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There are a couple of diaries on the rec list reporting/decying the idea of luring the blue dogs into voting for the robust public option by offering an opt-out for individual states.  Most of the commentary rejects the idea, arguing that the public option would be hopelessly sabotaged by having less than full national participation.  But this is really beside the point, because

No State Will Ever Opt Out of the Public Option

How can I know this?  Because it's already happened before: Medicaid and the Interstate Highway System.  Between our experience with those, and the more recent lessons of the stimulus fall-out, it's clear that once a federal benefit has been conferred on the states, internal practical and political considerations make it impossible for the state government to reject it.

The evidence and a political analysis after the jump.

Let's start with Medicaid.  It was created in 1965, and is solely for poor people.  The feds pay for half or more of each state's means-tested health care program.  But the states still have to make up the difference.  They can opt out if they want.  Every state has been in Medicaid since 1982.  None have ever dropped out.  True, Arizona wasn't in until 1982, but that's partly because for a state to get in, they had to actually set up a program.  

Now obviously, a lot of those states' political leadership was against the Medicaid bill, and even more would have been opposed to any attempt at setting up a program independently to help poor people with their health care.  But once the benefit was there, there it stayed.

Likewise, the Highway Trust Fund is opt-outable -- you just have to refuse to conform to federal requirements about alcohol and traffic laws.  And at the time the national speed limits and drinking age issues came up, there was all kinds of talk about resistance.  And yet they all fell into line.

And the stimulus -- probably the best example of all, even though it isn't clear that the states had any actual authority to opt-out.  We saw the usual gang of idiots saying they were going to reject the stimulus, or in one case, actually attempt to do so over the objections of his state legislature.  And what happened?  We've got Bobby Jindal carting around oversized stealth stimulus checks to promote himself, and Mark Sanford fading into irrelevance after (among other things) the Republican leaders of the South Carolina legislature told him to walk the Appalachian Trail.

The public option will be no different.  Once the die is cast, and this "socialist" system is in place, no state legislator is going to want to tell their constituents that they voted to take away something that would save them money, and that everyone else in the country is getting.  

Now, I don't think Rahm & Co. can actually get the blue dogs to go for this.  Because the blue dogs certainly know that no state will ever opt out of the public option.  The question is, can they be convinced that enough people in their key demographics will think its a meaningful, responsible compromise, as opposed to a smokescreen, which it is.

For my part, I'm rooting for the smokescreen.

Originally posted to Turtle Bay on Wed Oct 07, 2009 at 07:10 PM PDT.

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Comment Preferences

    •  Afghan esclation will cost 1/2 of health reform (0+ / 0-)

      An Afghan escalation of 40,000 troops (the amount requested by Gen. McChrystal) will cost 1/2 of the annual cost of the Senate healthcare bill.  President Obama himself said that for each additional 1,000 troops sent there, the price is $1 billion.  So 40,000 more troops will cost $40 billion annually.  Note too that all politicians understate military costs (remember Bush's Iraq war budgeted for $30 billion; Nobel Prize winner Joe Stiglitz tells us it cost $3 trillion).

      Meanwhile, today, the Congressional Budget Service set the cost of the Senate healthcare reform bill at $829 billion but that is for 10 years.  So a one year cost is $82.9 billion.  Thus an escalation in Afghanistan of 40,000 troops amounts to almost half of the Senate healthcare reform bill.

      Obama has to choose between guns and butter.  Let's hope that he decides to spend our taxpayer monies on real healtcare reform, education, increased unemployment benefits, job training for the unemployed and other social causes.  But given Obama's record, I think a major escalation in Afghanistan (but phrased in a different way and cloaked to look like something else) is more unlikely.  

      "Tyranny & oppression are just as possible under democratic forms as under any other...democracy is a life & involves continual struggle." Robert LaFoll

      by fflambeau on Wed Oct 07, 2009 at 08:21:56 PM PDT

      [ Parent ]

      •  but we are talking about sending (0+ / 0-)

        people abroad who would be likely unemployed if here. In sense war can be a form of stimulus. Just tick up the top tax rate to pay for it...

