Public Option (Of Some Sort) Looking Good

Ken AshfordHealth CareLeave a Comment

A lot of Republicans are coming forward in support of "Obamacare" suddenly.  Unfortunately, none of them are current congressmen.  They include Republican overnors (like Ahhnold), or former Republican Congressmen, like Bill Frist and Bob Dole.  It doesn't seem to be having much effect on current Congressmen.

But there is a new "compromise" solution, which seems to be catching fire — the public option, but with a clause allowing states to "opt out".  Josh Marshall explains:

To be clear, this is not 50 different state-based public options, where individual states could opt out. It's a national public option, which individual states could opt not to participate in.

The idea is from Sen. Carper (D-DE). But Sen. Schumer (D-NY) seems to be pushing it. He just went on TV a few moments ago and said the idea was gaining traction. The two of them apparently met yesterday evening to discuss the idea.

Now, I haven't heard yet from the people who really understand the policy dimensions of this stuff, the people who know all the moving parts and whose opinions I trust. So consider my comments as very tentative, subject to change if, as is quite possible, there are dimensions of this I'm not considering. But just on the face of it, this sounds like a compromise reformers could embrace because I suspect many, probably most states would opt in, providing a plenty large enough pool to get to the bargaining power that is essential to make a public option work.

Part of my assumption here is that you'd have relatively few states opting out and they'd tend toward lower population states, likely clustered in the South and mountain states. So I suspect that a substantial majority of the population would be in opt-in states, providing the bargaining power that would make the public option threshold viable. And if the public option works, one would think the people in opt-out states would quickly become pretty envious of the folks in states who had the option and pressure their state governments to get in. Of course, if the public option was an abysmal failure the reverse would happen. But that's another matter.

I like the compromise, too, assuming the full public option won't pass.  And I'm not sure where North Carolina would fall.  I suspect it would not opt out.