This whole debate tells me that the next thing that needs to be reformed are the rules of the Senate. Reputable polls shows sizeable majorities favor the public option….Yet, it supposedly requires 60 votes in the Senate to pass what this majority wants and voted for. Where’s is the will of the people in all this? The will of the industry and lobbies is well served. Lobbyists give massive amounts of money to influence the GOP and a few Blue Dogs, and the people are left out. Pass a strong public option then reform the Senate.
———————————————————————————————————————–
The “public option” is not a true “public option” if it isn’t available until 2013 and if it isn’t available to those with insurance. How can a plan which is so hobbled compete with private insurers?———————————————————————————————————————–
The entire Opt-Out scheme is an example of the Senate, and particularly Mr. Reid, acting irresponsibly. Had this happened when tMedicare was passed, it would be a shambles.
———————————————————————————————————————–
Does anyone think that an organization authorized and funded by Congress to make decisions on payment for claims is going to deny a claim by a patient, doctor, hospital, equipment manufacturer, or drug manufacturer located in Harry Reid’s district or contributing to his campaign fund? Or that of any other influential member of Congress? Cost containment indeed!

———————————————————————————————————————–
To facilitate compromise, make the Public Option available to people 55 and older. These are the people who need it most, who face the highest premiums from private insurers, and who have the greatest difficulty getting a job with health care if they are laid off or unemployed. This can be used as the experiment to see if private insurers can compete and if a government plan can be well run and fair to the marketplace.
———————————————————————————————————————–
It’s rather ironic that conservatives would deny Americans the opportunity to use a public insurance system under the pretext that the current system is the ‘greatest healthcare system in the world.’ If it’s so great, why would anyone want to choose an alternative? Where’s the threat?
———————————————————————————————————————–
Mr. Reid has been in the Senate long enough to know how dangerous his position is. When the Clintons’ healthcare reform initiative was derailed, all attempts at reform went away for years. By introducing a public option proposal that is guaranteed to fail, he risks throwing out the baby with the bathwater. There is nobody who does not think we need healthcare reform. But, can we afford to add to the $56 trillion national debt?
———————————————————————————————————————–
Great…make health care improvements, but allow a conservative state like mine to “opt out.” This move may make it through congress, but it will most certainly mean it will not happen here, in the state of Texas. Does this mean my federal taxes will pay for such an option in other states, yet not be available for me or my family?
———————————————————————————————————————–
It’s doubtful that any state will opt out. The politicians who ot out will face the wrath of their voters and legislators. Remember South Carolina and the stimulus money?
———————————————————————————————————————–
I’m self-employed and pay over $8000 per year for a mediocre policy with a high deductable and limited benefits. No dental, no mental. Thanks senator reid from the 39,000,000 residents of Texas and Florida where regressive legislatures and Republican governors are sure to opt out of this scheme. This opt-out for the states needs to die in conference.
———————————————————————————————————————–
I have to say, it’s politically shrewd of Democrats to pass an Opt-Out Public Plan. It forces conservative states to take a stand. If it fails, Democrats can say they did what they could, but will still take some heat for it. But if it works, they can claim a huge victory, and conservative politicians will have to perform the political equivalent of eating crow.
———————————————————————————————————————–
(The implication that) conservative states will definitely opt out glosses over the potential for political pressure in a given state, as folks see and hear how their neighbors are enjoying the public plan, and internalizing the facts that it’s the public plan that is going to do the most to rein in premiums and promote competition. Folks in Alabama, Georgia, Louisiana, Oklahoma, Arkansas, might start to get pretty vocal about their lack of any real, quality choice besides Blue Cross or Wellpoint.
———————————————————————————————————————–
Deep thought: when I fly over the flyover states that “opt out” of a Public Option, and I happen to have bought public insurance, will I become temporarily uninsured? Will the flight attendant make an announcement like:

“Warning – we are about to enter an opt-out zone; in the unlikely event of a forced landing, those who have public health insurance will have to pay for any medical treatment out of pocket. In the next five minutes, if you choose to purchase supplementary coverage for medical injuries that may occur while we are cross this opt-out zone, please ring the call button. Our partners at Humana accept all major credit cards.”
———————————————————————————————————————–
Obama claimed that we need a public option to keep insurance companies “honest.” So if they weren’t honest, why didn’t the government just go after them? And why is Obama basically shrugging his shoulders now at the idea of a public option?