        An Afghan escalation of 40,000 troops (the amount requested by Gen. McChrystal) will cost 1/2 of the annual cost of the Senate healthcare bill.  President Obama himself said that for each additional 1,000 troops sent there, the price is $1 billion.  So 40,000 more troops will cost $40 billion annually.  Note too that all politicians understate military costs (remember Bush's Iraq war budgeted for $30 billion; Nobel Prize winner Joe Stiglitz tells us it cost $3 trillion).

  •  Thanks... (9+ / 0-)

    I'm glad someone made a diary out of what I just posted as a very short comment in another diary.

    Saved me the typing!

    Excellent stuff.  States rights is bullshit...they all want the money.


    "Sick Around the World"

    Watch it, send it along to all you know.

    by oxfdblue on Wed Oct 07, 2009 at 07:13:11 PM PDT

  •  Again (8+ / 0-)


    Let's get this done.

  •  By that logic... (2+ / 0-)
    Recommended by:
    middleagedhousewife, kevinpdx

    the last Redstate holdout will be on board in 2027....which while not a forever "opt-out" is quite a while for their residents to wait for the PO...

    Obama - Change I still believe in

    by dvogel001 on Wed Oct 07, 2009 at 07:18:49 PM PDT

  •  We'll see (4+ / 0-)

    One of the mistakes folks around here make is to assume we're still in an era of "politics as usual".  We aren't, but I suppose it will take some time for the majority of Americans to put all the pieces together.  The dangerous part is that given the character of the forces that have moved us outside of "politics as usual", we may not have the time for the majority to put it all together.

    "99% of the battles and skirmishes that we fought in Afghanistan were won by our side." ~ Marshall Akhromeyev

    by ActivistGuy on Wed Oct 07, 2009 at 07:19:14 PM PDT

  •  Utah took steps (6+ / 0-)

    months ago to opt out in anticipation of this.  Some of us actually live here and don't enjoy having politics played with our already non-existent health care.

    "You are a child of the universe, no less than the trees and the stars; you have a right to be here." Max Ehrmann

    by middleagedhousewife on Wed Oct 07, 2009 at 07:19:17 PM PDT

  •  Good analysis...but I think there won't be a need (3+ / 0-)
    Recommended by:
    Turtle Bay, Superribbie, Larsstephens

    to guess..

    We will quickly find out.  If this gets traction, any Republican Gov who wants to separate from the 2012 pack will come out to say they would opt out.  

    But I highly doubt they will.  Just like in the stimulus no one ever said they wouldn't accept the money except Mr. Appalachian Trail.  They just said why they didn't "really" want it.  And look who received the short end of the stick...Sanford (And that is without his Argentinian escapades...)  He had the Republican legislature jumping all over him....

    "Republicans drove the country into a ditch and now they are complaining about the cost of the tow truck"-Jim Cornette

    by justmy2 on Wed Oct 07, 2009 at 07:22:53 PM PDT

  •  I think the only way to be sure of that (4+ / 0-)
    Recommended by:
    Turtle Bay, WisVoter, soms, Larsstephens

    is to require that opting out be done only by referendum of the citizenry.  No state legislators to be paid off, no governors trying to raise their 2012 creds.

    And the verbage of any ballot initiative should be set out specifically in the bill, to be uniform across all the states, in order to be valid.  That way, we don't have to worry as much about local wingnuts skewing the vote by messing with the language in the ballot question.

    That's my .02 anyway.

  •  but don't you think (1+ / 0-)
    Recommended by:
    Turtle Bay

    that the right wing is even more entrenched, doctrinaire, and loony now?

    I don't know about this comparison to the 60s.  That was 40 years ago - the Republican party is a very different animal now.

