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News & ArtsMonday, October 26, 2009
Health / Politics / News The Opt-Out Con
Posted by Dan Savage on Mon, Oct 26, 2009 at 11:07 AM
So it looks like a public option is going to be in there—and that's good news—but not all the public is going to have access to the public option. Bloomberg:
Senate Democratic Leader Harry Reid will announce his support for establishing a government-run health-insurance program that would allow individual states to opt out of the plan, a Democratic aide said today. Reid’s move gives new momentum to the so-called public option as Congress considers the biggest changes to the U.S. medical-care system since it created Medicare, the health program for the elderly, in 1965.
It should be enough that individuals can opt-out of the public option by sticking with their employers' insurance plans or buying private insurance on the open market. Why don't right-wing politicians in red states—those are the states that will opt out, the same states that opted out of federal stimulus packet—trust their citizens to make the "right" decision? If government-run health care is self-evidently inferior, if it's a clear and present danger, if it's bad for our democracy and bad your health, if it's SOCIALISTAMANISM!!!! and wocka wocka wocka, no one will sign up, right? Why don't conservative politicians trust the people to make the right choice?
1
This is a brilliant plan to force those same right-wing politicians to answer to their own uninsured and underinsured citizenry when they look around and realize people in other states have affordable health care and they don't.
2
If right-wing politicians want to go to their states and explain why they're refusing federal funds for their residents' healthcare, that's for them to work out. No doubt the Senate leaders would rather cover 50% of the uninsured in the blue states than let a couple of conservative senators kill it for everyone.
3
I'm not so sure. For the sake of Olympia Snow we are establishing the precedent that there are some Federal laws that don't apply to all 50 states? Really?
4
The opt-out really is the best-of-both-worlds answer to the "public option or no public option" dilemma. It's a way to achieve real competition while immunizing it against the usual criticisms of a federal government takeover. Well, that and mandating that the public option be self-sustaining, i.e. once it's up and running, it gets paid for only through premiums, not by the taxpayers.
Folks, time to rally around the public option and to tell all those pragmatists in the Obama administration who are too pragmatic for their own good (I'm looking at you, Rahm Emanuel) that maybe for once in their careers they should stand up for the right thing policy-wise because it also happens to be the right thing politics-wise.
Folks, time to rally around the public option and to tell all those pragmatists in the Obama administration who are too pragmatic for their own good (I'm looking at you, Rahm Emanuel) that maybe for once in their careers they should stand up for the right thing policy-wise because it also happens to be the right thing politics-wise.
5
This is Brilliant.
And a Really Good deal.
Liberal states will opt in.
The Mooch Class will flock from Red states to Blue ones.
In a few years the Blue states will realize how ruinously expensive the public option is but by then the rift-raff will be settled.
And a Really Good deal.
Liberal states will opt in.
The Mooch Class will flock from Red states to Blue ones.
In a few years the Blue states will realize how ruinously expensive the public option is but by then the rift-raff will be settled.
6
Let them opt out. If the people in the states really do want the public option, the Right wing politicians will quickly find themselves unemployed.
The opt out is brilliance since it takes the entire decision making process for the public option long term OUT of the hands of politicians and over an electoral cycle or two puts it 100% in the hands of the electorate, who are overwhelmingly for it.
The opt out is brilliance since it takes the entire decision making process for the public option long term OUT of the hands of politicians and over an electoral cycle or two puts it 100% in the hands of the electorate, who are overwhelmingly for it.
8
The opt out provision tracks perfectly well with The Stranger's urban archipelago manifesto from 2004. If the red state rubes don't want health care, well fuck 'em anyway.
9
It's always remarkable to me how so much of the opposition to the public option fundamentally misrepresents how it works. And I've come to the conclusion that much of that misrepresentation is not deliberate; it comes from people who are just too stupid and ill-informed to know better.
Case in point Bread and Circus @5:
The public option is not a government handout. It's something you have to buy. There's nobody to mooch off of.
Also, with an opt-out clause, it would be easy enough to establish residency requirements so that you can't move from a state without a choice to a state with one and immediately become eligible.
Case in point Bread and Circus @5:
The Mooch Class will flock from Red states to Blue ones.
