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The Politics of Opt-Out
Andrew Sullivan thinks the "opt-out" public option is a piece of political genius. Imagine, he says, what happens next if it passes:
Well, there has to be a debate in every state in which Republicans, where they hold a majority or the governorship, will presumably decide to deny their own voters the option to get a cheaper health insurance plan. When others in other states can get such a plan, will there not be pressure on the GOP to help their own base? Won't Bill O'Reilly's gaffe — when he said what he believed rather than what Roger Ailes wants him to say — be salient? Won't many people — many Republican voters — actually ask: why can't I have what they're having?
....Imagine Republicans in state legislatures having to argue and posture against an affordable health insurance plan for the folks, as O'Reilly calls them, while evil liberals provide it elsewhere. Now, of course, if the public option is a disaster in some states, this argument could work in the long run. But in the short run? It's political nightmare for the right as it is currently constituted. In fact, I can see a public option becoming the equivalent of Medicare in the public psyche if it works as it should. Try running against Medicare.
I was mulling over the exact same scenario last night and couldn't quite make up my mind about how this would play out. In the end, though, I think Andrew's argument is pretty compelling. As Rich Lowry complained over at The Corner, "Does a state get to opt-out of the taxes too?" That's technically a moot point if the public option is truly self-funding, but in the reality of the political world it's powerful whether it makes sense or not. It's like Republican governors turning down stimulus money: it sounds good on the stump, but who's going to do it in the real world? It's crazy if you're paying for it anyway.
So yes, this could be a huge winner. If it passes, then for the next four years Republican state legislators all over the country will be teaming up with the universally loathed insurance industry to try and deny their citizens access to a program that, to most of them, sounds like a pretty good deal. I don't know if Harry Reid was deviously thinking exactly that thought when he decided on this, but I'll bet someone was. It's hard to think of something that could force the GOP to make itself even more unpopular than it already is, but this might be it.
Joe Leiberman
Is out there saying he isn't going to vote for cloture on this bill.
So maybe now the dem leadership can strip this a-holes seniority on committees.
Seriously, this guy is a f*k*tard.
More fiscally conservative
Also, I wouldn't be surprised if the "optional public option" comes out better in the CBO scoring than the other plans. This would put pressure on fiscal-conservative moderates to support the public plan. That's what I think Reid was thinking.
Deviousness
"I don't know if Harry Reid was deviously thinking exactly that thought when he decided on this..."
Really? It was the first thing that occurred to me. And it's why "opt-in" is not as terrible as people make it sound (although it's obviously inferior).
Maybe I should run for Senate...
old news
Not to brag, but this aspect occurred to me long ago. I remember there was a day a couple of weeks ago, when the opt-out stuff first popped up, and Josh Marshall was very enthusiastic about it, and a TPM reader wrote in to say, "Wait, what good does this do the citizens of Louisiana and South Dakota, who get nothing?" And Marshall responded on the blog in apologetic terms, that so and so many millions of people would be insured and that the laggard states would enter eventually.
I wrote to Josh:
"If I'm understanding this correctly, if Republican governors refuse to opt in on principle, there's a simple way to fix that, La. and SD voters -- make your next governor a Democrat......
Am I way off base?"
Marshall never replied, or betrayed any inkling that the opt-out provision had some political benefits for aspiring Democratic governors, but, well, it's obvious that it does. Good to see Sullivan catch up with me, lol.
Making the GOP even more unpopular
than it is. Sounds like a plan!
The hope of getting health care insurance and health care before I die keeps me showing up at the polls and voting Democratic.
Why hasn't any legislator
Why hasn't any legislator put a rider to allow states to opt out of Medicare? Seems like a no-brainer.
I'm skeptical. The public
I'm skeptical. The public option is actually available to so few people (and generally people without any real political voice or clout) that it's hard to see how it would ever become as popular as liberals hope, at least in its current incarnation.
