Health Care Update

Good to see (0.00 / 0)

I'm a teensy bit cynical about the process, but any way you cut it, transparency is good.

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by: JimC @ Thu Oct 08, 2009 at 16:59:07 PM CDT

I think opt-out is a bad idea. (4.00 / 3)

Bad in principle - potentially leaving millions uninsured - and:

bad in practical terms.  Leaving a federal public option up to the whims of 50 idiosyncratic, electorally buffetted, lobbyist bullied, state legislatures? No thanks.

And I don't at all buy the argument that only some small red states in the south would do opt out.

We have a governor who wouldn't sign a letter about health care reform because of state cost concerns about the bills floating around . If those concerns aren't addressed, will we be opting out?

Moreover, it would hand a giant issue for the libertarians in our state to kick around and run on.  "Elect me, and I'll vote to remove NH from that socialist federal program."

Opt-out is asking for trouble.

We've had a long, national health care debate, involving the US Senate US House and POTUS.  Are we going to end this show by merrily leaving some Americans out of the fold?

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by: Dean Barker @ Thu Oct 08, 2009 at 17:55:24 PM CDT

An affirmative act of opt out would be difficult -- (actually impossible in NH). (4.00 / 2)

It is light years from an opt in provision-- you would have to get two legislative branches and a governor to go against the wishes of two thirds of the population-- actually the polling would probably be more like 75% against an opt out in most states. It is a wholly different question from whether people want to set one up in the first place--who would vote to have less options that people in other states? Think anyone would vote to opt out of Medicare?

As for NH, while the governor might have concerns over cost, the fact is that there is zero chance that the house as presently constructed would vote to opt out. (In truth, I dont think the governor or the Senate would entertain an opt out for one nanosecond either).

The key here though is to make sure the public option is indeed robust enough to bring down costs and available to enough people.

"But, in the unlikely story that is America, there has never been anything false about hope." Si se puede. Yes we can.  

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by: Paul Twomey @ Thu Oct 08, 2009 at 18:14:47 PM CDT

[ Parent ]

In Mass, no optout (4.00 / 1)

But atill, some opt out (6%, I think).

I have the (somewhat speculative) sense that the president thinks people who genuinely can't afford health insurance shouldn't have to buy it. I think that's why he supported opt-out during the campaign.

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by: JimC @ Thu Oct 08, 2009 at 18:26:02 PM CDT

[ Parent ]

Depends on the level of subsidy-- (4.00 / 1)

Does it go to 2X poverty level? 4X?
Is there a limit on out of pocket costs for those who just miss the subsidy level.

The fatal flaw in Mass (unavoidable in my opinion) is that Mass had no real leverage to control costs.
It is a totally different story on the federal level as the CBO costs estimates show-- when done on a comprehensive federal level, health care reform saves money.

"But, in the unlikely story that is America, there has never been anything false about hope." Si se puede. Yes we can.  

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by: Paul Twomey @ Thu Oct 08, 2009 at 18:49:18 PM CDT

[ Parent ]

We need more info (4.00 / 3)

Over at dKos I read that Medicaid has always been opt-out once a state signs up. All 50 have signed up now, and no state has ever left.

From the descriptions I have see so far, the public option is intended to get no more subsidy than a private insurance option would. So it doesn't appear that there is any financial reason for a state to opt out.

But we need more info.

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by: elwood @ Thu Oct 08, 2009 at 18:38:57 PM CDT

[ Parent ]

There are increasing signals that a robust public option will be available. (4.00 / 1)

If there is an opt out provision, I hope that it needs to be by popular vote and there should be a mandatory second vote four or five years in. But either why this is a very positive sign in a week of increasingly positive signs.

If the GOP in the South causes states to opt out, it may be have the same paradigm changing effect as Lyndon Johnson's signing of the Voting Rights Act of 1965. Nakedly depriving people of affordable health care will be costly, as it should. This is why their are ever increasing numbers of GOP leaders from outside of the Congress such as Dole and Jindahl who are coming out  for health care reform over the past couple of weeks.

