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A Blue State Public Option?

By Big Tent Democrat, Section Other Politics
Posted on Mon Sep 14, 2009 at 12:05:02 PM EST
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Late in the day on HCR for creative thinking, but Ezra Klein writes:

This, from a smart reader, seems like a better compromise than a "trigger":

Maybe we should be allowing states to choose if they bring in a public option themselves? At least we can get CA, NY, and many of the big pieces into play and see how it works. That seems far better than giving up the whole pie, as they seem intent on doing.

. . . This would be particularly true if states could choose whether or not to tie their public option to Medicare rates, thus creating an insurance alternative that would actually work to provide savings. . . .

If you allowed states to band together in "public option co-ops" and only imposed an individual mandate in states with public options, you would have my support, FWTW (nothing.) This way, the red states could be happy with lousy health care and blue states could be happy with real health care reform. Of course, that's abandoning a lot of Dems in red states (and a lot of Progressive Caucus members hail from some of those states, CBC members especially.) They'll rightly protest. But "incrementalism" is the watchword right?

Speaking for me only

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    A Blue State Public Option? | 76 comments (76 topical)

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    Not going to happen (5.00 / 2) (#20)
    by Coral on Mon Sep 14, 2009 at 12:32:06 PM EST
    Interesting idea, though. The mandates issue is really tough. The insurers want it, in exchange for no pre-existing conditions, etc. Without very generous subsidies for people near median household income levels, mandates will be extremely unpopular.

    I am curious to see how they are going to bridge the gap if they don't go with public option available to uninsured no matter where they live.

    Sometimes I wonder if policy makers--and this includes Obama--have any idea how financially stressed a broad swath of Americans in the middle of the income distribution are.

    This statement says it all (none / 0) (#76)
    by cal1942 on Tue Sep 15, 2009 at 08:28:07 AM EST
    Sometimes I wonder if policy makers--and this includes Obama--have any idea how financially stressed a broad swath of Americans in the middle of the income distribution are.

    They don't know.  Everything done in the Village is done with vision that is blindered by the Beltway.

    The same attitudes and ideas carom off the beltway to be recycled in the Village.  

    And BTW, especially Obama.  We're probably witnessing a permanent major shrinkage of the middle class.

    Parent

    Yay! (5.00 / 2) (#48)
    by lambert on Mon Sep 14, 2009 at 03:52:32 PM EST
    Not content with never pushing single payer, "progressives" now seek to undercut single payer at the state level, where the Kucinich amendment to permit single payer experiments is already in play.

    Cue the calls of "idiot..."

    Mandates are the issue (5.00 / 1) (#55)
    by Big Tent Democrat on Mon Sep 14, 2009 at 05:50:16 PM EST
    Get the chip off of your shoulder.

    Parent
    Feh (5.00 / 1) (#56)
    by lambert on Mon Sep 14, 2009 at 06:24:52 PM EST
    Pounding the table again!

    Parent
    Ugh, no (none / 0) (#1)
    by andgarden on Mon Sep 14, 2009 at 12:09:15 PM EST
    All you'd be doing is replacing the difficulty of passing a public option in with legislature with 50. I doubt if there are more than three states where it would be possible to do this.

    Worse than a trigger IMO.

    That is, in one legislature (none / 0) (#2)
    by andgarden on Mon Sep 14, 2009 at 12:10:00 PM EST


    Parent
    No mandates until they do (none / 0) (#3)
    by Big Tent Democrat on Mon Sep 14, 2009 at 12:12:07 PM EST
    but all the Medicaid funding and subsidies and preexisting conditions and other stuff.

    What's wrong with that?

    Parent

    Based on what I can glean from the (5.00 / 2) (#6)
    by inclusiveheart on Mon Sep 14, 2009 at 12:16:29 PM EST
    current plans, none of that will affect affordability for the vast majority of Americans - which is one of the things that I thought we were trying to address in this effort to reform the healthcare system.

    Little did I know, this effort was really always about further propping up the private insurers' failed business model.

