Politics And Policy: The Virtues Of The Blue State Public Option

By Big Tent Democrat, Section Other Politics
Posted on Mon Oct 05, 2009 at 03:04:00 PM EST
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When FDR was running for President in 1932, the base of the Democratic Party was strongly in favor of the repeal of Prohibition. FDR privately agreed, but was concerned about the political implications of that position. His solution? He called for repeal of the federal prohibition but stated that the question should be left to the states to decide individually. Of course FDR won, Prohibition was repealed and in 1935, the federal government took over regulation of alcoholic beverages. A classic case of the camel's nose under the tent working.

Whatever one may think of the strategy employed by the Obama Administration to this point on health care reform, the question we now face is what is the best way to proceed. I come down squarely in favor of a Blue State Public Option as described by Andy Stern of the SEIU - Medicare +5, tied to individual mandates, subsidies funded by a surtax on wealthy individuals. This is a better course, both in terms of politics and policy, than the Schumer level playing field public option. I'll explain why I think so on the flip.

When selling the Blue State Public Option, it obviously will not be called that. It would be called I think, the phrase Ezra coined - the "Federalist Option." The important part politically of this option would be the need to opt out, rather than opt in (which was the Carper proposal.) Consider all the railing about the stimulus monies (Mark Sanford's refusal to accept it, etc.) In the end, everybody took the money. They always do.

But the option to NOT take the money, and not take "government run health care" can be emphasized politically. This approach makes the public option optional at the STATE level, not just the individual level. I feel confident that this is a winning political strategy.

On policy, the "Federalist Option" will allow, imo, for a program much more likely to be effective in terms of reach, cost and fairness. The Schumer level playing field public option is likely to have success and more likely to be accepted if no State opt out is allowed, but a robust Blue State public option is more likely to work as policy, with tangible results being demonstrated sooner.

At this point in the game, I am firmly in the camp of a robust "Federalist Pubic Option."

Speaking for me only

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Politics And Policy: The Virtues Of The Blue State Public Option | 56 comments (56 topical)

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I don't know if it's comparable or not (5.00 / 1) (#5)
by Faust on Mon Oct 05, 2009 at 10:37:41 AM EST

but isn't something like this how it happened in Canada? Started at the province level and then spread to the whole country?

No idea (none / 0) (#6)
by Big Tent Democrat on Mon Oct 05, 2009 at 10:38:20 AM EST

I should research that though.


It did start in provincial governments. (none / 0) (#8)
by Salo on Mon Oct 05, 2009 at 10:39:23 AM EST

That's why it will not be allowed to pass though.


: Canada's provinces... (none / 0) (#36)
by lambert on Mon Oct 05, 2009 at 01:43:40 PM EST

... have a much stronger role, and their Federal government a much weaker role, in Canada than here.

You are correct (none / 0) (#44)
by eric on Mon Oct 05, 2009 at 02:42:18 PM EST

it was Tommy "The Greatest Canadian" Douglas who started it in Saskatchewan. Other provinces followed.


I would feel better about the (5.00 / 2) (#34)
by Anne on Mon Oct 05, 2009 at 12:14:51 PM EST

incremental approach if I thought there was an overall plan, and someone or some committee had analyzed it enough to know what elements had to be in the package on Day One and which ones could be introduced in stages in order for us to end up with a reformed system that actually works.

With regard to a Federalist Plan, I think residents of states that are already at the bottom of the health care barrel will not get any help climbing out of it, even if the people demand it. Do you really think a red-state legislature is going to have the kind of epiphany that would make them vote for these kinds of "socialist" programs? And what if the people want to vote them out - are those who want affordable health care going to take the chance that they could elect a legislature that might also have liberal views on abortion, for example? I can see and hear the campaign ads now, can't you?

And let's not forget that red-state governors and legislatures might just be thrilled if opting out of such a plan meant that the poor and sick people draining their treasuries would up and move to a state that is participating. What do you do then - put residency requirements in place? And what happens if the participating states find that they cannot economically sustain the influx of people moving to their state for the chance to have health care, especially if they are also unemployed and need other government services?

And what about the practices of insurance companies doing business in states that opt out? What's the effect there?

Health care should not depend on where you live or where - or if - you work. If this has to be about insurance, my preference is Health Insurance/Health Care: Portable and Affordable.

