Sen. Chuck Schumer (D-N.Y.), after consulting with Sen. Tom Carper (D-Del.), one of the five Democratic senators who voted against Sen. Jay Rockefeller's (D-W. Va.) public option proposal in the Senate Finance Committee last week (another was Florida's own Bill Nelson)*, is circulating a compromise health care reform proposal that purportedly is gaining some traction among moderate Democrats and Republicans alike. Under the Schumer/Carper plan, a vigorous public option would be included in the final bill, but individual states themselves would have an "option:" to "opt out" of the federal scheme. But, in a situation when the "public option" already is a compromise -- we've already backed down from single-payer to get to the "public option" level -- this is a further compromise that is both unwise and unnecessary.
More below the fold ....
Some observers, like Nate Silver of FiveThirtyEight.com, insist that the "opt-out" is probably the best compromise we're going to be able to get. Silver contends that anyone on the Left who is opposed to it is afflicted with "public option purism" and that this is "leaps and bounds better than most of the others that have been floated," for several reasons:
- If the public option is indeed popular -- and the preponderance of public polling suggests that it is -- we should expect the solid majority of states to elect to retain it. Perhaps some Republican governors or legislatures would seek to override the popular will in their states -- but they would do so at their own peril (and at Democrats' gain).
- Behavioral economics further suggests that default preferences are extremely powerful. Making the public option the default would probably lead to much greater adaptation than requiring states to "opt in".
- If the public option indeed reduces the costs of insurance -- and most of the evidence suggests that it will -- than the states that opt out of it will have a pretty compelling reason to opt back in. Say that Kansas opts out of the public option and Missouri keeps it. If a Kansan realizes that his friend across the border is buying the same quality health insurance for $300 less per month, he's going to vote restore the public plan in a referendum or demand that his legislator does the same in Topeka.
- Even in states that do opt out of the public option, the fact that voters could presumably elect later to restore it creates an extremely credible threat to the private insurance industry that will itself help to create price competition.
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I wish I shared Silver's optimism, but I can't really see a scenario where Florida doesn't opt out. We already have two wingnut members of the legislature who are proposing a bill (which almost undoubtedly would be unconstitutional under the Supremacy Clause) that would prohibit Florida from complying with any federal health care plan, and with a legislature that is pretty overwhelmingly Republican -- and wingnut Republican at that -- I am certain that there would be a bill introduced to "opt out" of this compromise faster than you can say "Terri Schiavo."
But then this bill, assuming it passes, would go to Gov. Crist's desk. Crist, you may recall, refused to join with many of his fellow Republican governors in the South in attempting to reject federal stimulus funds; he openly accepted them -- and he's taken a load of crap from the Right for having done that. And, of course, Crist is facing a primary challenge in next year's U.S. Senate race from the right, by Marco Rubio. Although there is a lot of skepticism about Rubio's chances, I'm not going to pooh-pooh his straw poll success; it shows a tremendous amount of dissatisfaction among GOP grassroots (such as they are), which basically means the extremists who control the party in Florida as elsewhere.
So, does Crist veto this hypothetical bill to have Florida opt out of the federal scheme, knowing that's the best decision for Floridians, or does he burnish his conservative credentials and sign it in order to improve his electoral chances in 2010? Well, in recent decisions when it's come down to what's best for Florida versus what's best for Charlie Crist, he's tended to go with the latter -- his appointment of his crony George LeMieux to the vacant U.S. Senate is evidence enough of that. I suspect it would be extremely hard for Crist to stand in the way of any opt-out effort from the legislature.
I've been challenged on my position several times on Twitter today. Kos himself has "bet" me that Florida won't opt out. Another insists that the large elderly population in Florida wouldn't stand for opting out ... but, of course, they already have government health care in Medicare, so they're unlikely to be major players in the opt-out debate in Florida. And one contends that any Republican move to opt out would "be the death of the [Florida] GOP ... [Florida will] opt back in in 2-3 [years with Democratic] majorities."
Elsewhere, mcjoan also predicts that few if any states will opt out, since no state opted out of Medicaid in the '60s (although it took Arizona until 1982 to join):
[L]eaving any people out of the system should be of vital concern to lawmakers. There's a relatively simple fix to that--make uninsured citizens of those states who choose to opt out eligible to enroll in Medicare. Of course, that might create huge citizen lobbies in every state to get their state to opt out so that everyone could join Medicare, but it would be critical fix for covering more of the uninsured.
Well, exactly. There has to be some kind of safeguard so that every American has a chance to exercise the option; otherwise, there might as well not even be a public option for those people whose states opt out. Moreover, I don't think the Medicaid experience is a good means of predicting how things will go now, with rabid wingnuttery having taken a hugely disproportionate role in state government in Florida and elsewhere. Needless to say, it's hardly 1965 out there anymore.
So much for "unwise" ... as for the opt-out proposal being "unnecessary," it's just another in a long series of attempts to earn 60 votes in the Senate ... which the bill doesn't need. I guess it's because Democrats want to make sure they can prevent a GOP filibuster and 60 votes would be needed for cloture ... but Rachel Maddow reported last night that plans were in the works to revoke chairmanships from any Democratic senators who oppose cloture ... pretty powerful political pressure, if true, and further evidence (maybe?) that Harry Reid may have grown a pair. But that just shows that all real health care reform needs -- with a meaningful public option -- is 51 votes, not 60 ... so I really don't know why folks like Max Baucus keep pushing for the "magical" 60, except that they really want to dilute the public option beyond recognition.
So, sure, you may support the opt-out, and your state may well reap the benefits of it ... but I'm not so sanguine about our chances here in Florida.
(cross-posted at Blast Off!)
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* Carper and Nelson
subsequently voted for Schumer's public option proposal, but that, too, failed.
UPDATE: Apparently I misread or conflated the original Carper proposal, which was an "opt-in," with the proposal after Schumer and Carper met, which is the "opt-out" described above. I apologize and thank somsfor the correction.
My argument against "opt-out" still stands, though.