"But, in the unlikely story that is America, there has never been anything false about hope." Si se puede. Yes we can.  

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by: Paul Twomey @ Thu Oct 08, 2009 at 18:05:42 PM CDT

The poorest states (0.00 / 0)

It is the poorest states that would be hurt, and the poorest people in the poorest states. Something wrong here.  

"When you get to the end of your rope, tie a knot and hang on."  Franklin D. Roosevelt    

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by: Kathy Sullivan 2 @ Thu Oct 08, 2009 at 20:14:44 PM CDT

[ Parent ]

You're correct, but (4.00 / 1)

it's that way now. I was watching one of the teevee news shows and the health statistics of South Carolina and Texas were on par with developing countries, not with industrial or post industrial economies. The teen pregnancy rates and the infant mortality rates in these states should be a national disgrace.

Unfortunately, the people the citizens of these states have elected to represent them are fighting tooth and nail against any reform of our health care system.

I don't know what to do about it.

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by: Jennifer Daler @ Thu Oct 08, 2009 at 20:27:30 PM CDT

[ Parent ]

Not allowing opt out (0.00 / 0)

Not allowing opt out would be a start. Imagine if we had passed the Civil Rights Act or the Voting Rights Act or Social Security with an "opt out". If we consider health care to be a right, if we think it is an imperative for both the moral and economic health of our country, then allowing states to "opt out" is just plain wrong. Either we are in this together or we are not.  


"When you get to the end of your rope, tie a knot and hang on."  Franklin D. Roosevelt    

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by: Kathy Sullivan 2 @ Fri Oct 09, 2009 at 08:00:20 AM CDT

[ Parent ]

Only if you make a couple of assumptions (0.00 / 0)

1. It in fact ends up in the final bill after merging with House bill. If this is what comes out of the Senate, then we are light years ahead instead of starting the negotiations with phony coops or triggers that will never get pulled. AS Howard Dean said, if this is what it takes to get to 60, its a trade worth making.

2. Any states in fact opt out (and stay opted out).
I doubt the first will happen in many places if at all due to the difficulty and horrible political consequences, but even if so, the history of the Medicaid opt out (holding at zero states presently) indicates that eventually all will get in.

Of course the best solution is a robust public option for all, but that might not be a choice on the menu in the end. You can hold out for filet mignon, but if you are dining at McDonalds and starving, you might want to accept less than your dreams. Finally, the key is the details-- how robust is the public option and how significant are the obstacles to opt-out. (As well, how easy is it for an originally opted out state to reverse course and opt in).

It is a good idea to remember what the default is if we dont enact health care reform--- it is a catastrophe every day for the poorest and a looming economic implosion.

Finally, at some point people in these states are going to have to make decisions based upon their own economic interest and not thinly veiled appeals to racism. This may be the catalyst the puts the cynical southern strategy of the GOP to bed at last.

"But, in the unlikely story that is America, there has never been anything false about hope." Si se puede. Yes we can.  

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by: Paul Twomey @ Fri Oct 09, 2009 at 06:58:59 AM CDT

[ Parent ]

It's easier to not do things than to do things. (4.00 / 2)

Especially in legislative bodies.  If this opt-out thing gets 60 votes for a real public option, I'm on board.  It's real, it's not based on future conditions, and it's easier to kill bills in state legislatures than  to pass bills in the United States Senate.

I have a great deal of sympathy for those in need in the small handful of states that might actually opt out, but frankly, theirs are the Senators who are standing in red rover formation against healthcare reform in the first place.

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by: Douglas E. Lindner @ Thu Oct 08, 2009 at 19:16:48 PM CDT

We need more like (4.00 / 1)

this guy ( h/t to Ministry of Truth):

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by: Jennifer Daler @ Fri Oct 09, 2009 at 07:18:55 AM CDT