: And don't forget (none / 0) (#35)
by TeresaInSnow2 on Mon Oct 05, 2009 at 12:41:45 PM EST

that the insurance companies would cherry pick states that have the least "competitive" public options. No politician wants to be responsible for insurance companies "opting out" of a state. And yes this happens. It happened in Washington State a few years ago -- all 3 of our health insurance companies opted out of the individual market until they got what they wanted.
And insurance companies opting out of a state while retaining a public option sounds good on paper -- until you see how many doctors refuse to take Medicare patients (or potentially Medicare+5) patients. People with corporate insurance would get the better doctors, the rest would get the potentially less proficient Medicare+5 doctors.

Assuming the "opt out" is written in (none / 0) (#1)
by scribe on Mon Oct 05, 2009 at 10:29:07 AM EST

and the whole Federalist option passes, I think it is fair to expect pretty much the same set of counties that went "Dry" after the end of Prohibition will wind up being the ones without a government health care option available:

backward, impoverished redneck counties in the South, the Ozarks, Texas and parts of the Plains states, where the local version of Boss Hogg and the fundie preachers run the place in a 21st century version of feudalism, and the locals tug their forelocks while looking down as those local worthies pass.

Has anyone ever done a map of dry counties and, say, Republican voting habits?

Just asking.

I just don't see (none / 0) (#2)
by lilburro on Mon Oct 05, 2009 at 10:32:31 AM EST

where the votes are coming from for this. And anyway, in order to get the votes, a robust Federalist public option is going to be watered down---into a Blue State Level Playing Field Public Option.

This concession come in exchange for votes (none / 0) (#4)
by Big Tent Democrat on Mon Oct 05, 2009 at 10:37:27 AM EST

To wit, the Opt Out is the compromise.

That's what the Blue Dogs get for their votes, either for cloture in the Senate or Bill Nelson's Aye vote for example.

In essence, Pelosi and the CPC keep pushing for no Opt Out robust public option and then the President makes the grand bargain.

Given the playing field, this is what I think should be done.

I wish the playing field were different.


It's possible that (none / 0) (#10)
by Salo on Mon Oct 05, 2009 at 10:41:28 AM EST

a public option created at the state level might end up working better than a plan created at the federal level. It's possible that a state that is faithfully attempting to cover everyone will do a better job thatn jacka sses like Baucus or Reid or whatever GOP scoudrel replaces them in 2012.


No (5.00 / 1) (#11)
by Big Tent Democrat on Mon Oct 05, 2009 at 10:42:30 AM EST

I want a federal plan.


Me too. (none / 0) (#21)
by Salo on Mon Oct 05, 2009 at 11:14:20 AM EST

Although I feel a public option is a compromise already. I'd like an NHS here with doctors on public salaries and med school paid for by the state.

Not happening of course. I think California would run one in good faith and if the public sector unions were allowed to join it there it would be a proper structural revolution.

A federal plan will probably end up being a subsidy to the poor and marginal--not a bad thing in absolute terms but a poor one relatively speaking. We could simply expand medicaid to the margins in our society and be done with it.


Well (none / 0) (#22)
by Big Tent Democrat on Mon Oct 05, 2009 at 11:17:10 AM EST

Politically, I see the value of saying the public option was a compromise, but since the President nor any Dem leader proposed single payer, that is not really accurate.


I think it's obviously... (none / 0) (#27)
by Salo on Mon Oct 05, 2009 at 11:28:27 AM EST

...a compromise on an ideological level. The actual left in the US has been told to accept something incremental in lieu of a push toward the destination. Party discipline in order to get half a loaf instead of none. That's fair enough. I wouldn't want to miss the possible in search of the perfect.

I think there was a bill in Congress for single payer though. So things like single payer are a real part of the ideological mix in a formal way.


: Keep saying it (none / 0) (#31)
by Big Tent Democrat on Mon Oct 05, 2009 at 11:38:21 AM EST

It has value.

Judging by comments (none / 0) (#14)
by lilburro on Mon Oct 05, 2009 at 10:55:43 AM EST

from Senators and the voting on the public option amendments in the SFC last week, there is significant opposition to the Medicare rates when it comes to the public option. Are these Senators so anti-public option they want to give it up entirely? What happens to them vis-a-vis their more liberal constituents?

Again, not understanding why we can't just twist Blanche Lincoln's arm....


This is why the compromise works (none / 0) (#17)
by Big Tent Democrat on Mon Oct 05, 2009 at 11:02:25 AM EST

Take Kent Conrad for example. He says he is worried about what will happen to North Dakota hospitals.

This is the solution - North Dakota can opt out. Hell, give him a North Dakota co-op option if he wants it.

