I don’t support a public option opt-out (and you shouldn’t either)

In the ongoing healthcare debate, the “opt-out” provision is the hot ’solution’ to the dispute over a public option plan for the health insurance exchange. Here’s how proponents explain it: The public option would be part of the health care reform package, but individual states could opt out of including it as part of the health insurance exchanges. The decision to opt out would rest with state legislatures or governors.
Sounds like a great compromise, doesn’t it? I thought so too, at first. It gives states autonomy over their own health insurance options while preserving a robust public option. Then I began working through the details, using my own state as a prototype.

California, as everyone knows, is in a state of budget meltdown. There’s a complete impasse between the governor and the legislature, representatives who actually agree with a tax increase are afraid to vote for it because of our idiotic recall laws here, and so nothing is resolved, nothing can be resolved, and the citizens of California are just left with a colossal, statewide mess.

Let’s toss a health insurance exchange and public option into the mix. Let’s say for the sake of argument that the opt-out power rests with the governor. Do you see where I’m going with this? Suddenly, the question of our access to more affordable health care rests in the hands of one person, and that person happens to be a Republican who is opposed to any ‘government plan’. Moreover, the largest health insurers would have no problem putting pressure on the governor to make that choice.

The opt-out provision politicizes our health care and health insurance choices more than they already are. If this provision were vested in the people, if it took a majority vote to opt out, I’d say it was fair. But placing that power into a process which is already highly dogmatic and partisan, and where recalls are used as a stick to paralyze elected representatives is simply a formula for disaster, exclusion, and deeper burdens on the state budget than we already have.

Looking at the national picture, I can envision a scenario where all of the Southern states and rural midwestern states where affordable health care and insurance is desperately needed are opted out, leaving citizens stuck with an individual mandate and no affordable options.

There’s really no excuse for not including a public option as one of the choices in the exchange. As a practical rather than political matter, it really is the only way to really push for competitive insurance rates. It’s one option among many.

If the concern is over creating another bureaucracy, then the practical alternative is an expansion of Medicare coverage as an available option to any American not covered by employer-provided health insurance with appropriate premium payments for those who choose it. As a political matter, Republicans will always oppose Medicare until it succeeds, at which time they will embrace it, even use it as a weapon to hammer the elderly with irrational fear of losing theirs, just as they did this summer.

Whatever the final public option looks like, the decision to opt out of it should rest only with the individual rather than the politicians who will use it as a hammer, a carrot, or a football.

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Tagged as: budget, California, health care reform, horsetrading, opt out, public option, schwarzenegger