New 3rd Rail
Of course the GOP is acutely aware that genuinely affordable, universal health care is a huge loser for them politically -- just like Medicare and Social Security. That's what Kristol said in his famous memo back in the Hillarycare fight; and it's exactly why they've gone nuclear this whole summer.
Granted, an opt-out format isn't going to change the landscape overnight the way single-payer would have, but over time I think the net effects will be the same: coverage will improve; costs will moderate and private plans will seep away -- and people will bless the memory of Barak Obama the same way their grandparents did FDR.
Jeez, Kevin, keep in touch, will you?
This is just now occurring to you??? It's been the whole premise of the opt-out idea since it was first floated.
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Doesn't take deep thought
If it did, it wouldn't have been the first thing that occurred to me.
Graphics
Can we please lose the graphic that MJ seems to peg to every health care posting?
It's almost as tiresome as the whole health care "debate".
It's mainly the red states that need the public option
In NY, where I live, and CA, where you live, there's already lots of competition. On a level playing field the public option wouldn't really add much to the party... there are already competitors that are non-profit and have negligible marketing costs. It's the small states, which are mainly red states, where the public option would make a difference because there are effective monopolies or duopolies there. This might mean that the public option isn't as effectively show-cased as some with hopes of expanding it hope.
NY?
Wagster, I live in NY too and when my husband got laid off we had to go shopping for health insurance. I saw very little difference in premiums between any of the insurance companies. Most averaged around $12,000/yr for husband/wife. Luckily our income level made us eligible for Healthy New York, so we're paying $7,200/yr for the two of us and would probably be eligible for the public plan, although the cost may be similar if not more. The premium amount for a public plan is something that I haven't seen discussed. My husband is only 56 years old and for various good reasons doesn't foresee working again. I teach piano privately, hence no benefits from my work. $7,200/yr = $72,000/ten years. That's a sizeable chunk out of savings and for those without savings an impossibility. If you can give me pointers to cheaper health insurance in NY, I'm all ears.
The Point of the Above
Sheesh, to be a bit clearer, my point in the above comment is that the public plan with or without subsidies would be extremely valuable for anyone who is unemployed or has a job without benefits or even someone who has to pay an increasingly larger share of their job health benefits. This group encompasses an increasingly percentage of the population. A secondary point is that I disagree, perhaps ignorantly, that competition exists in NY in the insurance industry or that there are affordable not-for-profit companies. I know that Blue Cross/Blue Shield is non-profit, but its premiums are unexplainably similar to the for-profit companies.
I'm with nepeta
Nepeta and I both represent IBMers who were laid off and who are right now shopping for next years health insurance. In my case I have a options, so my situation is not dire, but I still do not want to overpay. My hope is that the increased competition in health insurance will eliminate some of the 'fat' (like overpricing for MRI scans) that is bloating our current system, and enriching my local GOP spokesman who is a radiologist at the Mayo Clinic.
I wish to heaven that I did not have to get involved in politics, because I don't like many of the people who are in politics and I don't like the dishonesty and phoniness and lies, but when you start messing with my livelihood then I have no choice but to get involved. I have a feeling that a whole lot of people feel the same way that I do about this, but I can't prove it, and I'm not running for office so I guess it doesn't really matter. I must speak out because it is the right thing to do.
Tripp
It would be useful
To the unemployed and self-employed, but it would not be offered to those getting health insurance through their job. The public option has been oversold. Only 10% of the population would be eligible for it.
The Public Option, under the current plan, would be in a similar position to Blue Cross/Blue Shield. They would have to negotiate their rates just as private insurers do. And as I understand it, they would even have to amortize their start-up costs over a number of years so that the taxpayer doesn't have to cough up any dough. What we're getting is a pretty weak public option that will still help, but more in some states than others.
Bad news
Hate to tell you this, but $12,000 a year for two people IS a good deal on health insurance. My family of four will pay $20K annually, at least when COBRA kicks in.
Ain't that America?