    Parent

    Yea I missed that memo too (5.00 / 1) (#59)
    by DWCG on Mon Sep 14, 2009 at 08:53:46 PM EST
    Somewhere along the line health care reform transformed into a health insurance give away.  And a bunch of liberal bloggers apparently have no problem with it.

    Parent
    Why does it matter who gets the money? (none / 0) (#62)
    by s5 on Mon Sep 14, 2009 at 09:23:06 PM EST
    If we have universal health care, if it's affordable, if costs are kept in check, if premiums are stable, and if health outcomes improve, why does it matter who gets the money? Those are a lot of "if"s, I know, but if we can achieve those goals, then that's what matters.

    I agree with BTD that a mandate and a public option must go hand in hand. A mandate won't work without public competition, and no one should pretend otherwise just to get a bill passed.

    But I disagree with the reflexive desire to call everything "a giveaway" if it involves subsidies to private corporations. If it's working for the people and if we can afford it, then there's no problem. Corporations can waste money and the government can waste money. The point is to make sure we're getting value, regardless of who is providing that value.

    I agree that single payer provides the most value. But since we're not getting single payer, we shouldn't fight an effective plan just because corporations are involved. We should fight to make sure the corporation isn't ripping us off, and to have a way to cut them out if they are (ie. a public option).

    When the bill passes, we'll move from having a mishmash of a system that kills people to a mishmash of a system that provides decent health care. The next fight will be to clean up the mishmash. One thing I didn't agree with from Obama's speech was the idea that he'll be the last president to try and reform health care. Unless, of course, he meant that he'll pass single payer in his second term. But somehow I doubt that's what he meant. :)

    Parent

    10 yard penalty: illegal use of straw man argument (5.00 / 1) (#65)
    by DWCG on Mon Sep 14, 2009 at 11:24:16 PM EST
    we shouldn't fight an effective plan just because corporations are involved.

    Mischaracterizing opposition to this plan, may make it seem easier to rebut, but it doesn't change the facts.  There are several severe flaws in Obamacare, among them the increased federal investment in health insurance industry.  We're already being ripped off.  We spend twice as much as any other industrialized nation and half of the adult population (sans elders) is either uninsured or underinsured.  

    Adding fuel to the fire is solely going to subsidize insurance industry profits.  It is stupid, plain and simple.  Many seem to have forgotten the first step in digging oneself out of a ditch they created: STOP DIGGING!  

    The same people seem to have forgotten that when the original concept of the public option was proposed (you know the one that predicted 130 million would be covered, not the current one that is between zero and 11 million) that limiting federal subsidies solely to the public plan was one of the 5 major principles.

    And by the way, these aren't corporations who do a necessary job by providing an essential service like the Joe American who runs the corner convenient store, which you seem to imply.  They're a middle man, whose sole purpose is to get in the way of health care.  It's a business, whose entire model is predicated on providing the least amount of health care service possible at the highest possible cost.

    Again, this is one of those DUH! things that some have seemed to have forgotten as health care reform transformed into health insurance reform.

    And by the way I'm not a single-payer or bust advocate.  I just know that this plan is a P.O.S. and I have no problem being truthful about it, instead of living in this alternative universe where the stars all align perfectly all of the time and the sun starts rising in the west and setting in the east.  Furthermore, I recognize the bigger impediment to enacting single-payer is not the corporations and bought-off White House and Congress, but the dumb Americans who are under this illusion that insurance companies offer something to the health care equation.  

    I am an advocate for Medicare Buy-In, so that the rest of Americans who aren't under the delusional that private insurance works, and the business who are tired of being ripped off by their big cousins can get the health care they need at a fraction of the cost that private insurers charge.

    Incidentally, any faith in the public option is totally un-researched.  Just google Kip Sullivan.

    Parent

    Just google (none / 0) (#73)
    by Big Tent Democrat on Tue Sep 15, 2009 at 08:11:37 AM EST
    posts the agree with my point of view. Convincing indeed.

    Parent
    You missed a lot more than that (none / 0) (#72)
    by Big Tent Democrat on Tue Sep 15, 2009 at 08:10:20 AM EST
    Like the point of my post.

