Opinions, Context & Ideas from the TPM Editors TPM Editor's Blog

Scenes from the 'Opt-Out' Craze

I confess that something did sound a little off to me about the proposition that differing factions agreeing on one palatable policy option was irrelevant since it's not what the leadership is focused on. Especially because I'm not sure the leadership has inspired a great deal of confidence in their ability to pilot this ship to port. But that's one clear part of the equation.

Another issue is just what votes such a compromise would secure. If 3/4 loaf doesn't secure more votes or enough votes more, you might as well stick with a whole loaf. And this issue just isn't clear yet. Republicans have made clear that they'll oppose any form of public option, indeed likely any reform bill at all. So you're still working with 60 Democrats and potentially Olympia Snowe to get to 60. Some seem to think you still can't get to 60 with this. But that's their line.

Then there's the issue of people in opting-out states -- a point about which we've received many emails today.

The general assumption is that the opt-out states would be heavily red, disproportionately small in population and centered in the Mountain West and the South. And a number of people from these states wrote in today saying, Why is this such a great idea if it leaves me high and dry? It's a good question. And I think there's a decent issue of principle at stake in reform being national. We didn't do opt-outs for Medicare or Civil Rights (we'll okay, for a while, but not eventually) or Social Security (labor laws provide something of a counter-example). So why now? 10th Amendment gonzos notwithstanding, we are a national community, one people. So if reform is needed it should be for everyone.

I get that point and in many ways agree with it. But I don't find it sufficient in this case. As I suggested earlier, an opt-out would create an interesting and somewhat controlled experiment. We'd get to see how a public option and the lack thereof affected insurance markets in different states. If the public option really is a good idea and it works to lower prices and foster competition, I think you'd in short order have a lot of political pressure on Republican opt-out governors to let their citizens have access to lower costs too.

So the assumption I'm operating on is that an opt-out regime would nevertheless create real momentum for adoption nationwide. Second, getting something good for most people in the country simply shouldn't be hostage to a limited number of hold out states. It would be national in as much as it would be available to every state -- sort of a public option option, you might say. And at the end of the day the citizens of opt-out states need to and I think should be able to force the matter through their own state governments if it becomes clear that the public option is improving costs and access in other parts of the country.

All that said, it's important to emphasize that for now this does seem like the outside-the-box thinking of a couple Democratic senators, not the state of play for key leaders in Congress or the White House. Just speaking for myself, though, it's the one 'compromise' I've heard of that sounds like it might be the way to thread the needle.