In a few years the Blue states will realize how ruinously expensive the public option is but by then the rift-raff will be settled.
The public option is not a government handout. It's something you have to buy. There's nobody to mooch off of.
Also, with an opt-out clause, it would be easy enough to establish residency requirements so that you can't move from a state without a choice to a state with one and immediately become eligible.
10
But doesn't having what essentially amounts to a massive-scale opt-out make the whole idea of the Public Option a no-go?
The only reason the Insurance Industry is going along with this version of health care reform in the first place is because of the notion that, if EVERYONE has to have some form of health insurance, they'll be able to leverage the larger pool of insured against the offsetting cost-reductions. If there's suddenly this ginormous loophole that would allow literally millions of people to "opt out" on a state-by-state basis, then the whole concept of 100% coverage along with the corresponding cost-savings goes down the drain, doesn't it?
The only reason the Insurance Industry is going along with this version of health care reform in the first place is because of the notion that, if EVERYONE has to have some form of health insurance, they'll be able to leverage the larger pool of insured against the offsetting cost-reductions. If there's suddenly this ginormous loophole that would allow literally millions of people to "opt out" on a state-by-state basis, then the whole concept of 100% coverage along with the corresponding cost-savings goes down the drain, doesn't it?
11
First we let the America-hating red states opt out of the public plan.
Then we invade them when they deny emergency services to Americans who have coverage under the public plan.
End result: America Wins!
Then we invade them when they deny emergency services to Americans who have coverage under the public plan.
End result: America Wins!
12
It's fine with me if red states want to opt out. I just hope that they live their lives by their anti-government views. They could opt out of going to public universities, using the post office, and driving on publicly-owned roads. Clearly the private versions of all these institutions are far superior.
13
We should point out that most of the Red States that are likely to opt out have the unhealthiest people in our nation in the first place.
Which would make the surviving public option even more competitive and destroy the market share of for-profit plans even FASTER.
Unintended consequences ftw!
Which would make the surviving public option even more competitive and destroy the market share of for-profit plans even FASTER.
Unintended consequences ftw!
14
"But doesn't having what essentially amounts to a massive-scale opt-out make the whole idea of the Public Option a no-go? "
No. If 50% of US states - or even fewer, for that matter - put together a shared public plan in the right way, it could still be a perfectly viable solution. What would make it more difficult would be if certain groups of people - namely, the healthier ones who pay in and don't take out as much - opted out of it. We can lose several states, but not well-off young people.
No. If 50% of US states - or even fewer, for that matter - put together a shared public plan in the right way, it could still be a perfectly viable solution. What would make it more difficult would be if certain groups of people - namely, the healthier ones who pay in and don't take out as much - opted out of it. We can lose several states, but not well-off young people.
15
@10,
The opt out is for the public option, not insurance mandates.
It'll be interesting to see red state politicians try to opt out. Without a public option, private insurance rates will skyrocket if mandated, and I'm certain that government will only subsidize premiums for the poor and maybe the lower middle class. The middle and upper middle class (i.e. the people who actually bother to vote) will feel the pinch very quickly.
That said, red states are generally less healthy than blue states. I'm perfectly happy to leave them out of the public option insurance pool.
The opt out is for the public option, not insurance mandates.
It'll be interesting to see red state politicians try to opt out. Without a public option, private insurance rates will skyrocket if mandated, and I'm certain that government will only subsidize premiums for the poor and maybe the lower middle class. The middle and upper middle class (i.e. the people who actually bother to vote) will feel the pinch very quickly.
That said, red states are generally less healthy than blue states. I'm perfectly happy to leave them out of the public option insurance pool.
16
One more reason I'll be leaving the state of Florida as soon as possible.
(not that I needed any more reasons)
(not that I needed any more reasons)
17
COMTE @10: But doesn't having what essentially amounts to a massive-scale opt-out make the whole idea of the Public Option a no-go?
No. First off, very, very few states are going to opt out. Even if they do, suppose there are 35 states representing 80% of the population that are still eligible. That gives the public option more than enough scale and leverage and bargaining power to be effective.
