Assessing the Opt-Out - A Lessson from the Abortion Debate

So the public option isn't quite dead yet. Democrats – Harry Reid, no less – showed some spine. Progressive advocacy groups are ecstatic. Conservatives are aghast.

But before anyone on the left (or right) gets too excited, it's worth taking a clear-eyed look at what the "opt-out" actually entails. As the ever-shrewd Ezra Klein has observed, "It is a compromise, and a conservative one at that."

The option of a government-run plan will apparently only be offered to people who don't rely on employer-based insurance, and only in some states. Is this an improvement over the status quo? Certainly. Is it a formula for universal coverage? At least in the short-term, it's more likely to bring about a patchwork system in which less affluent people in more conservative states end up being denied choices that individuals who happen to live in places like Boston and New York enjoy.

This is exactly the way the system works for something else: abortion. Since passage of the 1977 Hyde Amendment, which forbids the use of federal funds for most pregnancy terminations, the decision of whether or not to pay for abortions for poorer women has fallen to the states. As any reproductive rights advocate will tell you, the result is far from ideal. Massachusetts, New York, California and fourteen other states subsidize abortion procedures for women who can't afford to pay for them. Mississippi, Kentucky, Oklahoma and thirty other states do not.

"Choice" in America thus varies dramatically depending on where a woman lives and how wealthy she happens to be. The system is fair only in that it accurately reflects what's missing: a broad social consensus that reproductive rights should be available to all.

The "opt-out" is premised on a similar kind of tacit admission: since no consensus can be reached on what is desirable, states will be allowed to experiment and design their own systems. Beyond the uniquely polarizing passions that swirl around abortion, the one major difference is that, whereas the Hyde Amendment forces states to provide funding for a medical procedure that the federal government as a rule does not underwrite, under the "opt-out" states will have to proactively deny a more affordable health insurance option to their citizens. It may well be that even many conservative governors will lack the stomach to do this. But, if the 'opt-out' ends up becoming law, nothing will be in place to stop them.

Comments (36)

1. PRESS: "So the public option isn't quite dead yet.....Progressive advocacy groups are ecstatic."

   Mission Accomplished, again??

   Posted by Happy at 10/27/2009 @ 6:59pm

2. My guess is that over time most states at some point will opt-in. I think some of the Reddest states will do so, if it saves the state money, as it will not remain a hot button religous issue like abortion, that continually fires up the religious right. Once states opt-in it will become political suicide to opt-out at later point in time.

   Posted by Extraneous at 10/27/2009 @ 7:03pm

3. Sure there will be something to stop those governors. That's why this "opt out" option is a bogus ploy to get a foot further into the door of convincing Americans that they have a right to everyone else's earnings.

   Because you CANNOT opt out of the taxes that are going to pay for the public option. Those will still be taken from you or your employers.

   Oh, a state governor can exclude his state from the program, but he cannot shield the people in his state from paying for the healthcare of people in other states through this ghastly lurch to national entitlement mentality.

   So you cannot opt out of anything, in reality, for no electorate is going to quietly sit back and pay for something it isn't taking part in.

   This is similar to the Left hating to allow somebody to "opt out" of paying taxes for public schools because they prefer to send their children to private schools instead. Oh hell no, The Party of Choice simply won't abide that.

   That's why Reid's ploy is unworthy of the lowest snake.

   Posted by Citizen_Carrier at 10/27/2009 @ 7:16pm

4. Posted by Citizen_Carrier at 10/27/2009 @ 7:16pm

   Why the right is confusing a public option with single payer is beyond me. A public option is not an entitlement program. It is not giving healthcare away to people for free. It is going to be a government run healthcare option.

   I would not be surprised if the next republican president insures that it is outsourced to a private corporation to run. Like many other government programs, from the state department, to the forest service. Many of the services they provide have been "outsourced" in recent years to be run by private companies.

   Anyone who want the public option will have to pay their premium for it, and there is no guarentee it will be more affordable than the private options. The private healthcare corporations fear it because it will not have a profit motive, but it will likely be mandated to pay for itself, so it will not be suported by tax payers, and thus it is an unknown if it will be more affordable than private policies.

   You fear mongers on the right need to get your facts straight before you go off half cocked against a program that you really know nothing about.

   Posted by Extraneous at 10/27/2009 @ 7:26pm

5. Why the right is confusing a public option with single payer is beyond me. A public option is not an entitlement program.

   Posted by Extraneous at 10/27/2009 @ 7:26pm

   I'm not confusing it. I've been around long enough to know incrementalism when I see it.

   I suspect that you know this is a necessary first step towards single payer too. The difference between us is that you are amenable to that end.

   Because it isn't about competition. There can be no competition against an entity that doesn't operate under the same constraints you do. Like say for instance if your pricing is determined by operating costs and a profit margin and your competition ISN'T constrained by a need to be profitable.

