - but it is a target.

    Union workers (5.00 / 1) (#70)
    by Steve M on Wed Sep 30, 2009 at 03:12:36 PM EST
    get great health care, in most cases, but I wouldn't say it makes them wealthy.  More like middle class in an American Dream sort of way.

    They also gave up wages to get great (5.00 / 1) (#93)
    by MO Blue on Wed Sep 30, 2009 at 05:16:15 PM EST

    Not exclusively union members and (none / 0) (#72)
    by inclusiveheart on Wed Sep 30, 2009 at 03:20:05 PM EST
    they're the people who aren't likely to be able to get through a loop hole.  I'm thinking about the platinum coverage at executive level in corporations which will likely just be renamed or slightly adjusted not to fit whatever definition the bill assigns to "platinum".

    The only only way around this at this (none / 0) (#77)
    by Militarytracy on Wed Sep 30, 2009 at 03:30:33 PM EST
    time is single payer.  We aren't going to get that.  It will not happen at this moment.  I can get an assured coverage for all though....and maybe it is just me but that is "social reform".  And once people lose this militant view that some deserve care and others don't....once any kind of accustomed healthy health care for all is experienced and realized...we will never settle for less self worth again.  You have a point, but I don't think it is going to get us any place at this time.  And I'm sorry for anyone who likes their Platinum coverage, but they should probably prepare to say goodbye to it because I don't see this kind of for profit insurance surviving a public option where insurance companies have to compete for the new customers.  Nobody on the operating table or in the doctors office or in the emergency room should be "more special" just because they have bucks.

    The wealthiest don't use health (none / 0) (#74)
    by me only on Wed Sep 30, 2009 at 03:24:49 PM EST
    insurance.  They use boutique medicine.

    I know some weatly people (none / 0) (#78)
    by Militarytracy on Wed Sep 30, 2009 at 03:37:52 PM EST
    but I don't know what Boutique medicine is.  I do know that my son's clubfoot surgery is failing.  I do know that the highly thought of doctor in Birmingham that came Boutiquely recommended and who I fought Tricare for doesn't seem to want to "deal" with challenges and failures either.  He's too precious.  He is an artist and will tell you so. He is a total petted wussy.  So.....those crazy dudes who do all those secret masonic rituals are going to take over Joshua's feet now.  I go to the local lodge here in three weeks and park, they will drive us to South Carolina that day to their hospital that specializes in FEET.  They will even pay for and take us to our hotel, and the Boutique doctor failed....miserably...and won't return calls cuz he's a coward.  The Shriners are brave it seems, and every health care situation is personal and different.  But count me as one who is not impressed with Boutique medicine.

    Boutique (5.00 / 1) (#83)
    by me only on Wed Sep 30, 2009 at 03:57:07 PM EST
    medicine is when you retain a doctor for a fee, like a lawyer.  The doctor does house calls.  The doctor is there when you get treatment from another doctor.  Boutique doctors don't take insurance.  They charge a monthly fee whether you use them or not.

    Oh...well...I use a boutique dentist for (5.00 / 2) (#84)
    by Militarytracy on Wed Sep 30, 2009 at 04:11:36 PM EST
    Joshua.  He will only take cash payment, but he gives me the forms to submit to our dental insurance.  He is priceless though.  My son has micrognathia, it goes with his syndrome.  And he is going to have teeth removed permanently and this means "planning his mouth" as he is losing teeth and they come in.  All of his permanent teeth are bonded too....expensive!  Dr. Flowers in Dothan is a dentist as well as an orthodontist, and he puts Joshua under for all of this work that would be horrible for Joshua to endure wide awake while they crank on his mouth and pull and stretch his poor small mouth opening. I am always in the room too, parents are right there with their kids.  And his daughter has just begun to work with him now that she is done with schooling.  Their practice is filled to brimming over, but they are damn GOOD.  Cash in hand though.  We lead a simple life though for the most part because our son needs this.  There isn't any living from paycheck to paycheck in our house.  We drive older paid for cars that need cheap insurance.  No fancy vacations.  But we are happy, the dental insurance pays 80% of common things...nothing for bonding or anesthesia, but his mouth is healthy.