In answer to your second line of questioning, the states that have opted out will still be governed by the same combination of individual and employer mandates. The public option is not about directly getting the millions of uninsured insured. It's about providing competition so that these mandates don't cause insurance rates to go through the roof.
Folks, time to go all-in on the opt-out. It's the real deal. Harry Reid, I never thought ya had it in ya.
No. First off, very, very few states are going to opt out. Even if they do, suppose there are 35 states representing 80% of the population that are still eligible. That gives the public option more than enough scale and leverage and bargaining power to be effective.
In answer to your second line of questioning, the states that have opted out will still be governed by the same combination of individual and employer mandates. The public option is not about directly getting the millions of uninsured insured. It's about providing competition so that these mandates don't cause insurance rates to go through the roof.
Folks, time to go all-in on the opt-out. It's the real deal. Harry Reid, I never thought ya had it in ya.
18
If this is what's needed in order for we to move forward and establish a government health insurance program then i think it's a good idea, regardless of this stumbling block, this bone thrown at the repubics will only go so far. I'm well confident that down the road it will be ruled unconstitutional anyways, and the people of those same states that now want to opt out will be pushing for it.
20
Well, if the red states empty out except for your exceptional John Galt types, they will lose seats in the House and will get overwhelmed there too.
21
It's important to figure out what they need to do to opt out. Can the governor just say no or would the legislature have to vote it down? I think you'd better put it in the hands of the legislature if you're going to do it. Can't put that much power in 1pair of hands.
23
"Why don't conservative politicians trust the people to make the right choice?"
Because republicans don't trust the will of the people. They don't beleive people will make the best decisions. Hello abortion rights, death rights, marriage rights, drug-use rights... well, pretty much any instance of self-determination the republicans are against because they do not trust people to do what is best for themselves. Generally, they think people are weak, stupid and lazy and left to their own devices (as in SOCIALISM), the world will colapse.
Because republicans don't trust the will of the people. They don't beleive people will make the best decisions. Hello abortion rights, death rights, marriage rights, drug-use rights... well, pretty much any instance of self-determination the republicans are against because they do not trust people to do what is best for themselves. Generally, they think people are weak, stupid and lazy and left to their own devices (as in SOCIALISM), the world will colapse.
24
Medicare has an opt out clause, too, but Arizona was the last state stupid enough to employ it. That ended in the early '80s.
25
@20 - but still have 40 votes in the Senate with 10 percent of the population.
@23 ftw. Cause Republic Party of No comrades hate America.
@23 ftw. Cause Republic Party of No comrades hate America.
27
9
"The public option is not a government handout. It's something you have to buy. There's nobody to mooch off of."
Ah-
the wonder of EFFICIENT GOVERNMENT!
It works every time!!
Everything the Government touches to Gold!!
The United States of Midas!!!
Do you know how much Medicare costs and how much it was projected to cost?
Do you know how much unfunded obligation Medicare has accumulated? ($74 TRILLION)
You dear naive trusting boy-
I have a bridge for sale...
"The public option is not a government handout. It's something you have to buy. There's nobody to mooch off of."
Ah-
the wonder of EFFICIENT GOVERNMENT!
It works every time!!
Everything the Government touches to Gold!!
The United States of Midas!!!
Do you know how much Medicare costs and how much it was projected to cost?
Do you know how much unfunded obligation Medicare has accumulated? ($74 TRILLION)
You dear naive trusting boy-
I have a bridge for sale...
28
Opt out is a horrible idea!
A hard trigger -- one that defaults to automatically being pulled unless insurers meet specific goals/pricing by a set deadline -- would be so much better.
Still... without a public option, states in the South and MidWest will likely have lower survival & higher mortality rates which will help to further thin out their herd.
And that's noth'in but natural selection at its best, baby!
A hard trigger -- one that defaults to automatically being pulled unless insurers meet specific goals/pricing by a set deadline -- would be so much better.
Still... without a public option, states in the South and MidWest will likely have lower survival & higher mortality rates which will help to further thin out their herd.
And that's noth'in but natural selection at its best, baby!
30
This isn't a red state-blue state issue in the way people seem to think it is.