This proposal addresses those concerns.


And there are other sweeteners as well (none / 0) (#18)
by Big Tent Democrat on Mon Oct 05, 2009 at 11:03:22 AM EST

Increased rural Medicare reimbursement rates, etc.


You think that Conrad (none / 0) (#23)
by lilburro on Mon Oct 05, 2009 at 11:23:33 AM EST

wouldn't vote for cloture otherwise? And what are you going to do about the House, where I doubt this Blue State Public Option bill has any chance of passing? How does this bill address the Medicare v. Negotiated Rates debate in the House?


Your nose counting seems quite off to me (none / 0) (#25)
by Big Tent Democrat on Mon Oct 05, 2009 at 11:27:53 AM EST

Pelosi has 217 votes for a robust public option imo.


A NATIONAL one (none / 0) (#26)
by Big Tent Democrat on Mon Oct 05, 2009 at 11:28:09 AM EST

not a Blue State one.


Ok (none / 0) (#32)
by lilburro on Mon Oct 05, 2009 at 11:45:42 AM EST

so I can believe it would get through the House. But I also believe that Kent Conrad cares more about insurance companies than the people of his state, and is going to vote against your proposal anyway. Or again, try to water it down.


: He needs some cover (none / 0) (#33)
by Big Tent Democrat on Mon Oct 05, 2009 at 11:58:19 AM EST

This takes away the biggest one he has.

In addition to my concerns listed in the other (none / 0) (#3)
by steviez314 on Mon Oct 05, 2009 at 10:33:04 AM EST

blog entry, I have another worry about this.

It feels like we are consigning a large segment of uninsured and underinsured people to the whims of their Red State governments.

Sure, eventually those state will come around--since everyone always wants what someone else has.

But until then, we leave sound public policy, fairness and humanity in the hands of the likes of Rick Perry, Mark Sanford, etc--i.e, those who have shown the least compassion for those in need.

well yeah (none / 0) (#7)
by Salo on Mon Oct 05, 2009 at 10:38:47 AM EST

That's the cost isn't it?


Expansion would occur later (none / 0) (#9)
by Big Tent Democrat on Mon Oct 05, 2009 at 10:40:45 AM EST

That would be most likely, but in the meantime (none / 0) (#15)
by steviez314 on Mon Oct 05, 2009 at 10:58:03 AM EST

we'll be blogging here about how Rick Perry is killing the uninsured, just like he's killing the innocent prisoners.

I know that politically, a Blue State option is attractive. It just seems, like most good politics, it also leaves a bad aftertaste.


Politics is a dirty business (5.00 / 1) (#16)
by Big Tent Democrat on Mon Oct 05, 2009 at 11:00:57 AM EST

: Hmmm..time for you to watch Mr. Smith Goes to (none / 0) (#19)
by steviez314 on Mon Oct 05, 2009 at 11:06:50 AM EST

Washington again, you cynic.

: I say Pinche Tejanos! (none / 0) (#29)
by Salo on Mon Oct 05, 2009 at 11:33:18 AM EST

If it can be made to work in a state like Cal or NY all the better.
If you think that the plan would help get a federal thing happen that's the best case scenario though.

Perhaps those w/o the PO (none / 0) (#12)
by nycstray on Mon Oct 05, 2009 at 10:43:16 AM EST

will start voting for their interests instead of against?


: You could say that (none / 0) (#13)
by TeresaInSnow2 on Mon Oct 05, 2009 at 10:51:38 AM EST

about any number of things that red states lack. Doesn't happen. Right wing media consolidated in those areas controls the outrage and the right wing stays in power.

If my Red legislature (none / 0) (#20)
by Maryb2004 on Mon Oct 05, 2009 at 11:12:05 AM EST

would vote to "opt out" it might finally spell the death knell for them. Let them try.

Besides, they won't. They never do.


The beauty of this approach is that (5.00 / 4) (#24)
by Big Tent Democrat on Mon Oct 05, 2009 at 11:27:15 AM EST

imo.


I'd call it the Healthy Patriots Act HPA (5.00 / 1) (#28)
by Salo on Mon Oct 05, 2009 at 11:30:43 AM EST

or the Freedom of Healthcare Act. FOHA.

You never did marketing did you?


: Will the Federalist Society support (5.00 / 1) (#39)
by oculus on Mon Oct 05, 2009 at 01:51:27 PM EST

this?