    All this wasted time learning and acquiring skills... And all along I should have just squinted to see Russia

    by fizziks on Wed Oct 07, 2009 at 07:29:25 PM PDT

  •  It would be (2+ / 0-)
    Recommended by:
    Superribbie, Futuristic Dreamer

    political suicide for state GOP legislators to opt out.  I doubt there are enough of them dogmatic enough to take the chance.

  •  no state will opt out of the public option (4+ / 0-)

    for the same reason that no state will reject stimulus funds.  tea baggers don't mind socialism as long as its socialism for them.

    •  there were no corporate interests (2+ / 0-)
      Recommended by:
      WisVoter, DRo

      who benefited by state refusal of stimulus funds.

      There is a huge corporate behemoth that will be benefited by state refusal of a public option: the insurance companies.

      "In America, the law is king." --Thomas Paine

      by limpidglass on Wed Oct 07, 2009 at 07:41:24 PM PDT

      [ Parent ]

      •  They will learn to deal with it (0+ / 0-)

        The PO will be likely a bare bones option for those who truly have no other health insurance options (at least at first). That's why I support it primarily, not as some kind of grand competition for the major insurers. I believe access to exchanges and getting rid of big insurance's antitrust exemption would do much more to spur actual competition. They know they aren't doing to lose money, particularly if some sort of mandate remains in the final bill (after all they refuse to ensure many of the people who will likely end up opting for the PO).  

  •  Medicare Was 40 Years Ago. Almost No US Leaders (2+ / 0-)
    Recommended by:
    limpidglass, DRo

    were in any power at that time. Half the country is younger than that and has never seen such a major program for the people passed.

    I bet a room of my house that Confederate states will opt out.

    We are called to speak for the weak, for the voiceless, for victims of our nation and for those it calls enemy.... --ML King "Beyond Vietnam"

    by Gooserock on Wed Oct 07, 2009 at 07:31:45 PM PDT

  •  the state plans will take years to set up (1+ / 0-)
    Recommended by:

    Given what's happened in states like Massachusetts, having a small "public option" + mandates isn't enough to provide competition and ensure access to health care.

    And then you'll have the insurance companies gunning for them every step of the way, especially in the sparsely-populated Southern and midwestern states where media markets are cheap. So it will be easier for them to pervert the process by dividing and conquering.

    To achieve the economies of scale necessary to be competitive, the public option has to be federal and widely available. There's just no way around that. The insurance companies know this, that's why they're floating the ideas of "co-ops" and optional state run plans, anything except a widely available federal health insurance option.

    "In America, the law is king." --Thomas Paine

    by limpidglass on Wed Oct 07, 2009 at 07:31:47 PM PDT

    •  But I thought the plan WAS Federal (1+ / 0-)
      Recommended by:

      "The individual mandate is 'just one part of the bill' - its not worth losing everything else in the bill just to get it through." BruceMcF

      by irmaly on Wed Oct 07, 2009 at 07:50:23 PM PDT

      [ Parent ]

      •  the newest proposals are not federal (1+ / 0-)
        Recommended by:

        though the earlier ones were.

        The Carper plan is to leave the states to figure it out.

        A new proposal by Sen. Tom Carper would spell out how to boost competition in the private market by enacting government-run plans at the state level. States could act alone or in concert with others to gain more leverage in the marketplace, and would be bound by the same rules established for private companies using the national insurance exchange envisioned by the Senate Finance bill. Another option would entail states opening their workers' employee-benefit plans to the general public.

        "In America, the law is king." --Thomas Paine

        by limpidglass on Wed Oct 07, 2009 at 07:54:24 PM PDT

        [ Parent ]

        •  That was one of his floated ideas, yes. (2+ / 0-)
          Recommended by:
          Superribbie, Larsstephens

          But what we're talking about now is (from the front page) "Senate Democrats have begun discussions on a compromise approach to health care reform that would establish a robust, national public option for insurance coverage but give individual states the right to opt out of the program."

          As I read it at least, that would be a federal plan.  It would just allow any states crazy enough to opt out to do so.