    sorry (none / 0) (#80)
    by Capt Howdy on Wed Sep 30, 2009 at 03:48:53 PM EST
    to hear that

    I was bummed at first (none / 0) (#82)
    by Militarytracy on Wed Sep 30, 2009 at 03:56:56 PM EST
    But need breeds awarenesses and fresh appreciations.  They are also paying for a new P.T.  He went to the P.T. that the Boutique doctor sent him to and all they wanted to do was sell us one of those new therapy bikes.  What's the deal?  Do they get a kickback or something?  The new P.T., she is psysically working with him and teaching him how to exercise his body to fight the muscular problems leading to the  failure.  She is from New York....Long Island.  Some helicopter pilot wooed her here and then dumped her like 50% of them do because they are so fantasticaqlly in love with themselves, and I thank God every single day right now that he did :)  She is amazing, and I don't even have to deal with copays now with his therapy either.  I just need to find a very good medically trained masseuse around here and some hen's teeth.

    Send supportive thoughts your way. (none / 0) (#86)
    by oculus on Wed Sep 30, 2009 at 04:22:49 PM EST
    It's good (none / 0) (#87)
    by Militarytracy on Wed Sep 30, 2009 at 04:26:33 PM EST
    Truly.  I can't believe how terrific this P.T. is.  I can't believe the headway she has made already.  Between her and the Shrine Doctors I'm not experiencing a lot of anxiety anymore.  But a petted doctor in Birmingham who calls himself an artist and doesn't call back will give you anxiety.

    Or maybe a med mal lawsuit. (none / 0) (#88)
    by oculus on Wed Sep 30, 2009 at 04:28:02 PM EST
    Ugh, it just seems like such a (5.00 / 1) (#89)
    by Militarytracy on Wed Sep 30, 2009 at 04:44:02 PM EST
    giant annoyance to legally go after someone.  You know where they get you in these things?  You are so busy working on the outcomes that your loved ones need that you just want to skip the incompetency once you've identified them.  In fact, you just want to run past quickly :)  This is the second time now that Shriners will have stepped in when "available" services have ceased to function at all.  When his scoliosis was killing him and his top curve was passing 90 degrees, Shriners were the only ones brave enough to show up for that fight.  His feet are going to be simpler, but once again something gets complex and they are the only ones who show up for the big fight he must win.  He is such a smart kid though.  Once he begins talking to them they love him like crazy.  He is exactly the person all these Shriners work so hard for...the kid who is ortho challenged and just needs a hand to take his place in life and society.  His G.P. has placed him in the Shriners hands here. They haven't met him yet in person, but when they do they will love him.

    Are you speaking about a Tenn. state (none / 0) (#4)
    by Militarytracy on Wed Sep 30, 2009 at 01:29:10 PM EST
    health plan?  Because one of my daughter's friends was talking about the insurance they were on, offered by the state, and it sounded wonderful.  They didn't move to Tenn for the insurance, but it has helped them decide they wouldn't be going any place else during this economic crisis.

    Yes, the govenor (none / 0) (#15)
    by me only on Wed Sep 30, 2009 at 01:38:58 PM EST
    created a plan called TennCare.  I can't seem to imbed links, but the writeup on Wiki is fairly accurate.  It was intended as a replacement to Medicaid and was originally extended to many people beyond Medicaid (400,000+).

    The state has been throwing people off the roles for the last several years because the state cannot afford the program.  All doctors that I know stopped taking new TennCare patients years ago.


    Sounds like how the state runs (none / 0) (#16)
    by andgarden on Wed Sep 30, 2009 at 01:39:53 PM EST
    SCHIP/Medicaid. Not uncommon.