I'm pretty sure that NC would not opt out, in spite of it being supposedly a red state (as defined by the 2000 and 2004 elections, and only barely contradicted by the 2008 election), because locally Democrats have a lot of power.
It'll only be those red states that are also red locally.
I'm pretty sure that NC would not opt out, in spite of it being supposedly a red state (as defined by the 2000 and 2004 elections, and only barely contradicted by the 2008 election), because locally Democrats have a lot of power.
It'll only be those red states that are also red locally.
31
Something to be aware about the practically of opt-out:
* As @24 pointed out, there are other related government programs with the exact same policy, that by and large states do not take advantage of. For example, I understand that Medicaid has the same opt-out provision, and that no state has taken advantage of it.
* Note that the people who are crafting this legislation (Congress) are not the same people who will be charged with passing an opt-out bill (State legislators). State legislators will have different political realities to face.
* An example: while significant numbers of red state congressman and govenors made a lot of noise about how bad the Stimulus Plan was, very few state legislatures (and even those same govenors - Bobby Jindal, I'm looking at you) refused the money. Their excuses for doing are either reasonable or entertaining, depending on which side of the aisle you are, but for the purposes of this argument they are irrelevant. Fundamentally, it seems likely, given past behaviors, that the opt-out provision will not be used all that much.
* As @24 pointed out, there are other related government programs with the exact same policy, that by and large states do not take advantage of. For example, I understand that Medicaid has the same opt-out provision, and that no state has taken advantage of it.
* Note that the people who are crafting this legislation (Congress) are not the same people who will be charged with passing an opt-out bill (State legislators). State legislators will have different political realities to face.
* An example: while significant numbers of red state congressman and govenors made a lot of noise about how bad the Stimulus Plan was, very few state legislatures (and even those same govenors - Bobby Jindal, I'm looking at you) refused the money. Their excuses for doing are either reasonable or entertaining, depending on which side of the aisle you are, but for the purposes of this argument they are irrelevant. Fundamentally, it seems likely, given past behaviors, that the opt-out provision will not be used all that much.
32
i am so confused on this public option thing. is it really a good thing to force everyone to have insurance? what if i would rather choose to have no insurance and save my money? (not that i do, i pay a bundle for shit insurance) but shouldn't i have the right to pay nothing for no insurance if i want to? why isn't that public option optional for individuals, only for states?
34
Please explalin:
no, we all have to buy insurance because when we need health care the rest of us are unwilling to deny it; we don't want to step over people crawling into hospital doorways demanding care, we are unwilling to let them die.
Loveschild you idiot, we have mandatory unemployment insurance and mandatory auto liability insurance and mandatory minimum wage and mandatory OSHA and mandatory rules about your fucking hetero marriages regulating adults don't worry this plan is constitutional you have no idea what nonsense you're talking about.
cressona and others:
"80% of the population that are still eligible" nope you're not getting it, if you are already insured you are NOT eligible for this so called public option so it's small scale -- est. to be about 12 million people -- is a problem. Even if you state does not opt out you are not eligible if you already have insurance, get it?
Like Madow said it's a fucking piss poor compromise.
Everyone: as long as democrats support the stupid, stupid, stupid 60 vote rule in the senator for cutting off debage and voting on the bill (to get to the 50 vote thing) we dn't even live in a democracy.
So why didn't Obama go mobilize grass roots in maine mt. mo. sd etc. to build support for this thing? He coulda.
Don't blame the GOP, it's their business to be lying assholes. that's a cop out. We knew about the 60 vote thing ALL aLONG, until you SHOW Landrieu and Conrad etc. they have to vote for public option or for socialism to get reelected, then don't expect them to vote for something that will make them not get reelected, duh!
no, we all have to buy insurance because when we need health care the rest of us are unwilling to deny it; we don't want to step over people crawling into hospital doorways demanding care, we are unwilling to let them die.
Loveschild you idiot, we have mandatory unemployment insurance and mandatory auto liability insurance and mandatory minimum wage and mandatory OSHA and mandatory rules about your fucking hetero marriages regulating adults don't worry this plan is constitutional you have no idea what nonsense you're talking about.
cressona and others:
"80% of the population that are still eligible" nope you're not getting it, if you are already insured you are NOT eligible for this so called public option so it's small scale -- est. to be about 12 million people -- is a problem. Even if you state does not opt out you are not eligible if you already have insurance, get it?