    Parent
    The preexisting condition clauses (none / 0) (#10)
    by Militarytracy on Mon Sep 14, 2009 at 12:20:11 PM EST
    are really damaging people as well as the lifetime caps in coverage.  It may not immediately affect affordability but it would affect insurers accountability and that is a big one too. No more bankruptcy due to insurance coverage that is junk.

    Parent
    Trust me - the caps will stick around; (5.00 / 2) (#15)
    by inclusiveheart on Mon Sep 14, 2009 at 12:27:43 PM EST
    the pre-exising conditions will be covered but they will still yield a premium price; the delays in care will continue to debilitate and/or kill people; and the private insurers will never be accountable.  And with mandatory participation as it is described now, we'll end up building Healthcare Debtors' Prisons instead of finding ways of reducing the cost of insurance - because god forbid we'd cut into the private insurers' profit margins.

    Parent
    Sure (none / 0) (#71)
    by Big Tent Democrat on Tue Sep 15, 2009 at 08:09:52 AM EST
    My thinking is about something different.

    I thought that was clear in the post.

    Parent

    Fine, but call it something else (none / 0) (#5)
    by andgarden on Mon Sep 14, 2009 at 12:14:56 PM EST
    And BTW, if you do the preexisting condition stuff without mandates, you'll probably not get more people insured. The insurers will have to raise their rates.

    Parent
    Not all mandates are created equal. (5.00 / 2) (#18)
    by inclusiveheart on Mon Sep 14, 2009 at 12:31:25 PM EST
    It is a vastly different thing to be required to pay a private entity than it is to be required to pay your government.

    People really need to start focusing on the difference here because it will be extremely important whether or not the private insurers can really be held accountable for delivering their services in return for these compulsory premiums.

    Without a real public option open to all, the mandates are just legalized indentured servitude.

    Parent

    Exactly (5.00 / 2) (#60)
    by DWCG on Mon Sep 14, 2009 at 09:13:54 PM EST
    There's a big difference between:

    A) a mandate that requires a person to buy insurance, firewalls the public option to "less than 5% of the population," and imposes a tax, enforced by the IRS, for the 95% who dare to refuse to buy a corporate product that everyone knows won't be there when it is needed (the whole point of insurance) and undeniably be too expensive.

    vs.

    B) a mandate that auto-enrolls anyone who doesn't want or have private insurance into a public plan that is priced very low, which with Medicare open for anyone or business to buy-in totally could do at probably less than $100 bucks a month.

    Yet on both fronts: allowing anyone to buy into Medicare and thereby having an affordable public plan, progressive bloggers are totally out to lunch.

    This is straight political suicide, and none of them seems to GET THAT!  Is there any wonder not one Republican is afraid of NOT voting for it?  They'll be beating Democrats over the head for this for a few election cycles.

    I'd bet you that if we had a plan that allowed a person 60 years old to go from paying $600-1200 a month for private insurance to $100 to buy into Medicare we'd bet no less than 1/3rd of Republican Senators on board.  Oh they'll huff-and-puff, just like they did when Medicare was originally passed, but when it comes time to count the votes they'd vote Yay! because they wouldn't want the Democratic Party to solely claim they drastically cut America's health insurance bills.

    This bill's a P.O.S. though, so there's nothing for Republicans to possibly fear.

    Parent

    Precisely the point of my post (none / 0) (#75)
    by Big Tent Democrat on Tue Sep 15, 2009 at 08:12:50 AM EST
    What part of it did you not understand?

    Parent
    No PO, no mandates (5.00 / 1) (#74)
    by Big Tent Democrat on Tue Sep 15, 2009 at 08:12:21 AM EST
    on a state level.

    Parent
    Public Option with Medicare rates (5.00 / 1) (#19)
    by Big Tent Democrat on Mon Sep 14, 2009 at 12:31:40 PM EST


    Parent
    Yes, but how do you get there? (none / 0) (#21)
    by andgarden on Mon Sep 14, 2009 at 12:32:46 PM EST
    Not by leaving it up to the states to implement a public option.

    Parent
    Again NO MANDATES (5.00 / 1) (#23)
    by Big Tent Democrat on Mon Sep 14, 2009 at 12:34:08 PM EST
    without a public option.