    Other than the (none / 0) (#23)
    by me only on Wed Sep 30, 2009 at 01:44:34 PM EST
    400,000+ people who were not eligible for Medicaid being on the plan, yes.

    Bummer (none / 0) (#19)
    by Militarytracy on Wed Sep 30, 2009 at 01:42:04 PM EST
    They have a new baby, and have covered baby and mom so far.  Somehow, they even got a stipend or something for gas and car insurance money too when mom went back to college right after the baby's birth.

    I am not sure why this is a "bummer" (none / 0) (#34)
    by me only on Wed Sep 30, 2009 at 01:56:02 PM EST
    If your daughter is still eligible why is the program a bad thing?

    It isn't my daughter (none / 0) (#48)
    by Militarytracy on Wed Sep 30, 2009 at 02:24:37 PM EST
    It is her best friend who used to live here and moved to Tenn over a year ago.  It sounds as though this isn't something that they will be able to rely on while going to college if they are cutting everyone off and doctors aren't taking it.

    My daughter qualifies for NOTHING (none / 0) (#49)
    by Militarytracy on Wed Sep 30, 2009 at 02:25:57 PM EST
    in Alabama after she loses her Tricare coverage in her divorce :)

    Better encourage West Point guy (5.00 / 1) (#50)
    by oculus on Wed Sep 30, 2009 at 02:28:47 PM EST
    I'd say. Oh wait, that is too calculating.

    Not for nothing (5.00 / 1) (#52)
    by andgarden on Wed Sep 30, 2009 at 02:32:07 PM EST
    but that wouldn't be an option if the daughter were a son. FWIW.

    If the West Pointer was a woman (none / 0) (#55)
    by Cream City on Wed Sep 30, 2009 at 02:37:33 PM EST
    it sure would be an option.  Welcome to the new military (for a few decades now).

    Not even getting into the few places, at least, where two West Pointers of the same sex can wed.


    Understood, but that's obviously not (none / 0) (#59)
    by andgarden on Wed Sep 30, 2009 at 02:40:27 PM EST
    what I meant.

    In the world we would imagine (5.00 / 1) (#64)
    by Militarytracy on Wed Sep 30, 2009 at 02:54:23 PM EST
    Nobody would lose their insurance due to divorce either, or need to gain it through a marriage.  Marriage wouldn't define worth or deny worth.

    Not unheard of for parties to agree or (none / 0) (#73)
    by oculus on Wed Sep 30, 2009 at 03:22:00 PM EST
    for judge to order one former spouse to carry his or her kids on his insurance policy.

    The kids are covered (none / 0) (#85)
    by Militarytracy on Wed Sep 30, 2009 at 04:19:36 PM EST
    but a serving soldiers insurance is not his or hers.  It is given to him or her during their service and it is granted for six month to their spouses when divorce is involved.  The kids are covered as long as mom/dad is serving, not my daughter though.  Once you pass 20 years service then we start talking about something called Tricare for Life, now that is something that supposedly "belongs to us".  That is mine now if we decide we don't like each other anymore.  But it takes 20 years service to get that.

    If two female West Pointers started shacking up (none / 0) (#60)
    by Militarytracy on Wed Sep 30, 2009 at 02:45:39 PM EST
    THAT'S SOME NEWS!!!!  I suspect male West Pointers have done this though a time or two already :).....Old Hat......old guns......old camo...done quietly.  It is a lot easier to focus on being serious without estrogen flying around, every soldier knows this until some chick saves your ass.

    Not So (none / 0) (#61)
    by Militarytracy on Wed Sep 30, 2009 at 02:46:56 PM EST
    You just don't know how to appear to be a REALLY serious soldier yet andgarden.

    heh (none / 0) (#63)
    by andgarden on Wed Sep 30, 2009 at 02:52:02 PM EST
    Not exactly my thing, but the law says that still wouldn't work. . .

