Joe Lieberman is an ass, there's no denying that. But his assholeitude poses a serious problem-the Democrats need 60 voted the bring the health care bill up for a vote. He doesn't want a public option, he doesn't want an opt-out. But I think he would go for an opt-in, as would many of the conservadems. And there may be a way to bring Olympia Snowe back on board by adding a trigger.
The Opt-in
The federal government would establish a health insurance option. To get around the reimbursement rates debate, put a cap on the reimbursement rates medical providers can charge insurance companies, including the public option. In November of 2010, each state would vote on a ballot initiative to determine whether the state will take part in the public option. You want to guarantee the Dem base turns out for the mid term elections? Put the public option on the ballot.
The Trigger
For the states that decide not to accept the public option, there is a triger. Starting January 1, 2011, private insurance companies will have 3 years to lower the cost of their product by 30%. After the initial 3 year period, the rates must not rise more than the rate of inflation. If the private insurance companies to not meet these requirements, the trigger is pulled.
The Exchange
Instead of creating a new health insurance exchange, why not just use the one that already exists? The federal employee health benefits exchange should be opened to all Americans.
I think this framework could satisfy a lot of people. Let me know what you think.