   And not only does it not have to be profitable, but gets it's operating costs involuntarily from taxpayers. Even the owners and employees of the insurance companies will have to pay the taxes to fund the government program that is in direct competition with their livelihood.

   And it pointedly keeps you bottled up in indivdual states, unable to compete with other insurance companies (or the government) in the same manner we can all by car our fire insurance.

   Because this isn't about choice or competition. It's about getting a foot in the door towards socialism. And using simple economic realities to get people dumped out of their employee insurance and left with nowhere else to go but Big Brother.

   Posted by Citizen_Carrier at 10/27/2009 @ 7:46pm

6. You fear mongers on the right need to get your facts straight before you go off half cocked against a program that you really know nothing about.

   Posted by Extraneous at 10/27/2009 @ 7:26pm

   If true, then who is most responsible for that state of affairs?

   For it is hypocritical to complain about people being ill-informed about the healthcare deform bill, while simultaneously refusing to make it available to the public for scrutiny.

   And which of the two parties has led the way in keeping it from the public, hmm?

   Posted by Citizen_Carrier at 10/27/2009 @ 7:49pm

7. And which of the two parties has led the way in keeping it from the public, hmm?

   Posted by Citizen_Carrier at 10/27/2009 @ 7:49pm

   and the wheels on the bus go round and round.

   does a cricket have just two sides?

   Posted by frosty zoom at 10/27/2009 @ 9:21pm

8. No, but Congress does.

   And one side's leadership pointedly does not want this healthcare bill up on the internet for the public to see.

   All the while complaining that "teabaggers" and "nazis" at town hall meetings have their facts wrong about the unposted, huge, unread healthcare bill.

   Posted by Citizen_Carrier at 10/27/2009 @ 10:11pm

9. Posted by Citizen_Carrier at 10/27/2009 @ 10:11pm |

   Quit cursing the darkness and light a candle already...

   http://thomas.loc.gov/

   Posted by snowball777 at 10/28/2009 @ 12:30am

10. "That's why this "opt out" option is a bogus ploy to get a foot further into the door of convincing Americans that they have a right to everyone else's earnings."

    can i have my portion of earnings which was stolen from me to pay for two totally nonsensical wars?

    can i "opt out" of the war funding machine?

    "It's about getting a foot in the door towards socialism"

    actually, it's about giving people, who cannot afford health insurance, a choice. and life or death choice, actually. and that you are opposed to that, on some lame-ass ideological, rand-ian principle, says pretty much everything we need to know about your lump of coal for a heart.

    Posted by darladoon at 10/28/2009 @ 12:34am

11. we know, for a fact, that people go bankrupt, or even die, because they lack health insurance.

    and i'm not talking about drug-addicted homeless people.

    i'm talking about middle class people.

    this is happening because health care IS TOO EXPENSIVE IN THE UNITED STATES.

    that is a FACT, people!!!!!!!

    so, what is the republican plan to tackle the problem?

    just die. and die quickly.

    Posted by darladoon at 10/28/2009 @ 12:40am

12. The simple message the American taxpayer is recieving is "just trust the Obamanation and Demoncrats and buy our pig in a poke".

    Beside the general public is just to dumb to understand or read the laws we pass and we don't want those who can to read and interput the legislation in terms of existing laws because you might discover what we are really doing!

    Posted by BigPasture at 10/28/2009 @ 12:40am

13. "The simple message the American taxpayer is recieving is "just trust the Obamanation and Demoncrats and buy our pig in a poke"

    of course, the message is always simple if you're.....

    stupid.

    Posted by darladoon at 10/28/2009 @ 12:54am

14. of course, the message is always simple if you're.....

    stupid.

    Posted by darladoon at 10/28/2009 @ 12:54am | ignore this person | warn this person

    You have bought it all "hook line and sinker" so I wouldn't speak if I were you!

    Posted by BigPasture at 10/28/2009 @ 01:06am

15. "Obviously the public option is something that's been talked about a lot," Reid said. "It's something I believe in. In the state of Nevada, uh, all the national polls show a wide majority of Americans support the public option."

    The one major poll showing majority support was the ABC/Washington Post poll weighted 33 percent Democrat, 20 percent Republican and 42 percent "independent."

    All the real major polls show that there is no majority support for the Democrats' health care bills whatsoever.

    The latest from Rasmussen yesterday shows what polls have shown all along: the overwhelming majority of people continue to reject health care "reform." Support has remained steady, between 41 and 46 percent since July. Opposition has remained a steady 48 to 56 percent in the same time frame.

    The latest poll of likely voters conducted October 24-25 shows 45 percent approve while 51 percent disapprove of Democrat health care proposals. Those numbers include 23 percent who strongly favor the plan and 40 percent who are strongly opposed.