    Parent
    Why would rates need to be raised? (none / 0) (#7)
    by Militarytracy on Mon Sep 14, 2009 at 12:17:57 PM EST
    I need to see their financials before that's an option.  There are no preexisting conditions in other industrialized countries and their costs aren't insane.

    Parent
    Pretty straightforward: people won't buy (none / 0) (#9)
    by andgarden on Mon Sep 14, 2009 at 12:19:50 PM EST
    until they need coverage. If we're going to have a private system, this is a real concern.

    Parent
    If insurers can't be accountable (5.00 / 1) (#11)
    by Militarytracy on Mon Sep 14, 2009 at 12:23:49 PM EST
    then we can't have a private system.

    Parent
    Not having a private system is off the table (none / 0) (#13)
    by andgarden on Mon Sep 14, 2009 at 12:24:45 PM EST


    Parent
    And I guess not having a public option (none / 0) (#17)
    by Militarytracy on Mon Sep 14, 2009 at 12:29:30 PM EST
    is off the table if we are going to address reality :)

    Parent
    I could go for this in a very big way (none / 0) (#4)
    by Militarytracy on Mon Sep 14, 2009 at 12:14:13 PM EST
    And I live in the last state that would probably ever get a public option.  I live in a state with a huge proportion of uninsured as well and a state that sees and experiences itself as deeply red.  It would be fascinating to watch, and a shift in awarenesses could even be encouraged.

    Well, a lot of the voters that I know (none / 0) (#8)
    by inclusiveheart on Mon Sep 14, 2009 at 12:18:37 PM EST
    in your state - my ancestral home - are already on Medicaid and/or Social Security disability - so I am not so sure that this incrementalism would ever lead to more progress down the road.  I've never been anywhere in my life where I've met more people living on the public dole and railing against the "govinmint!"

    Parent
    There is no Medicaid for adults here (none / 0) (#14)
    by Militarytracy on Mon Sep 14, 2009 at 12:26:23 PM EST
    that aren't destitute, it only exists for children.  According to the website that Waxman put up, Alabama is in deep trouble with uninsured adults.

    Parent
    The state is pretty darned broke right now (none / 0) (#16)
    by Militarytracy on Mon Sep 14, 2009 at 12:28:28 PM EST
    the public health department seems to have a full waiting room whenever I've been anywhere near it though.  We live very close to it.  Just a couple of country blocks down the road.  Don't know what services they provide.

    Parent
    What is a country block? :) (none / 0) (#40)
    by samtaylor2 on Mon Sep 14, 2009 at 02:20:09 PM EST


    Parent
    About a 1/4 of a mile (none / 0) (#64)
    by Militarytracy on Mon Sep 14, 2009 at 10:50:47 PM EST


    Parent
    Let's go even further: (none / 0) (#12)
    by steviez314 on Mon Sep 14, 2009 at 12:24:44 PM EST
    Any state whose legislature passes a "state sovereignty" resolution should have all its post offices closed.

    Naw (5.00 / 1) (#22)
    by Big Tent Democrat on Mon Sep 14, 2009 at 12:33:19 PM EST
    That's expressly in the constitution. I like the idea of closing the Interstates to any traffic not related to the post office.

    Parent
    OK then, how about ... (none / 0) (#27)
    by steviez314 on Mon Sep 14, 2009 at 01:20:11 PM EST
    ...cancelling their national flood insurance.

    ...letting their pharmacies sell any drugs, FDA approved or not.

    ... Same thing with food.

    ...

    Parent

    flood insurance...bad joke (none / 0) (#36)
    by diogenes on Mon Sep 14, 2009 at 02:07:18 PM EST
    Nationally subsidized flood insurance is what enables people to build houses in risky flood plains and makes everyone else subsidize their risks.  If the public option is going to be the same sort of market failure as flood insurance, then we really are better off not having it.

    Parent
    See New (none / 0) (#42)
    by Wile ECoyote on Mon Sep 14, 2009 at 02:24:46 PM EST
    Orleans.

    Parent
    With you on the flood insurance issue (none / 0) (#51)
    by gyrfalcon on Mon Sep 14, 2009 at 04:17:14 PM EST
    but I fail to see how that relates in any way to public health insurance.