    Oh, You're talking one soldier and one civilian? (none / 0) (#67)
    by Militarytracy on Wed Sep 30, 2009 at 03:01:27 PM EST
    It's true.  In order for the electrons of insurance coverage to flow you have to be like magnets with one connubial ovary or essense of ovary and one swimmer or essense of swimmers.  Now I'm totally lost......but we need the electrons of insurance coverage to flow "straight".  If it flows crooked, pretty soon we're covering dogs and birds and turtles :)

    Could you possibly explain (none / 0) (#90)
    by Spamlet on Wed Sep 30, 2009 at 04:47:45 PM EST
    "not for nothing" to me? I hear this idiom when I'm in NY but can't figure out just how it's used. Does it mean something like "Don't want to . . . , but . . . "? Thanks.

    I using without thinking really (none / 0) (#91)
    by andgarden on Wed Sep 30, 2009 at 04:52:36 PM EST
    but my understanding is that it means "this matters and." Somehow I picked it up over the years.

    The older I get (none / 0) (#57)
    by Militarytracy on Wed Sep 30, 2009 at 02:38:55 PM EST
    The more okay I find myself becoming with calculated love.  It's really sad too.  It's like the dying embers of my youth.  I wasn't marrying for anything but love.  Ducked out of four engagements, there were even dresses involved twice and invitations once.  The word marriage and my name in the same sentence sent my family and friends into hysterical laughter.  George Clooney used to have nothing on me.  And then I met him..."THE ONE".  But my daughter should make my nights restful and find ways to like West Point more :)  She has it all backwards anyhow.  You start out narcissistic and self centered like Bill Maher and then you grow up.  You don't breed before you have been completely selfish and utterly self absorbed though....sheesh.

    They haven't cut everyone. (none / 0) (#51)
    by me only on Wed Sep 30, 2009 at 02:29:44 PM EST
    Those who can't qualify for MediCaid are the ones at risk of not getting TennCare.

    My knowledge of doctors is not necessarily representative of all docs, just long established specialists local to me.  OB's can't be as choosey, neither can young docs.  It also varies from location to location in the state.


    Tenn. is placing these guys on their feet (none / 0) (#58)
    by Militarytracy on Wed Sep 30, 2009 at 02:40:09 PM EST
    and heading toward being contributing members to all things social.  Wish other states could be as smart.

    States will balk (none / 0) (#22)
    by Stellaaa on Wed Sep 30, 2009 at 01:43:46 PM EST
    the feds do this kind of transfer of responsibility all the time.  The Baucus plan includes all kinds of dumping, particularly with Medicare that the states will have to pick up.  

    Another ponzi scheme.  So, what will happen, the lazy states get another handout.  


    MedicAID you mean (none / 0) (#27)
    by Big Tent Democrat on Wed Sep 30, 2009 at 01:48:42 PM EST
    Medicare as all federal money.

    MedicAID is shared.

    Case you are wondering, that is going to happen in BaucusCare too so so much for "balking."


    I think you might mean Medicaid (none / 0) (#31)
    by MO Blue on Wed Sep 30, 2009 at 01:52:13 PM EST
    particularly with Medicare that the states will have to pick up.  

    I have been known to type the incorrect word myself at times.


    Oops, (5.00 / 1) (#71)
    by Stellaaa on Wed Sep 30, 2009 at 03:18:11 PM EST
    Yes, MedicAid, provisions are worrying Governors and the so called "shared responsibilities".  

    California passed a law in 2003 (none / 0) (#41)
    by oculus on Wed Sep 30, 2009 at 02:11:35 PM EST
    requiring employers to provide health care insurance to employees.  Probably some exemptions.  Or the employer could contribute to a state-run insurance pool.  Not sure how that turned out though.

    I think it was eliminated by (none / 0) (#47)
    by me only on Wed Sep 30, 2009 at 02:24:35 PM EST
    Prop 72.

