Friday, October 9, 2009

Opt for Opt Out?

In their latest attempt to compromise on the public option, Senators Carper and Schumer are proposing a public option that gives individual states the choice to opt out.

health-insurance Having taken the read of some of the shrewder health care policy nerds, it seems that the Carper/Schumer Public Option 'opt-out' compromise may really be a winner in policy terms. As I tentatively argued this morning, it would seem to get you a sufficiently large and nationally based plan that would provide the negotiating leverage that is the key to a successful public option. And, again, assuming the plan worked as advertised in the 'in' states, there'd be growing political pressure for the hold out states to come on board.

That's the policy side of the equation. For the political calculus, the ability for states to opt out would deflate some of the 10th Amendment/government take over/death panel freak show and give conservative Democrats enough breathing room to come on board. And a number of key conservative Dems as well as liberals seemed to warm to the idea.

Over the course of the day though it became clear that none of the key power centers -- not the White House or the Dem leadership in either chamber -- seemed at all interested. From some of the leadership sources we spoke to, the idea seemed to be: 'Sure, interesting idea. And a lot of people are talking about it. But it's just not on the radar for the leadership. So why are we talking about this?'

I confess that something did sound a little off to me about the proposition that differing factions agreeing on one palatable policy option was irrelevant since it's not what the leadership is focused on. Especially because I'm not sure the leadership has inspired a great deal of confidence in their ability to pilot this ship to port. But that's one clear part of the equation.

Another issue is just what votes such a compromise would secure. If 3/4 loaf doesn't secure more votes or enough votes more, you might as well stick with a whole loaf. And this issue just isn't clear yet. Republicans have made clear that they'll oppose any form of public option, indeed likely any reform bill at all. So you're still working with 60 Democrats and potentially Olympia Snowe to get to 60. Some seem to think you still can't get to 60 with this. But that's their line.

Then there's the issue of people in opting-out states -- a point about which we've received many emails today.

The general assumption is that the opt-out states would be heavily red, disproportionately small in population and centered in the Mountain West and the South. And a number of people from these states wrote in today saying, Why is this such a great idea if it leaves me high and dry? It's a good question. And I think there's a decent issue of principle at stake in reform being national. We didn't do opt-outs for Medicare or Civil Rights (we'll okay, for a while, but not eventually) or Social Security (labor laws provide something of a counter-example). So why now? 10th Amendment gonzos notwithstanding, we are a national community, one people. So if reform is needed it should be for everyone... [emphasis added]

Inserted from <TPM>

On the surface it sounds like a great idea, but I agree with the author’s premise that everyone needs reform.

Also, consider, if you will the following progression.  As national health care goes into effect, the reddest of red states opt out as anticipated.  People driven into poverty because they lack health care in those states migrate to neighboring states that offer the public option.  Those people apply for state aid in those neighboring states, driving up the cost of state government there.  The GOP floods those states with tea party patriots to strike fear into residents there that the only way to save their states from this hoard of undesirable (that is black or brown) people is to elect Republican candidates.  Their fear tactics work, and the newly elected Republicans opt out.  This process repeats itself until  the Republicans have control of the new whiter South.  Before you dismiss this projection, remember that for all the bubba jokes, Republicans are consummate masters at screwing their own constituents, while making them believe it’s the Democrats’ fault.

I suppose I’d choose this plan over no public option at all, but do not want to abandon all the good people, such as our friend Mad Mike, who already suffer having to live under the cloud of red state mania.


Sue said...

Tom I'm not the smartest egg in the nest but I see it differently. I see those red states opting out, yes, but I see the people from those states once they realize how their rethug leaders are screwing them will turn on them and put in dem leaders in the next election. Why should they have to pack up their lives and move to a friendlier state, just change the one you are in. I see the country turning blue because of it. Of course we will always have the fringe wackos who will want to cause trouble, but maybe they will move to their own deserted island in the Pacific!


What don't people understand about public option?

TomCat said...

Sue, are you referring to Lisa Land? ;-) Here's the problem. People with concrete thinking error, the norm in red states, generally tend to consider themselves bulletproof. Those who are wiped out through illness will only be a small percentage of the population at any given time. That is not enough to vote out the Repuglicans. The rest will turn on Fax Noise and carefully insert their heads in their hind-parts.

HB, the Repuglicans and Special Interests have instituted a massive campaign to indoctrinate people. Their lies are numerous and varied. One example is that, under the public option, all Americans will lose their private coverage and end up languishing in long lines for too few medical services like you Europeans have to do. I know you don't, but remember... I said they were lies.



One example is that, under the public option, all Americans will lose their private coverage and end up languishing in long lines for too few medical services like you Europeans have to do.

Do they really believe that? That we have too few medical services because of public option? Ohmigosh!

Oh boy, you guys are in real trouble indeed. If in this day of internet technology, Republicans can't even seem to do research about what public option (as we have here) is all about, then nothing else can convince them.