Nothing has changed in the way the money grubbing insurance companies operate in the past several months, but Obama never fought for public option after claiming we needed it. So why did he ever claim that we needed it in the first place when he was never prepared to fight for it?
The insurance companies will become even more dishonest now.

Thanks for nothing, Obama. And spineless Harry Reid.
———————————————————————————————————————–
No state would opt out of the public option because they would be effectively subsidizing health care in other states while getting none themselves. Single payer will never fly in the U.S….so the public option (that mythic yet-to-be-precisely-defined brain storm from some liberal think tank) is the best the libs can get…
———————————————————————————————————————–
I’ll say it again – EVEN IF JESUS COMES DOWN AND BLESSES THIS BILL, REPUBLICANS WILL VOTE AGAINST THIS BILL BECAUSE THEY DON’T LIKE OBAMA. Sorry to say it.
———————————————————————————————————————–
When will health care reform take place?
1) When Americans learn to take care of themselves and not whine to the government for everything…Many problems can be solved by learning about your own body and what it needs and what it doesn’t need and how to take care of it…no excuses.

2) When the government is honest and will say that there are about 12 million that really need help and that 177 million are happy with what the present system with some improvements.

3) When the government quits being a bunch of little babies behind the wheel, outrageously vilifying insurance companies and doctors for their own agenda. Insurance companies are highlgy regulated by state governments…

4) When this present government gets out of bed with the Ambulance Chasers and the Slip and Slide Lawyers like Edwards. He, like others, bring phony science into court, turn those court rooms into soap operas and wipe out the High risk Obstetricians and drive up the cost of insurance so they can live in Palatial Estates.
———————————————————————————————————————–
Ugh. If employees can’t choose the public “option” over their employer’s plan, how will insurance companies be forced to compete?
The public option will be only for the uninsured or uninsurable and insurance companies will get a healthier pool of customers.
Tell me again how this is a good thing for anybody except the insurance industry?

This post by economics professor Bruce Webb from the Economics blog Angry Bear posits that any opt-out by states is basically unenforceable. Here is the money quote, which comes at the end:

Unless states can mandate that all individuals and employers purchase insurance in-state in addition to whatever coverage they may have through another state I just don’t see how opt-out does anything but prevent insurance sales on your own state exchange.

Which is why I don’t think supporters of the PO have much to worry about as concerns Opt-Out. It seems to just be a sop thrown to more conservative states who don’t want to get tinged with accusations of collaboration with socialism (or something). From a mechanical standpoint I just don’t see how you enforce this.

The full post below…

Some questions:

Let’s say I am from Washington State and have an individual plan through the Public Option and am visiting relatives in Indiana, an opt out state. And I fall down on the ice and break a bone. Under those circumstances I would think they would have to accept my insurance, opt out can’t mean that you just become uncovered every time you fly over Mississippi. That’s scenario one.

Scenario two. I move to Indiana temporarily for a contract job lasting more than a year. Surely I can maintain my coverage?

Scenario two A. I move to Indiana on that temporary contract and get engaged and marry my High School crush. (Hi LT!). Am I prevented from adding her to my plan?

Scenario three. I am an executive in Seattle for a company that buys insurance from the PO but maintain my full time residence in Coeur d’Alene Idaho (which as a live free or die red state opted out) and commute by plane. Is my Public Option plan affected?

Scenario four. I am a self-employed consultant based out of my lake front house in Coeur d’Alene but spend much of my time working for clients in Portland and Seattle. Whether or not I maintain a residence in either city what prevents me from stopping by the insurance office and signing up for the PO through the Exchange? Can one state actually prevent you from buying a perfectly legal product in another state and having your local doctor accept that product? What use then is the Commerce Clause?

Scenario five. I run a consulting shop incorporated in Idaho but with a small office in Portland and Billings and a larger one in Seattle. If Idaho has opted out I am actually prevented from buying a group plan on the Washington Exchange and including myself and my small Oregon and Montana staffs in it along with my larger Seattle group?

I could multiply scenarios endlessly but the question remains: how do individual states enforce an opt-out and under what circumstances? How much presence do you have to maintain in a state that offers the public option to be able to buy through their exchange?

Under our system states have a certain amount of freedom to decide what gets bought and sold within their state boundaries plus some rights to regulate what crosses those borders (for example fireworks). But I just don’t see how they can block medical providers from accepting health insurance policies written in another state or realistically how they can block their own citizens from purchasing such insurance. And certainly I can’t see setting up a system where tourists and part-time residents have their insurance honored but full time residents don’t.