    Thanks. Link: (none / 0) (#53)
    by oculus on Wed Sep 30, 2009 at 02:32:44 PM EST
    California, New York, Illinois (5.00 / 1) (#6)
    by Capt Howdy on Wed Sep 30, 2009 at 01:31:47 PM EST
    seems like a pretty significant nose under the tent.

    and since I am currently in IL.  it works for me!

    As a bi-coastal blue state gal (none / 0) (#11)
    by nycstray on Wed Sep 30, 2009 at 01:36:37 PM EST
    works for me too!!

    The devil is in the details (5.00 / 1) (#45)
    by MO Blue on Wed Sep 30, 2009 at 02:18:44 PM EST
    The overriding details for me is if the states will actually be able to band together in offering a public option based on Medicare rates +5 and with the Medicare provider list and what restrictions are put on who may access this program.

    If the pool eligible for access is relatively small, breaking them down into ever increasing smaller groups will only make them less able to compete with the private insurance industry. I think I will reserve judgement until I get more information on the actual proposal.

    It's a trick (5.00 / 1) (#46)
    by cenobite on Wed Sep 30, 2009 at 02:22:34 PM EST
    Get an axe.

    It's just another way to have an ineffectual designed to fail thing that can be called a "public option" so the CPC can cave with political cover.

    Individual mandates for junk insurance that has no cost restraints is going to work out real good for the Democrats, but this doesn't appear to bother them.

    Apres Obama, le deluge?

    Who pays? (5.00 / 1) (#62)
    by Steve M on Wed Sep 30, 2009 at 02:50:26 PM EST
    Public option or no public option, you obviously can't have mandates without subsidies for those who can't afford the premiums.  Are those subsidies going to be funded by the states who don't participate as well as the states who do?  Cause yeah, if everyone is paying anyway, you better believe the non-participating states will want to sign up!  This strikes me as an important detail.

    Like the Kucinich amendment (5.00 / 1) (#76)
    by lambert on Wed Sep 30, 2009 at 03:29:01 PM EST
    Except gutted.

    I always wondered why the public option advocates would never even consider whipping to allow single payer experiments in the states; I guess this is my answer.

    Is anyone else struck by the fact (5.00 / 1) (#79)
    by Anne on Wed Sep 30, 2009 at 03:41:54 PM EST
    that even though it seems like there is a relatively straight-line approach that could have been taken (Medicare for All, single payer), without all this clusterf**kery, these legislators insist on coming up with different routes that - for reasons that escape me - are not only not going to get us where we need to go, but stand a pretty good chance of making things worse?

    Carper's idea sucks, and - sorry BTD - I don't know why anyone would waste brain cells or keystrokes trying to make it into something it will never be: workable.

    Answer (5.00 / 1) (#81)
    by mmc9431 on Wed Sep 30, 2009 at 03:55:54 PM EST
    It has to be new and totally complicated so that all the pork will fit in. Medicare for all is too simple. Where would they be able to hide the pork projects?

    I'd rather have a federal option (5.00 / 1) (#95)
    by MrConservative on Wed Sep 30, 2009 at 07:10:18 PM EST
    I'm in Mississippi.  I don't want to be stuck with huge rates because of the ignorant oafs who run our government.

    with which money??? (5.00 / 1) (#96)
    by diogenes on Wed Sep 30, 2009 at 09:07:10 PM EST
    New York is going broke and California paid workers in IOU's this year.  Exactly which states are going to shell out money for a public option.  And if it costs more than expected, the states can't print money like the feds can to cover it.  

    We won't be getting it in Alabama (none / 0) (#1)
    by Militarytracy on Wed Sep 30, 2009 at 01:24:44 PM EST
    But hooray for everyone else who doesn't have to deal with Jeff Sessions!

    Don't feel bad (none / 0) (#21)
    by cawaltz on Wed Sep 30, 2009 at 01:43:26 PM EST
    We're probably going to be getting a GOP governor and I'd imagine the chances of Virginia getting something after that happens are slim to none.