With the median family being forced to pay $20K for health care while the median family earns $50K per year, I am a bit worried that Democrats will get blamed for high health care costs in 2012.
Oh, it's definitely expensive
But when you got HealthyNY you got a list of about 10 insurance companies offering a defined set of benefits and you were able to choose according to price. That's competition... now, obviously that's not enough to make it affordable for everyone, and you need and deserve subsidies from the federal government to make it cheaper for you. If health care reform passes you'll get it. But it's going to be the subsidies that make it more affordable rather than the public option. When there's already 10 competitors an unsubsidized competitor, even if it is non-profit, isn't going to do a hell of a lot.
Price
No, we got a list of probably 8 insurance companies, all of which offered similar coverage for similar prices. We chose the cheapest available, but at most only saved a thousand a year, if that. My feeling when investigating the various cost/benefit factors was that I might as well toss a coin to make my decision. Very, very little difference in premiums or benefits. Meanwhile, my husband has access to a couple group rate plans offered by professional organizations to which he belongs, but New York is one of just a few states that won't allow these non-NY insurance companies to do business in NY. Interestingly, my twenty-something daughter who works as an independent contractor opted for BC/BS "hospitalization only" for something like $2500/yr. But now she never wants to go to the doctor when she gets sick because she doesn't want to pay for the visit, tests, etc. I can't say that I blame her but it drives me crazy!!!
Subsidies
You're right that subsidies are the key to helping those least able to afford healthcare. I didn't mean to imply in my first comment that the public option would be valuable without subsidies but that the public option, as well as insuring those unable to afford insurance by subsidization, aims to lower healthcare costs and provide REAL competition to the insurance industry. I just googled United Health Care to find out what sort of profit they've made recently. Profits were $1B for the 3rd quarter, 2009. So something like $4B/yr profit. If all insurance companies are making similar profits, then there's a lot of cream flowing to shareholders. If, as Keith Olbermann said, healthcare, which saves lives and alleviates suffering, isn't an inalienable right, then what is? Profiting on the fear of death and pain is obscene.
We don't disagree
It will help. I'm just saying I don't think it'll be by too much. Yes, the government has no profit motive, but neither do non-profits. The government does have certain limitations as to hiring and firing, wages, etc. that might raise their costs compared to private companies.
The strong public option would probably have saved the government $150BN. I'm reading this weak option may only save $20-30BN or so. I just think the importance of the public option is overplayed... we're not paying enough attention to the questions that will make more of a difference in people's finances: subsidy levels and how to pay for them.
attempting to deny the benefits of citizenship
I don't think 'opting out' would survive a Supreme Court challenge because in denying citizens something freely available to all citizens it denies them a basic benefit of US citizenship, participation in public life.
Additionally opting out would establish the insurance companies as a cartel or trust monopolizing the market even beyond their present limited exemption. It would be exclusively to the private benefit of the Insurance Trust without even the pretense of a regard for the public good.
And if their limited exemption, the McCarran-Ferguson act, is repealed the abuse would be even more blatant.
So I think opt-out will fail its' first court challenge.
clarify?
This is a bit out of my league, but seems like an interesting point. Do you mean that the *act* of opting out would be ruled unconstitutional, or the whole opt-out plan? If the Supreme Court ruled that states don't have the right to opt out, would it scuttle the whole program?
That's an interesting
That's an interesting distinction between the provision and the act that I don't know the answer to.
I think there are a lot of precedents where the Supreme Court ruled some element of a program unconstitutional without scuttling the whole thing. Opt-out isn't integral to how it functions.
The SC has invalidated
The SC has invalidated portions of Congressional Acts on many occasions without voiding the entire piece of legislation. Generally, the various provisions of Acts are severable, although it depends on how the particular statute is drafted.
Nepeta, how easy is it to
Nepeta, how easy is it to find doctors who accept your plan? One problem I haven't seen discussed much is that many specialists (especially the ones you need for relatively uncommon conditions) accept very few insurance plans -- and many of the top specialists and surgeons accept no insurance plans at all.