: Not really (none / 0) (#30)
by Big Tent Democrat on Mon Oct 05, 2009 at 11:37:35 AM EST

Though I did some in my brief stint at a Media company in the mid 90s.

It's hard to keep track of all the names (none / 0) (#37)
by lambert on Mon Oct 05, 2009 at 01:46:39 PM EST

I've been using:

[a|the] public [health insurance]? [option|plan]

but it seems I now need to alter that to:

[a|the] [Federalist?] public [health insurance]? [option|plan]

with a hat tip to Ezra Klein, Good Policy's Friend.

* * *

Too bad "progressives" weren't whipping for the Kucinich Amendment to permit single payer in the states months ago. You know, for a policy option that can actually be shown, by evidence, to work?

Good to see you Lambert (5.00 / 2) (#38)
by Big Tent Democrat on Mon Oct 05, 2009 at 01:47:56 PM EST

Too bad for a lot of things my friend.

Now is now and what do we do now?

You like to talk a lot about then.


No reason it couldn't be revived (none / 0) (#40)
by Salo on Mon Oct 05, 2009 at 02:00:32 PM EST

as a leftwing threat.


Threats have to be realistic (5.00 / 1) (#41)
by Big Tent Democrat on Mon Oct 05, 2009 at 02:03:45 PM EST

You can't rob a bank with a banana.


But if you try, you can eat the evidence: (5.00 / 2) (#42)
by steviez314 on Mon Oct 05, 2009 at 02:31:30 PM EST

North Carolina Teen Tries to Rob Bank With Banana, Then Eats It Before Police Arrive


: That is funny (none / 0) (#43)
by MO Blue on Mon Oct 05, 2009 at 02:38:19 PM EST

a concealed banana (none / 0) (#45)
by Salo on Mon Oct 05, 2009 at 02:44:44 PM EST

would be handy though.


That's (none / 0) (#47)
by TeresaInSnow2 on Mon Oct 05, 2009 at 03:00:36 PM EST

what they're using for their current policy proposals.


Single Payer is actually quite a deadly weapon. (none / 0) (#49)
by Salo on Mon Oct 05, 2009 at 03:04:27 PM EST

It wiped out real conservatism in Canada. It wiped out the same plague in the UK.

That BTD would call it a fake threat makes me wonder about how much he understands the political earthquake it represents.


It has to have a chance of passage (none / 0) (#50)
by Big Tent Democrat on Mon Oct 05, 2009 at 03:22:53 PM EST

It doesn't NOW.


I don't want to sound like Kucinich (none / 0) (#51)
by Salo on Mon Oct 05, 2009 at 03:28:12 PM EST

but it should be continuously floated in the House and voted on so that we see who's backing what in the House at least. Even the Senate perhaps.

it doesn't have to PASS. Especially if a backbencher is the one writing/ sponsoring it.


: Keep floating it (none / 0) (#52)
by Big Tent Democrat on Mon Oct 05, 2009 at 03:35:24 PM EST

Never seen me criticize anyone for that.

Is that a banana in your pocket (none / 0) (#48)
by jbindc on Mon Oct 05, 2009 at 03:04:10 PM EST

or are you just happy to see me...??

;)


Who has (none / 0) (#55)
by Spamlet on Mon Oct 05, 2009 at 09:23:13 PM EST

the biggest swinging concealed banana?


I resent the idea that single payer is theft... (none / 0) (#46)
by Salo on Mon Oct 05, 2009 at 02:46:38 PM EST

... and that congress is the bank.

Surely it's the other way round?

I get your point though.


Why do you think you can do anything? (none / 0) (#56)
by lambert on Mon Oct 05, 2009 at 10:52:06 PM EST

Why do you think that doing anything is better than doing nothing?

Personally, I'm a pressure from the left on policy kind of guy, so that's what I'm going to support. I think following the legislative detail on all this is about as useful as patrons of a sports bar second-guessing the manager -- the game is clearly out of their hands.

Worse, there's tremendous opportunity cost; a lot of smart people like yourself are using a lot of bandwidth following "the process dodge," when it's all about as useless as t*ts on a bull.


leaving alcohol regulation up to the states (none / 0) (#53)
by andgarden on Mon Oct 05, 2009 at 03:53:32 PM EST

has been a really curious exercise. Several, including Pennsylvania, have socialist liquor stores.

: It is very hard to find cherry brandy (none / 0) (#54)
by Militarytracy on Mon Oct 05, 2009 at 07:06:00 PM EST

for Fondue. In fact we didn't find any so left it out.