Like Madow said it's a fucking piss poor compromise.
Everyone: as long as democrats support the stupid, stupid, stupid 60 vote rule in the senator for cutting off debage and voting on the bill (to get to the 50 vote thing) we dn't even live in a democracy.
So why didn't Obama go mobilize grass roots in maine mt. mo. sd etc. to build support for this thing? He coulda.
Don't blame the GOP, it's their business to be lying assholes. that's a cop out. We knew about the 60 vote thing ALL aLONG, until you SHOW Landrieu and Conrad etc. they have to vote for public option or for socialism to get reelected, then don't expect them to vote for something that will make them not get reelected, duh!
35
@34, people are not denied health care, but they are taking the risk that an accident or illness could put them in an insurmountable debt that could seriously fuck up their lives because, though we won't deny care, it is still not free just because someone doesn't have insurance. It should be an individual's right to not pay for health insurance if they choose not to without being penalized. The public option sucks, we need real universal health care.
36
Public option can't be left up to the people. That would be too free-market for the right. They only like the free market when it favors big business and campaign contributions. Or when it shits on gays and favors bigots. That's why they have to legislate against equal marriage. Can't just let the market decide who gets married and who doesn't.
37
@32, It does affect everyone if you choose not to have health insurance. If you have a horrible chainsaw accident and have to be rushed to the hospital and have emergency surgery and a long stay. If you can't pay those bills, who do you think does? $15 asprins and $700 ambulance rides aren't all to cover the overhead of the hospital; they're also to pick up the slack when the uninsured people either don't pay their bills or hospitals charitably write them off.
And to whoever said health care isn't denied in this country, you're out of your mind. EMERGENCY care isn't denied. That means we'll admit you to the ER when your lungs collapse from cancer but we won't give you chemo or radiation. It means we'll deliver your baby when you're in labor but we won't give you pre-natal care. I was pregnant and uninsured and was told by the clinic that in order to even see the ob/gyn I had to pay a $1000 deposit and then 9 monthly payments of $375. That was to pay the doctor's bill, not labs or hospital or anything else. Oh, and the price would go up for twins or c-section or anything else. This was what I had to pay for a sugar/pee test and to have my belly tape-measured monthly, and if I didn't pay it they would deny me health care.
And to whoever said health care isn't denied in this country, you're out of your mind. EMERGENCY care isn't denied. That means we'll admit you to the ER when your lungs collapse from cancer but we won't give you chemo or radiation. It means we'll deliver your baby when you're in labor but we won't give you pre-natal care. I was pregnant and uninsured and was told by the clinic that in order to even see the ob/gyn I had to pay a $1000 deposit and then 9 monthly payments of $375. That was to pay the doctor's bill, not labs or hospital or anything else. Oh, and the price would go up for twins or c-section or anything else. This was what I had to pay for a sugar/pee test and to have my belly tape-measured monthly, and if I didn't pay it they would deny me health care.
38
@8 Thanks for linking that, I've never seen it before.
I've got a buddy in school that's pretty much been conservative brainwashed. Listens to Faux News, Bill O'Reilly and Glenn Beck.
And he's gay as well! Closeted, naturally, but there you go.
I need to break this guy before it's too late. :/
I've got a buddy in school that's pretty much been conservative brainwashed. Listens to Faux News, Bill O'Reilly and Glenn Beck.
And he's gay as well! Closeted, naturally, but there you go.
I need to break this guy before it's too late. :/
39
It'll be the best social experiment ever. In one set of states, we'll still have the same old dynamic of unsustainable medical costs, which strangles businesses (those interested in insuring their employees) and creates the groundwork for huge civil lawsuit verdicts (need lifetime medical care? here's $40 Million to cover that) and in another set of states you'll have a business environment where small business can launch without the concrete leggings of employee health care costs and unfortunate victims of accidents who need lifetime care won't be excluded from the insurance pool (need lifetime medical care? here's your premium payments). The dems will end up solving the conservatives pet economic issues. Bring it.
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