A Game Changer?


A reader chimes in on the opt-out plan …

It’s a game changer. The proposal is consonant with Obama’s own approach to reform – what Cass Sunstein labeled ‘visionary minimalism’ – in its incremental, consensual approach that nevertheless possesses transformative potential. Instead of coercing adoption by imposing a mandate on the states, it invites their participation and preserves their choice.

There’s one key change that I’d like to see, to accentuate these features and raise its chances of passage.

The original Daschle/Carper compromise would have allowed states to develop their own public options, placing the onus on state legislatures to individually craft the plans. That offered the delightful prospect of replaying the national debate fifty times, and producing small and relatively ineffectual plans. This proposal would create a national framework, and allow states to opt out. That has much greater potential, and would lead to faster adoption, but comes too close to coercion to be palatable to most moderates.

Why not, instead, combine the most politically appealing features of each proposal, and create an opt-in national Public Option? Supporters of the Public Option, after all, are confident that if the idea is given a fair chance, it will triumph on the merits. So, for liberals, the key is creating a robust, national plan and getting it up and running. Conservative Democrats, on the other hand, fear that a Public Option would unfairly crowd-out private insurers, robbing consumers of choice. So offer them a bill that only extends the Public Option to their states if they affirmatively adopt it. They can honestly tell their constituents that they’ll only have to deal with the Public Option if they decide they want it. That’s a much more powerful formulation than setting it as the default.

Your readers in South Dakota and Louisiana, unfortunately, would be even more likely to be shut out under an opt-in plan. But there’s no reason to think that an opt-out plan would garner many more votes than the other failed proposals. The whole reason Carper was pushing his opt-in plan in the first place was that allowing states to decide their own destiny offers the best hope of passage. The flaw with the Carper plan is that state-level options don’t offer much in the way of gains over the present system. A national, opt-in proposal remedies that. I suspect it’s where this debate is headed.


Josh Marshall is editor and publisher of TalkingPointsMemo.com.