Under our system states have a certain amount of freedom to decide what gets bought and sold within their state boundaries plus some rights to regulate what crosses those borders. But I just don’t see how they can block medical providers from accepting health insurance policies written in another state or realistically how they can block their own citizens from purchasing such insurance. And certainly I can’t see setting up a system where tourists and part-time residents have their insurance honored but full time residents don’t.

Unless states can mandate that all individuals and employers purchase insurance in-state in addition to whatever coverage they may have through another state I just don’t see how opt-out does anything but prevent insurance sales on your own state exchange.

Which is why I don’t think supporters of the PO have much to worry about as concerns Opt-Out. It seems to just be a sop thrown to more conservative states who don’t want to get tinged with accusations of collaboration with socialism (or something). From a mechanical standpoint I just don’t see how you enforce this.

Thanks to our sister site EconomyStory.org for scouting this out.

Enter LEFTY, who posts Rachel Maddow’s report on astroturfing town-hall protesters.

Enter LIBERTARIAN.

Libertarian: So does this invalidate my opposition to this “Healthcare” catastrophe our President is trying to cram down my throat?

Lefty: And you would prefer to keep the broken down crap that we have now???

Libertarian: You think THIS is broken? (Unconvincingly) I don’t want to argue. (Convincingly again) We’re going to get government controlled health care, regardless, and you’ll understand then.

Lefty: Let me guess…you are a Republican, right?

Libertarian: I am a registered independent. And a libertarian. I’m still reeling that you feel it should be illegal for a company to not insure someone. By your reasoning, why should I have health insurance? Just wait until I need it, then buy it. It would be illegal for it to be denied to me. Private healthcare insurance will disappear when Obama-care becomes law. You should research all of the details.

Lefty: Obviously, private insurance companies are not going away anytime soon, so we need to fix their strong hold on such policies as denying anyone with pre-existing conditions, or at least offering something to people who are denied through private insurance.

Enter LEFTY 2, carrying Democratic Talking Points.

Lefty 2: Under at least some of the current proposals, insurance will be mandatory, so you won’t be able to game the system by only insuring yourself when you’re sick. If you don’t have insurance, then you will pay a fee that goes to the overall program.

The current system is the most inefficient in the industrialized world. We pay the most per capita to insure the fewest people. A huge part of your premium goes to marketing and administrative costs, which includes a giant infrastructure dedicated to retroactively denying people coverage who are very sick based on specious claims of unreported pre-existing conditions.

People only think they are completely insured. But when you really need your insurance the most, you will find that is when the fine print becomes relevant—lifetime caps, denial of treatment, etc. This fabled “government bureacrat” that will be controlling health care under the Obama plan will have to really work hard to keep up with the very real corporate bureaucrat that most assuredly controls it now. Of course, if you are dead certain you or someone in your family will never get seriously ill, than there is no reason to change a thing.

LEFTY 3 enters.

Lefty 3: Kudos to Lefty 2! The eternally healthy and perpetually wealthy have nothing to gain through Health Care Reform–but everyone else does.

LEFTY 4 enters.

Lefty 4: (Speaking to Libertarian’s last point) “Private healthcare insurance will disappear when Obama-care becomes law. You should research all of the details.” Citation needed.

Libertarian: Citation needed? Look it up yourself. I don’t try to change anybody’s mind. You all believe what you already want to believe. So insurance will be MANDATORY? Everyone is REQUIRED to have it? No thank you. They can try to fine me. I’m not playing their totalitarian game.

Lefty 4: Sorry, Libertarian. That’s not how that works. You don’t make a sweeping generalization and then place the burden of proof on the shoulders of the other guy.

Enter CENTRIST PRAGMATIST, smoking a pipe.

Centrist Pragmatist: The first bill was poorly drafted and presented hastily. It is intellectually dishonest to suggest that any legislation as monumental as this should be one-sided and quickly enacted. We should expect this process to be well funded and well organized on both sides — and include plenty of spin. As with the entire political process, everyone should be allowed to participate, irrespective of whether their party “lost.” Right now, the Republicans don’t have the power to stop whatever the Dems want to pass, so their strongest chance to participate is through this sort of community activism.

Libertarian: Enjoy your “free” healthcare, sheeple.