"many of the top specialists and surgeons accept no insurance"
Yet they accepted scholarships, grants and gov't guaranteed loans in order to become top specialists and surgeons. Many were even willing to attend publicly subsidized medical schools to become doctors, but they really wanted to become entrepreneurs.
Specialists
JS, Luckily we haven't had need of a specialist so I can't really tell you what the situation is like in that regard. BUT, I can tell you this. There's a medical center nearby with primary care doctors and specialists that has the reputation, rightfully so I think, of offering the best healthcare in the area. We have Oxford insurance under Healthy NY but the medical center only accepts the regular Oxford, not the Healthy NY Oxford. What makes this a little amusing to me, despite my not being able to take advantage of the best medical center around, is that the names of the two plans are "Liberty" and "Freedom." Can you believe it? I always get a big laugh out of the irony. And I also always forget which one I have. These plans had to have been named during the Bush administration.
Bringing in conservative dems
A few weeks ago there was a small spate of stories about why certain conservative dems were anti-public option, pointing out that the most vocal opponents were from rural states. The speculation was that a public option would cause significant, if not catastrophic, financial hardship on the states' (primarily rural) hospital systems. So it was a no-brainer for these senators to not support a public option.
Seems to me the opt-out plan gives these Dems cover to vote for what is overall a good move, without having to sacrifice themselves and their constituents on the alter of greater good. In the long run, these states will have time and incentive to do whatever they need to make opting in feasible.
Assuming the grand experiment is a success, of course. I still want to know who will be able to purchase into the public option--expect Repubs and like-minded Dems to be working on limiting access as a second line of defense here. If they can't stop the experiment, the next best action is to spike it.
The Republicans would use the referendum
Remember when Alabama held a referendum on taxes in 2003? The tax code had brackets for very low incomes (even George Will thought it was harsh) and the referendum would have done away with them while adding taxes elsewhere. It was even supported by the Republican governor, Bob Riley.
The referendum lost.
That was a referendum that you could call progressive in orientation. I think a referendum against the public option (i.e. anti-progressive) might pass in places like Alabama.
It might, initially
All those Alabamians who vote for it, though, are hereby invit ed to move.
But if it works well, the folks who were afraid of it and voted against it will begin to change their minds and clamor for a change.
the political gambit will not work to change state legislatures
When the Twenty-first Amendment was being drafted the writers chose state conventions rather than state legislatures to ratify it because they knew conservative legislatures would not vote for it. It is doubtful 2/3 of state legislatures would vote to ratify the 21st Amend today.
State legislatures are still that conservative because their constituents are still that provincial. Even though the majorities in conservative states need a public option to keep their health care costs lower than a private option, many voters will not be able to make the connection between their political and ideological loyalties and the high cost and low quality of their health care. Conservative Americans are too Chauvinistic to vote out their state reps over the cost of their health care, so the political gambit will not work to change state legislatures, but will work to increase insurance company profits at the expense of people unlucky enough to live in conservative states, which works out pretty well for the political duopoly in service to the corporations.
Good if it passes...or doesn't
In the end, even if the public option does not pass the Senate and make its way into the final bill, the most politically viable position is try for its inclusion.
If it does does not pass, and people complain about the high cost of insurance they are forced to purchase, then the political response can be, "We tried to include a public option to provide choice and competition that would lower cost, but the Republicans (and Lieberman) voted us down". A bit of a loin cloth, so to speak.
If it does pass, you just gave the liberal base a big policy bone. As it turns out, it probably is good policy too, if it passes, a sort of "icing on the cake".
No wonder Harry Reid is pursuing it.
DWN
Yeah this is a huge winner...
...unless you live in Texas and your governor is Good Hair Perry, who did turn down stimulus funds, and your state is full of jackasses who'd be more than happy to see the Texas leg opt out of the public option. Sullivan is completely wrong. Down here it's a short term WINNER to fight the public option. It only loses in the long-term...of course, after a few more thousands Texans die for want of health insurance.