          •  that would exacerbate inequalities (0+ / 0-)

            and plant the seeds for civil strife for the next generation.

            In sparsely-populated states where media markets are cheap, like Nebraska, the insurance companies would simply buy off the state legislatures and make them opt out. Guaranteed.

            And then you'll have a situation where some states are getting federal money for a public option, while other states are languishing under the same helot situation where the insurance companies dominate and are not getting any federal money for help with insurance.

            The citizens of those states will be jealous and envious of those in states with a public option, and wondering why they're not getting any federal help. Telling them it's their own state government's fault, however true, won't do anything. They will blame the federal government.

            That's a recipe for real animosity between states, if not outright civil war.

            "In America, the law is king." --Thomas Paine

            by limpidglass on Wed Oct 07, 2009 at 08:15:49 PM PDT

            [ Parent ]

            •  Which is why I think opting out (0+ / 0-)

              should be by referendum only. Less susceptible to corrupt and more-easily-paid-for local legislators.

              But also, I haven't seen anything that says that citizens of states that opt out wouldn't get any federal money...only that the choice of plans they would have would not include the federal public option.  Details I've seen are still sketchy at best, but I haven't seen anything that says "if your state opts out, your citizens still have to buy insurance, but we won't help at all with subsidies".  I would hope that the subsidies would be limited to amounts paid for citizens of states that didn't opt out, but I haven't seen anywhere that says all their tax dollars would flow to the states that didn't opt out and they would all be left out in the cold with nothing.

              •  I repeat, state ballot referendums (0+ / 0-)

                are easily perverted. Believe me, I live in a state where this has been proven time and again.

                Even if some states opt out and get federal money, they will still be at the mercy of private insurers and you will still be kindling the same kinds of resentments between states.

                I haven't heard anything about states being able to opt-out of the mandates, by the way, which is only logical if you're going to allow them to opt out of the public option.

                But I repeat, I don't think opt-outs are the solution.

                "In America, the law is king." --Thomas Paine

                by limpidglass on Wed Oct 07, 2009 at 08:40:25 PM PDT

                [ Parent ]

                •  That's why I also said (1+ / 0-)
                  Recommended by:

                  that the ballot initiative language should be spelled out in the bill specifically, to try and lessen that possibility as much as possible.

                  Yes, ballot initiatives can be perverted.  But politicians can be easily bought.  That's why we don't have universal care already.

                  As I look at the polling numbers of support for healthcare reform, and for a public option, tick up even after the tea partiers did their thing, I have more confidence in the people than in the politicians.

                  All that being said though, yes, my preference is for a strong federal public option, available to all on day one, no triggers, no co-ops, no opt-ins.

            •  So be it (0+ / 0-)

              If they can't figure out the problem, they deserve their crappy system.  Besides, we'd win the civil war; we'd be healthier. :)

              "Bi-partisanship is a code word for 'We are gonna screw the peeps 'cause we are rakin' in the dough from our lobbyist pals'"--Tommymac, 8/4/09

              by Superribbie on Wed Oct 07, 2009 at 08:57:06 PM PDT

              [ Parent ]

        •  that was the old Carper plan (1+ / 0-)
          Recommended by:

          it was DOA for the reasons you mentioned.

          This is the new Carper plan.

    •  This is a federal plan (1+ / 0-)
      Recommended by:

      The states simply decide whether or not they wish to take part.

  •  Stimulus funds (4+ / 0-)

    Despite all the whining and moaning, all of your reddest states... Alaska, Texas, South Carolina, Louisianna, they not only took the stimulus money, but then their governors, representatives and senators who had opposed the stimulus from the start (and sometimes after) changed their tune and start taking credit or asking for more money.

    If this gets us a robust public option, then absolutely.  And paint it as a state's right issue by giving the people the vote in the form of referendums... and make it easy to opt back in as well.  But if we could get this from the start instead of some weak public option that doesn't even take live until years from now... I'd say this idea definitely should be considered.

