With full apologies due to my fellow Democrats in deep red states, I must nevertheless admit that I really love the idea of an opt-out public option.
Not because it's the best idea by any means. A robust single-payer plan would be the best idea. Not because tens of thousands of real Americans won't die and go bankrupt in states with morally bankrupt legislators. They will.
But it would do wonders to completely reframe the entire debate over the public option and healthcare in general by allowing, at long last, those states with Randian ideological pedigrees to truly "go Galt", in a head to head test of ideologies to see who comes out ahead and why. If we play our cards right, it might just be the ticket to Democratic victories in the South. And it might be, over the long run, the best avenue toward real, affordable universal coverage for everyone.
Allowing GOP states to opt out of a public option creates all the following benefits:
- It forces GOP legislators to put up or shut up, leaving them in a very uncomfortable position. As it stands, GOP legislators have gotten away with the worst sort of cowardice and hypocrisy on economic issues by voting against stimulus funds, loading them up with local district pork and then demanding the money that they themselves voted down. The nature of a stimulus package allows them to do that, even as their voters aren't paying enough attention to really notice.
But the pressure on GOP legislators from their base (to say nothing of the insurance industry) to refuse a public option will be immense. They won't be able to skate around it. GOP legislators will actually have to take a vote to watch healthcare costs go down for the rest of the country even as they skyrocket in their own states, or prove that their intransigence was all hot air all along. Rather than leave Democrats in a bind, opt-out legislation puts Republicans in the hot seat.
- It leaves the rest of us with a strong public option, even after it's watered down. As it stands now, we know the public option will be weakened somehow. The chances of a firm, robust national public option coming out of this legislative mess are slim to none. Of all the possible ways to weaken the bill, an opt-out clause is by far the best.
Why? Because the population and economic power of Democratic-controlled states simply dwarfs and overwhelms that of Republican-controlled states. State-based public options won't have the purchasing power to compete with national insurers. But a public option operating in California, Illinois, New York, Michigan, Florida and elsewhere? You bet it will. And once those savings become obvious, the pressure for redder states to fall into line and adopt it will be enormous, at a cost not only to insurance companies but to the very foundations of Republican ideology in red states as a whole.
- It hampers the ability of Republicans to lie about healthcare issues. Suppose for a moment that I'm a Republican governor of a state that has no public option, and strong tort reform laws. And yet my state's healthcare costs are going up 20% every year. Now suppose a neighboring Democratic state with higher malpractice awards but healthy participation in a national public option has seen its medical costs decrease. That's pretty cut and dry, and a hard straitjacket to wiggle out of.
On the other hand, if we impose a public option universally, Republican legislators will be able to blame every one of their own healthcare problems on government interference--and they'll get away with it.
- Businesses will have an incentive to move to blue states. The right-wing and its allies in the media constantly remind us of the business advantages for operating in "right-to-work" states and those with more corporate-friendly policies.
Well, with an opt-out system, businesses that can hire a talented, educated workforce without the necessity of paying health insurance costs will jump at the opportunity to do so, creating a self-reinforcing cycle of economic advantages for those that choose the public option over those that do not. The consequences of failure to adopt a public option will be visible almost immediately upon its availability in other states.
Rarely do the Left and the Right have a head-to-head opportunity to prove out, in real time, the relative superiority of their respective value systems and legislative choices, with real and immediate consequences not only for the partisan legislators involved, but for the legitimacy of a Party's entire ideological underpinnings.
An opt-out system will allow Republicans to use their own psychotic, sociopathic momentum to carry them to their doom. With apologies to the long-suffering citizens of those states who may have to wait a few more years for needed help on healthcare, I say let each state do as it pleases, and let the chips fall where they may.
And within a decade, the writing on the wall will be so clear even in Alabama and Mississippi that not only will we have a national public plan, but we might even see some deep South red states turn blue as a result.