I sympathize, but sometimes
I sympathize, but sometimes you gotta put yourself first and vote with your feet.
If for some reason you can't move, like say you are a rancher, then I guess you have to get together with like-minded neighbors and try to change your politicians.
Tripp
Conservatives have already managed to frame the issue
Conservatives have already managed to frame the public option as "government takeover of health care" and added other terrifying tropes to that initial demonization, all of which seem to be fervently believed by the hoi polloi in the red states. They already don't vote in their own self-interest! This would be no different.
In addition, the visible advantages/competitive pricing would be dependent on the timing and shape of the program as it comes into being. How well will it actually work? How soon will people see the benefits? All programs have problems on their shake-down cruises, and the extremely powerful and pervasive conservative press will make the most of any miscalculations or implementation mistakes.
Plus, the danger inherent in what seems to be the agreed-on limitations on who can buy in to the public plan (unemployed, poor and otherwise uninsurable) would guarantee a sicker and less financially stable risk pool, so that it will struggle to break even.
Opt-out is NOT a wonderful life saver for the public option, and frankly the fact that they are even discussing reform in these terms makes me fear that a total dog's breakfast will come out of this whole process. But I'm also tired of jumping out of my skin about every legislative rumor, so I'm going to try to Zen out on it for a little while.
When others in other states
States with such plans will be shining cities on the hill that everyone will try to emulate.
In reality it will be impossible to opt out because Big Brother will punish.
High -Deductible
I live in Florida and have been self-employed for about 6 yrs now. I am 42. For our family of 5, we pay about $4,800 / yr for a high-deductibly policy. It covers the kid's well-child visits & immunizations and 1 check-up each yr for my wife and me. We have had a few expenses due to accidents and such, but have never met the high deductible. However, the bills for medical services that we have had were reduced by approximately 75% (yes, that much because of negotiated rates with the providers) by the insurance company even though the insurance company has never paid for anything but our family's yearly check-ups.
I am on 2 generic medications (high blood pressure & depression) which cost me $4 each per month - thanks to Wal-Mart's extremely low prices. They work very well for me with no side effects.
The fortunate thing for us is that we had no significant pre-existing conditions and were able to get an affordable policy. I am pretty sure that my insurance rate will go up (because policies will be required to cover more things and insurers will be unable to disallow for pre-existing conditions). If the increase is not too dramatic, I am ok with that so insurance will be more available generally.
So, the insurance industry
So, the insurance industry makes $12 billion/year. Folks that's $40 per citizen. The Gov't wants to spend a $ trillion to fix it. Go figure.
Your loss of opportunities in the future will pay for it.
ugggh, these statistics that are meaningless...
it makes $12 billion a year, but off of how many Americans? how many americans don't have health insurance right now? how many americans pay into a plan, only to lose it later because they had pre-existing conditions or their bills were too high? how long is the trillion supposed to last? is that why americans pay almost a third or more than countries with socialized healthcare? where does the money go that we pay these companies if we don't reap the benefits of the care? i don't like knowing that my well-being is being used to line someone else's pockets who is hedging their bets that i won't get sick.
Got your attention! Good.
Got your attention! Good. Grandios idea, but it hasn't worked well elsewhere.
We are $9 trillion in debt and heading skyward like a rocket. You people are determined to eat the goose, instead of letting it continue to lay golden eggs.
I am worried about my children and subsequent generations ability to earn a living.
Maybe you don't have that problem.
I sure was
That was the appealing feature of opt out to me when I proposed it on September 4th (that would be about a month before Schumer proposed changing opt out to opt in)
http://angrybear.blogspot.com/2009/09/public-option-harder-ball.html
Why the public option is
Why the public option is available for few people. So now my question is, why Politics is not thankful about the common interest rather depend on on some debaters vote?
Why the public option is
Why the public option is available for few people. So now my question is, why Politics is not thankful about the common interest rather depends on some debaters vote?
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