    Parent
    Feingold's already suggested (none / 0) (#24)
    by Ben Masel on Mon Sep 14, 2009 at 12:48:19 PM EST
    State by State as his preferred fallback plan.

    His former top staffer, Jon Erpenbach, now in Russ' old State Senate seat, got a public option bill through the Senate last year, is and redrafting to have it ready for another go should Federal legislation fail. With the Assembly now in Democratic hands, it'd likely pass.

    I suggested a state by state (none / 0) (#31)
    by SGITR on Mon Sep 14, 2009 at 01:31:53 PM EST
    HCR movement here last week and most who responded didn't get it. It's not a hard concept. You lobby blue states to reform HC in a progressive way and when you have enough of them momentum takes hold across the country.

    Health care is legislated at the state level anyway so that is really the place to affect change without having to deal with national politicians and Senate rules, etc. In other words bypass the DC logjam.

    And this can be done regardless of what happens with the current federal reform. If federal reform dies a state by state movement can still move forward. If federal reform is enacted a state by state movement can still move forward with improvements that add to and enhance the federal plan. The only hold back to the state by state movement is their finances. So a state by state movement may not be an overnight solution but it is a viable solution and a doable solution and a solution that can take us were we want to go incrementally.

    Parent

    I suggested a state by state (none / 0) (#32)
    by SGITR on Mon Sep 14, 2009 at 01:32:53 PM EST
    HCR movement here last week and most who responded didn't get it. It's not a hard concept. You lobby blue states to reform HC in a progressive way and when you have enough of them momentum takes hold across the country.

    Health care is legislated at the state level anyway so that is really the place to affect change without having to deal with national politicians and Senate rules, etc. In other words bypass the DC logjam.

    And this can be done regardless of what happens with the current federal reform. If federal reform dies a state by state movement can still move forward. If federal reform is enacted a state by state movement can still move forward with improvements that add to and enhance the federal plan. The only hold back to the state by state movement is their finances. So a state by state movement may not be an overnight solution but it is a viable solution and a doable solution and a solution that can take us were we want to go incrementally.

    Parent

    Google Dirigo (none / 0) (#66)
    by DWCG on Mon Sep 14, 2009 at 11:29:21 PM EST
    Maine's failed public option.

    People seem to be proposing a solution to a problem that that completely misunderstand.  It really only takes a few hours to get up to speed to understand the major impediments to enacting any newly created plan in the health insurance market.

    Parent

    Stop insulting and start (5.00 / 1) (#70)
    by Big Tent Democrat on Tue Sep 15, 2009 at 08:08:39 AM EST
    providing info if you have any.

     

    Parent

    Divide and conquer? (none / 0) (#25)
    by oldpro on Mon Sep 14, 2009 at 12:57:35 PM EST
    OK with me.

    That takes care of post-partisanship nicely.

    Heh (none / 0) (#26)
    by cawaltz on Mon Sep 14, 2009 at 01:19:05 PM EST
    This way they can get screwed later on in much the same way that states that enacted a living wage have managed to get screwed because their standard of living is higher. (See housing programs or health care programs which have ceilings which left out places like California).

    Frankly, I have my doubts about "state plans." Particularly when it is the states which have managed to botch up programs like Medicaid.

    My sentiments exactly (none / 0) (#67)
    by DWCG on Mon Sep 14, 2009 at 11:35:37 PM EST
    In fact, I think one of the first moves towards creating a Medicare Buy-In program would be to transfer all Medicaid and SCHIP patients to Medicare.  It would simply be subsidized under the Medicare Buy-In program.

    One way I'd get the state's on board is by letting them keep the money they're currently using to match federal dollars.  

    Parent

    State plans (none / 0) (#28)
    by TeresaInSnow2 on Mon Sep 14, 2009 at 01:29:46 PM EST
    If private insurers providing individual plans don't like the state plan, they'll just leave the state.  I know this because it's already happened once in WA.  Insurers returned once they got everything they wanted.

    Now if the reason for leaving is because of the public option, it might be a good thing -- if the public option is funded appropriately.