Lefty 3: Libertarian, I don’t know you, but I think you’re probably feeling ganged up on. Let me say those who support reform are upset at the tactics being deployed at town meetings because their purpose appears to be stopping discourse. If the same energy were deployed in a more constructive way, to support a particular change in the proposed bill or to emphasize a particular problem, it might stand a chance of influencing the passage of a bill which, because of the current political balance, will be passed in some form this fall.

Libertarian: I don’t disagree Lefty 3. But ANY discourse on the subject is being characterized as Big (Pharma, AMA, Hospitals, Insurance, whatever) skewing the debate. There are people that legitimately feel this is a HUGE mistake. Cash-For-Clunkers, another government program, took less than a week to become a farce. NOTHING is free, and we’re ALL going to be paying more for less if it’s mandatory. I have chronic health problems that VERY FEW know about. I’m not insured. I work for a small hourly wage. I spent 4 months of last year in the hospital, and flat-lined twice. Supposedly, this would be a boon to me. I’m not falling for it. When it destroys our health care system, I WILL leave the country, on a sailboat, and live simply somewhere south, letting the global big-government pandemic chase me around the globe until there’s nowhere to run. I’m not an end of the world alarmist, I think we’ll weather all of this, but I’ll chose to not participate

Lefty 4: Oh my god. You actually said “sheeple,” and unironically, too.

Libertarian: OMG, you made an assumption that turns out to be false! I’m shocked!

Enter LEFTY 5.

Lefty 5: Libertarian, I hate to ask, but since you brought it up, if you don’t have insurance and work for a small hourly wage, how did you pay for 4 months in the hospital?

Libertarian: I’m still paying for it. Slowly. But I’m paying for it, not other people.

Lefty 4: I’m sorry. I can’t take seriously anyone who uses the word “sheeple.” Have a good day.

Lefty: Libertarian, you are deluding yourself if you think paying off your hospital debt slowly means you are being responsible for it all yourself. The hospital is carrying your debt for you as long as you take to pay it off. They have already paid off the doctors that treated you, so that money has to come from somewhere else until you pay it back. If you take too long, they will have to write it off as a loss and if everyone who could not afford the outrageous bills that hospitals charge took it upon themselves to pay it back as they could, the hospitals would probably go out of business, as this is not a sound business plan. Which further reinforces the idea that everyone needs to be insured. Including you, so you don’t pay things back slowly.

Lefty 2: I think we’ve basically come to the end of the road debating Libertarian. I am paying nearly $16,000 per year for COBRA coverage for my family, which means I’m working a good part of my day for the insurance company. I could choose not to pay it, but if I, my wife, or my daughter gets sick, who’s going to pay for it then? Family, friends, or the general public.

Fear-mongering people have claimed the end of civilization is nigh for every social benefit granted Americans from the end of slavery to Social Security to Medicare. The true sheep are the people who blindly follow a free market ideology despite all evidence to the contrary. These people live inside their heads spinning out fantasies even Ayn Rand wouldn’t try to pawn off on her readers.

Enter CONSERVATIVE.

Conservative: Here’s a 35 year old woman on vacation, celebrating her 10th wedding anniversary, so upset with situation that she attends her first town hall–yep, more fake grass roots, keep telling yourself that. (CONSERVATIVE posts a Fox News report.)

Lefty: Conservative, no one said the town hall meetings are ONLY filled with fake grass roots! But they ARE there. And they are spreading misinformation, which is why people like that woman on vacation is out at the town hall meeting horrified. Old people are coming out to meetings and saying stuff like “Keep the government out of my Medicare!” People are clueless and frightened. Spreading misinformation about what may happen does not help. Something MUST be done, so if the right does not like what the current bill states, then they should work together to make it acceptable. Otherwise, we get to keep this system where the only winners are the insurance companies! Is that what you are advocating?

A silence falls over the discussion, as it’s time to watch “Entourage.”

THE END…?

This single panel has generated over 1,000 comments. Here’s an interesting little side discussion on Medicare:

Comment:

-Medicare works. Lower the eligibility so more people can use it. Taking something that works, making it better, and expanding it to serve more people is simple.

Replies:

-Medicare works? It’s going to be bankrupt in 10 years – even worse than Social Security.

-The CBO has already put Social Security as insolvent by 2017 and I’m sure Medicare will follow the same route since more older folk will be using it. That means either looking toward market reforms or cutting benefits.

-Nobody is claiming that Medicare is free or properly financed. Just that it works.

-Many of the doctors I see don’t take Medicare. Here’s a hint: It’s not because it’s awesome.