TomCat said...

HB, they believe that you have too few medical services because you have government run health care. Most Republicans don't research because they think they're getting truth from the GOP Reichsministry of Propaganda, Rupert Murdoch's Fox News Channel.

MadMike said...

Living in a Red State is intellectually the "Heart of Darkness" in America. A church on every corner and a hypocrite behind every tree.



I wish those guys would go out of their way and see for themselves. why can't they send a fact finding team over to Europe and see for themselves instead of wallowing in blithing ignorance.

We have a wide range of medical services, complete services to take care of ailments, ranging from treating a bad flu to complex surgeries, curing complicated nuclear-caused diseases, all for "free."

Allow me to expound... In a nutshell here's how it goes:

An employee puts a certain amount of his pay into the cash pot to cover health care for him/her and members of his family (not working spouse included and children) which we call Securité Sociale (Social Security system). That amount ranges from 20 to 27% of his monthly pay. He is instantly covered from the 1st month of his employment. Changing jobs and employer will not affect his health care cover.

The employer puts in the rest ranging from 70 to 100% (depending on the employer) although the minimum amount put in by the employer (we call it part patronal in French) is around 70%. (Same thing goes for a self-employed person except that he has to take care of contributing to the fund as an employee and as an employer.)

This will entitle the employee (and members of his family) to health care cover of up to 90%, whatever the case. If a member of the family needs major surgery, eg., brain surgery or whatever, kidney transplant, etc., the cost will be covered by the public option of up to 90%. If the employee, who is the titular holder of the health cover, cannot pay for the remaining 10%, he could go to the state's social services (in the hospital itself) and ask that state pay for the remaining 10% needed.



The Securité Social is not "government owned," It is owned by its members, the employers and the employees, various interest groups, etc.; it is however, assisted and managed by the state and receives government window guarantees.

Hospitals are state-owned for the most part in France. They usually have the state of the art equipment. "Cliniques" which are small-scale "hospitals" (if I may describe them as such) and which are often specialised medical centers, however, can be privately owned by interest groups and doctors for instance but function under the same rules as state owned hospitals, i.e., patients going into "cliniques" are covered in the same way patients going to state-owned hospitals. The difference is that cliniques or private medical centers may charge higher than your normal state-owned hospital for say a surgery and hospital costs could go more than what normally your securité sociale covers. A rich person afford that difference of say, 10% but most people in France, rich or poor alike subscribe to a "mutuelle" (private individual insurance). If an employee has "subsribed" to a "mutuelle", that private insurance usually covers that difference. In other words, the patient gets treatment completely for free even in a private "clinique".

To give you a personal example: My brother had a brain surgery some 12 years ago (he was in coma for 40 days) following a skiing accident. He had lost his job before the accident but his wife was still employed. The total hospital costs (doctors, nurses, room, medications, etc., etc, up to the time he was released to a thereapy center, amounted to something under 4 million French francs (state-owned hospitals keep records too of what surgeries cost) or almost 1 million US dollars at the time. My sister in law who did not have a "mutuelle" at all (private insurance) DID NOT HAVE TO PAY A CENT. Her securité sociale took care of 90% of the costs while the state took care of the rest.

(I personally never ever went to a 'clinique'. I prefer state-owned hospitals because of the state of the art equipment they have and the greater number of doctors on the staff too. (Pretty soon though, we might have a problem as it seems there are less and less young people wanting to be doctors.)

No one is left by the wayside. No one!

Everyone is entitled to complete health care in France, rich or poor alike FOR FREE and immediately when the sitiuation calls for it! I know for a fact that health care functions in the same way in Belgium, in the UK and in Germany.

To do this of course, everyone contributes to the kitty. Everyone! Health care is expensive, but good health care is even more expensive. And fortunately, because people don't usually balk at paying high taxes (except me perhaps! I always complain at the amount of taxes my household pays, that's perhaps because we are relatively healthy in the family -- knock on wood!!!), we have this advanced kind of health care. Matter of fact, it's been said that France has one of the best health care systems in the world.

And that to me is public option!


Oh before I forget... even if a person is unemployed and has no working spouse's health cover, any person in France, by law is entitled to health care.

Health care services (exactly the same as those who have paid into the "Securité Sociale) for free can be availed of by the "destitute" simply by going to the social services in the hospital itself.

It's the law.


Good Lord! What mile-long comments... Sorry about taking much space in the comment section Tom, got carried away.

Brother Tim said...

I have to disagree on the opt-out BS. I, for one, have compromised single-payer for a strong public option. I will not compromise further. A weak bill is worse than no bill at all.

TomCat said...

Poor, Mike. I feel for you, friend. We run them all out here. :-)

HB, thanks for all the great info. The more we know, the more we can deflect Republican lies. And please don't apologize. Any day that you spend more time here than on your own blog is a great day for Politics Plus.

Brother, I'm fighting tooth and nail for one.