    Otherwise, it could leave a whole lot of people without insurance.

    The solution (5.00 / 1) (#29)
    by TeresaInSnow2 on Mon Sep 14, 2009 at 01:30:42 PM EST
    to the state plan dilemma has to be a NATIONAL plan, which prevents insurers from cherry picking the most insurer-friendly states.

    Parent
    Actually (none / 0) (#30)
    by TeresaInSnow2 on Mon Sep 14, 2009 at 01:31:48 PM EST
    the solution is single payer, but here in reality, the other thing is the consolation prize.

    Parent
    You can't force (none / 0) (#34)
    by SGITR on Mon Sep 14, 2009 at 01:38:34 PM EST
    insurance companies to insure in every state even with a national plan.

    Parent
    Yes (none / 0) (#41)
    by TeresaInSnow2 on Mon Sep 14, 2009 at 02:23:23 PM EST
    but if the public option regulations were uniform across states, you take away the desire to cherry pick insurer friendly states.  

    Why do you think so many credit card companies are in Delaware?  The same kind of conglomeration could happen (but involving more states) if the Public Option were differently implemented in different states.

    Parent

    Not Really (none / 0) (#46)
    by SGITR on Mon Sep 14, 2009 at 03:23:43 PM EST
    The reason your scenario won't work is because even if their was one of the public options enacted as law it would only cover a small percentage of the public because that is how they are drafted in the various bills. Which would leave a big majority of people with private insurance that is not subject to public option laws.

    Parent
    How do you know? (none / 0) (#52)
    by TeresaInSnow2 on Mon Sep 14, 2009 at 04:33:16 PM EST
    If states managed the program the coverage would depend on the state.

    Parent
    Well (none / 0) (#43)
    by cawaltz on Mon Sep 14, 2009 at 02:37:04 PM EST
    acually we could. All it would take would be saying either you cover people in all the states or you no longer get to be an insurer. Yeah, they could always choose to opt out(which is more than Americans are being told they'll get as an option) but it would mean forgoing any profit.

    Parent
    You really do live (none / 0) (#47)
    by SGITR on Mon Sep 14, 2009 at 03:29:20 PM EST
    in a fantasy world on some things. What gives the government the right to say a company, any company,  can't do business? You are aware that insurance companies are not regulated, licensed, or controlled in any way by the federal government aren't you?

    Parent
    The same thing (5.00 / 1) (#49)
    by cawaltz on Mon Sep 14, 2009 at 03:54:50 PM EST
    thazt gives the goivernment the right to mandate individuals purchase things.

    Just because you don't like regulation doesn't mean it's fantasy.

    Parent

    Individuals (none / 0) (#53)
    by TeresaInSnow2 on Mon Sep 14, 2009 at 04:34:39 PM EST
    don't have lobbyists working on their behalf.  So we get taxed, but doubtful big insurance companies would be disallowed from doing business.  

    Parent
    The disallowance wouldn't be (none / 0) (#63)
    by cawaltz on Mon Sep 14, 2009 at 09:49:15 PM EST
    to do business. Everyone would be free to do business providing they met specific standards. My opinion that a 50 state piecemeal system is inefficient isn't even unconventional. If you look for Federal Insurance Repulation then you would be able to see that its been proposed to Congress before(although it appears that the state regulators aren't anxious to let go of the reigns since NAIC applauded leaving the piecemeal system intact).

    Parent
    What TeresaInSnow2 said (none / 0) (#54)
    by SGITR on Mon Sep 14, 2009 at 05:03:43 PM EST
    in response to you.

    Parent
    I like this idea (none / 0) (#33)
    by abdiel on Mon Sep 14, 2009 at 01:35:56 PM EST
    but I'm surprised you're going states' rights on health care.  However, I think the article is a bit premature, both on what states would approve it and how effective the change will be.  CA is deep in the fiscal hole and they have illegal immigration as huge obstacles in the way.  I'd actually think TX would get it sooner.

    Also, any switch to the public option is likely to be chaotic for at least the first five years of the new plan.  If you're expecting a clean change and immediate improvements, you're either very naive or very stupid.  

