A Case for Opt Out
The latest news is that Senator Reid seems to be planning to try to get the Senate to vote on a health care reform bill with a public option which allows states to opt out -- to deprive their citizens of the public option and that White House officially supports Senator Reid's efforts out -- to deprive their citizens of the public option.
So this post is probably un-necessary. However, since, on September 4 2009, I proposed a (probably unconstitutional) form of opt out, I want to explain why I think it is a good idea.
Obviously the main advantage is an opt-out clause is probably needed to get to 60 votes for cloture. This is not the only advantage however.
I assume that opposition to opt out depends in very large part on the desire to help insurance companies. There is no other reality based reason to oppose the public option. This means that many governors and state legislators would be very eager to not give people in other states the option to by public insurance. Opt out would not give them the power to do that. It would only give them the power to force their constituents to subsidize insurance companies. This makes a state level opt out decision very different from the decision by a Senator to vote against the public option. Senators can take the option away from people who aren't their constituents. Many senators are so eager to do this that they don't mind hurting their constituents too in the process.
I hope that the number of states which actually opt out will be lower than the number of States which send 2 anti public option senators to Washington. The decisions are different. The costs to their constituents are the same. The benefits for insurance companies are much lower.
Now many opponents of the public option aren't reality based at all. Many people sincerely believe that the public option means death panels or something. The opt out debate will drive a wedge between the tea partiers and the reality based corporate stooges. As argued above, many corporate stooges who would vote to eliminate the public option nationwide will not be eager to shaft their own constituents. This will infuriate the tea partiers. Anything which separates the sincerely ideological from the mercenary tends to weaken the alliance of money and conservative ideology on which the Republican party is based.
Furthermore a patchwork in which people in some states have access to a public insurance plan, people in other states will be very irritated that premia drop at the state line. Public support for those non reality based state legislators and governors who opt out will suffer as a result.
I think opt out will make it clear to people if those in State government, who are supposed to be serving them, are, in fact, either bought tools of insurance companies, or ideological fanatics who can't see reality, or both.
Of course it is necessary that states be allowed to opt out of a centralized plan with a scale large enough for efficient administration and high bargaining power, or, better, one with rates linked to medicare and effectly immense bargaining power.
If they can opt out of a feeble tiny public plan confined to their state, they will, and it wouldn't matter much if they didn't.