    Wonder how long (none / 0) (#7)
    by lilburro on Wed Sep 30, 2009 at 01:34:38 PM EST
    it will take South Carolina to get on board...

    I actually think this could politically backfire more than anything else.  SC won't want it, but they'll be mad as hell that other people are using fed tax dollars to at least start up the plan.

    I'll bet that to be the case too (none / 0) (#35)
    by cawaltz on Wed Sep 30, 2009 at 01:56:37 PM EST
    Although one could argue that blue states have gotten the short end of the federal tax dollar stick prior to this.

    Sounds like real compromise (none / 0) (#14)
    by Slado on Wed Sep 30, 2009 at 01:38:15 PM EST
    To crazy to happen

    why not, (none / 0) (#17)
    by bocajeff on Wed Sep 30, 2009 at 01:40:46 PM EST
    As someone who doesn't support single payer on a national basis, I have no problem with each state setting up their own insurance plans and then we can see which ones work the best. That's all I'm after. I don't care which plan we get, just which plan works the best...

    The plan that works the best is (none / 0) (#69)
    by inclusiveheart on Wed Sep 30, 2009 at 03:09:08 PM EST
    Medicare which is both national and federally managed.  The research phase should be over by now.  Unfortunately, the traction for more "research" - after 40 years of it - seems to be alive still which is just stunningly silly in my opinion.

    If that's the best then we're in trouble... (none / 0) (#75)
    by bocajeff on Wed Sep 30, 2009 at 03:28:40 PM EST
    I have numerous personal anecdotes dealing with medicare with family and clients that if you consider Medicare the best then we are in deep trouble. Medicare "works"? There are many doctors who won't take medicare patients. There are many doctors who pass along the costs of treating medicare patients to those with health insurance through private companies. Have you ever tried working through the bureaucracy of medicare? I've had a family member wait almost 2 1/2 years to get a hearing on a cancer procedure that was ruled on in less than 5 minutes (kid you not) that she was entitled to the treatment. Not to mention the budgetary problems with Medicare.

    Now, I'm not saying it isn't better than private insurance - I'm just saying that if you think it's the best then we are doomed.


    We have a framework (none / 0) (#29)
    by eric on Wed Sep 30, 2009 at 01:50:45 PM EST
    here in Minnesota - MinnesotaCare.  Right now, you need to be pretty poor to qualify.  It could be expanded, though.

    Require states to allow (none / 0) (#32)
    by andgarden on Wed Sep 30, 2009 at 01:52:57 PM EST
    anyone at up to, say, 1000x poverty level to buy in, on a graduated basis.

    Not California (none / 0) (#40)
    by waldenpond on Wed Sep 30, 2009 at 02:09:58 PM EST
    ["Many of us agree that if ... there is a state or several states where there is no real competition and affordability is diminished in that state or those states, then we need to provide that state with a variety of options," Carper said. ]

    California has multiple insurers... it wouldn't meet the defination of 'need.'  I also didn't see where he would allow states to join together.

    "affordability" (none / 0) (#42)
    by nycstray on Wed Sep 30, 2009 at 02:14:46 PM EST
    NY has multiple insurers also. Affordability? Not so much.

    And/or (none / 0) (#56)
    by waldenpond on Wed Sep 30, 2009 at 02:37:35 PM EST
    I'm picky.... it doesn't say competion 'or' affordability.  For conservative Repubs and Democrats, competition equals affordability.  I can't see where Carper's plan lists anything the states aren't currently capable of doing [a government plan, a network of co-ops, or a large purchasing pool.]... all methods claiming to be able to control costs through competition.

    Reid (none / 0) (#66)
    by jbindc on Wed Sep 30, 2009 at 03:01:01 PM EST
    Canceled the Senate's October recess to work on healthcare and expects to pass legislation the week of October 12.