    Health care is (none / 0) (#35)
    by SGITR on Mon Sep 14, 2009 at 01:44:27 PM EST
    already governed by state rights. Other that Medicare and Medicaid funding all insurance rules are set by the states.

    Parent
    I'm surprised he's going states rights AT ALL (none / 0) (#45)
    by cawaltz on Mon Sep 14, 2009 at 03:20:15 PM EST
    Last I remembered BTD was not a big fan of states rights. He was more in line with the Federalist position which argued for a strong central government.

    Parent
    state by state? (none / 0) (#37)
    by diogenes on Mon Sep 14, 2009 at 02:08:20 PM EST
    You have state by state already--go ahead and do it.  You don't need obamacare for that.  Massachusetts did something like this.

    no public option (5.00 / 1) (#38)
    by CST on Mon Sep 14, 2009 at 02:10:50 PM EST
    in MA

    Parent
    but Massachusetts COULD"VE (none / 0) (#58)
    by diogenes on Mon Sep 14, 2009 at 07:54:02 PM EST
    Massachusetts could have had a public option, no?  As could any other state.  As if deficit-ridden NY or California could afford to put any more money into health care in the next several years.

    Parent
    No mandates then (none / 0) (#39)
    by Big Tent Democrat on Mon Sep 14, 2009 at 02:16:50 PM EST
    Leave the rest of the bill intact, we got a deal.

    Parent
    Well, (none / 0) (#44)
    by lilburro on Mon Sep 14, 2009 at 03:06:26 PM EST
    as someone living in the South, this is a depressing endgame.  I would never get this public option opportunity.  It sounds terrible to me.  And I'm assuming that some federal money would be required to get the ball rolling on the state by state public options - and I would guess that while South Carolina wants to refuse the stimulus money it also does not want to be denied it by the government, or watch others line their pockets.  This sounds like a great way to make the South and lots of other regions Republican permanently.

    Dennis Kucinich proposed exactly this (none / 0) (#50)
    by Bornagaindem on Mon Sep 14, 2009 at 04:00:27 PM EST
    leaving it up to the states but it is going to be expressly forbidden. Does anyone honestly think anything Dennis Kucinich proposes is going though???

    Either we're baking a cake, or we're not. (none / 0) (#57)
    by s5 on Mon Sep 14, 2009 at 06:26:07 PM EST
    Problem is, without mandates, you can't have community rating and pre-existing condition coverage. So we need the mandates. But I agree that we shouldn't do mandates without the public option.

    This bill is like baking a cake. You can't leave out any of the essential ingredients, and if you try, it's not cake. Leave out baking powder, and it doesn't rise. Leave out sugar, and it's not sweet. Leave out flour, and it's just mush.

    Without the public option, you can't have mandates. But without mandates, you can't have community rating and pre-existing condition coverage. And without any of those things, there's no cost control. We're back to a non-reform expand-existing-subsidies bill. Which wouldn't be a bad bill in normal times, but as the outcome of a reform process, it's a failure.

    So there are really no deals to be had, unfortunately. Either we're baking a cake, or we're not.

    Do any of you do any kind of research? (none / 0) (#61)
    by DWCG on Mon Sep 14, 2009 at 09:16:45 PM EST
    Geez just read about Maine's public option.

    So much for taking the high-and-mighty role against the mainstream media for failing to do basic research.

    Care to enlighten us idiots? (none / 0) (#69)
    by Big Tent Democrat on Tue Sep 15, 2009 at 08:06:58 AM EST
    Or just insult us?

    Parent
    that is what they do abroad (none / 0) (#68)
    by Oceandweller on Tue Sep 15, 2009 at 02:42:32 AM EST
    The so called NHS only works for England. Wales, Scotland , Northern Ireland have a different system, France CNAM is not working in Alsace , they have a different system. Yet it works. Exemplarity is the motto. Let each state offer its option, and let the ones who refuse the public option bear witness to what works and what does not work. Dont forget the CNAM/NHS were not built on the snap of fingers but took 50ys and are to my knowledge still works in progress. No shame in that and that would leave the door open to many changes of heart later. Never close doors...

    A Blue State Public Option? | 76 comments (76 topical)

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