  •  If Rethug politicians decide then some Rethug (1+ / 0-)
    Recommended by:
    Futuristic Dreamer

    states might opt out. But not if the states get to decide by referendum.

  •  I don't most of the commenters are against it (1+ / 0-)
    Recommended by:

    while several commenters have voiced legitimate concerns (that I respectfully disagree with), I'm surprised how well this has gone over.

    •  Give them a day or two (0+ / 0-)

      I doubt it will get any more support than Obama's other trial balloons.

      People are really opposed to pre-compromising.  It hasn't worked so far.

      Private health insurers always manage to stay one step ahead of the sheriff - Sen. Sherrod Brown

      by Betty Pinson on Wed Oct 07, 2009 at 09:09:26 PM PDT

      [ Parent ]

  •  We can guarantee that they don't (1+ / 0-)
    Recommended by:

    by tying the money to something they absolutely can't say no to. I suggest the "nuclear option" of highway funding.

    Ok, so I read the polls.

    by andgarden on Wed Oct 07, 2009 at 08:11:59 PM PDT

  •  A great idea (3+ / 0-)
    Recommended by:
    Turtle Bay, Superribbie, Larsstephens

    Make public option a state's option.  This is the amount of pressure the "I want everything that government can provide, but I want also to bitch about it and decry it" crowd needs.

    They need to be hauled up short, shown what they get vs. what they give, see the great benefits of a beneficent Federal Government, and then make up their minds.

    I feel safe that in my state the senators and congressman are smart, good people oriented toward their constituents.

    Too bad about all the folks who want all that government gives, including Social Security and Medicare, for example, but want to complain and vote against that same government--biting the hand that feeds them.

    It's the way it goes.  I could wish it better, but it is not.

  •  In some ways, the country was more sane back then (0+ / 0-)

    In the Sixties, old-school moderate conservatives made up the bulk of Republicans, and the crazies that run the Republican Party today were out on the fringes with the hippies back then. Not unlike today, Republicans and Democrats shared a fundamentally Establishment-oriented vision, but it was one that would have been all for big nation-building projects like the Interstate Highway System.

    It took the Civil Rights movement and the Great Society (of which Medicare was a part) to finally give the Far Right real momentum and turn mainstream conservatives against the government.

    I worry that conservatives have gone so far off the deep end since then, and that the Blue Dogs are just so compelled to follow, that they'd sabotage the already compromised public option without a second thought.

  •  I'd rather not gamble (0+ / 0-)

    Why pre-compromise, when we can get a real PO?

    Private health insurers always manage to stay one step ahead of the sheriff - Sen. Sherrod Brown

    by Betty Pinson on Wed Oct 07, 2009 at 09:07:26 PM PDT

  •  Is there a constitutional question here ? (0+ / 0-)

    Like equal rights for all citizens ? Laws of Discrimination ?

    Just asking for clarification.

    Between birthers, deathers and mouth-breathers, the gop has got 'teh crazy' and 'teh stoopid' covered.

    by amk for obama on Wed Oct 07, 2009 at 09:18:58 PM PDT

  •  Worried in big blue Illinois (0+ / 0-)

    Yes we're very blue right now, but the insurance lobby is very strong. They got the Democratic legislature and the Democratic governor (cough cough Blago cough) to pass tort reform a couple years ago.
    If they can do that here, they can surely fight the PO. Andif they can do it in Illinois, they can do it in many states.
    I am envisioning 50 states worth of  insurance astroturfed tea bag battles going on and on and on.

    60 for the Senate. Obama 08.

    by bornadem on Wed Oct 07, 2009 at 09:44:54 PM PDT

  •  me too (0+ / 0-)

    My worry isn't so much that a state-by-state fight will lead to the health care behemoths winning necessarily, but about all of the time and energy and money that will be expended (at the expense of other very crucial battles) by having to fight the plutonomy state by state, exhaustively.  Because fight they will and they will be emboldened to do so.

    Think of all the other state by state battles the other side has already tied up energy and resources in fighting over and over and over.


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