    The Politico reports, "Reid, who spoke with virtually every member of his 60-member caucus this weekend, currently has between 56 and 57 votes for a proposal to create a national insurance plan but allow states to opt out of it, according to Democratic aides."

    The looming question is whether or not Reid, in serious election trouble back home, can provoke the Democrat caucus to hold together for the necessary 60 votes for cloture to end debate.

    Senate Republican Leader Mitch McConnell issued a statement after the Reid presser.

    Posted by BigPasture at 10/28/2009 @ 01:24am

16. "While final details of this bill are still unknown, here's what we do know: It will be a thousand-page, trillion-dollar bill that raises premiums, raises taxes and slashes Medicare for our seniors to create new government spending programs," McConnell said. "That's not reform. So, wholly aside from the debate over whether the government gets into the insurance business, the core of the proposal is a bill that the American public clearly does not like, and doesn't support."

    Posted by BigPasture at 10/28/2009 @ 01:25am

17. Reid also said his bill will include an "opt out" at the state level which is a façade. Can individuals "opt out" of the penalties and the mandatory coverage? Can individuals "opt out" of paying for government-run health care for everyone else in the country in the form of higher premiums, higher taxes, and Medicare cuts? Can small business owners "opt out" of the higher payroll taxes?

    Who decides what a state does? The legislature? The governor? A state referendum? It's not clear. Also unclear is what exactly happens in Reid's "opt out" scenario between passage and the drop dead of 2014 for the state "opt out" date, if you'll pardon the unfortunate juxtaposition.

    Posted by BigPasture at 10/28/2009 @ 01:27am

18. actually, it's about giving people, who cannot afford health insurance, a choice. and life or death choice, actually. and that you are opposed to that, on some lame-ass ideological, rand-ian principle, says pretty much everything we need to know about your lump of coal for a heart.

    Posted by darladoon at 10/28/2009 @ 12:34am

    Yep, it just isn't nice to raise ideological, political, and economic reservations when something as billed as being strictly for "helping the poor", is it?

    Because you aren't supposed to ask questions like,

    "How much is this going to cost, really?"

    Or, "If you want to spark competition, why aren't you eliminating the barriers preventing companies from operating nationally instead of just in states? If I can buy car insurance from anybody in the country, why can't I buy health insurance the same way?"

    Or, "Was Howard Dean right? Is the reason we aren't doing tort reform because trial lawyers give too much money to the Democratic Party?"

    Or, "Every other government entitlement program is running in the red. None of them have ever operated at the estimated cost. Why should we believe this one will be any different?"

    Or, "Can you promise that employers won't simply kick people out of their private insurance just to reduce costs, especially if the public option is priced in a predatory fashion we would probably prosecute a trust for using? If you can't promise they won't, does that mean you intended for that to happen from the beginning?"

    Believe it or not, Darladoon, I would like to make insurance cheaper. But we can do that without the waiting lists, impersonal service, writing off old people (Obama's "pills instead of surgery"), and other faults that would come from what will eventually become single payer.

    Posted by Citizen_Carrier at 10/28/2009 @ 01:32am

19. Posted by BigPasture at 10/28/2009 @ 01:25am

    Hey RIO...what happens if McConnell DOESN'T filibuster a plan with a public option?

    Posted by Mask at 10/28/2009 @ 07:22am

20. DuNcE-Again we will weigh in on Medicare cuts. Why don't you worry about something your cause supports. What poll did you read that said there was not support the public option,one from the Drudge Report. I laugh that the first 2 guys to comment on many things here are the conservative guys trying to control the tone of the debate. It seems that even when they have good points because of the people they support(Big Pharma,Big Insurance) you can hardly listen to them.

    Posted by whatozz at 10/28/2009 @ 07:46am

21. No, but Congress does.

    Posted by Citizen_Carrier at 10/27/2009 @ 10:11pm

    put down that pipe!

    two sides, huh?

    think hard, now.

    Posted by frosty zoom at 10/28/2009 @ 09:23am

22. BTW, read a story on DarinTT's home state Senator Richard Burr.

    Apparently Burr made a big deal about voting against the Stimulus Bill.....but went to a small town in NC to celebrate the local fire department getting ...

    Stimulus Bill money and called it a "great thing for NC".

    Might give a good indication of how much "opting out" Red States would really do!

    heheh

    Posted by Mask at 10/28/2009 @ 09:25am

23. Or, "Every other government entitlement program is running in the red. None of them have ever operated at the estimated cost. Why should we believe this one will be any different?"

    Posted by Citizen_Carrier at 10/28/2009 @ 01:32am

    government entitlements are working out just great for boeing and kbr.....

    think hard, now..

    Posted by frosty zoom at 10/28/2009 @ 09:26am

24. This is similar to the Left hating to allow somebody to "opt out" of paying taxes for public schools because they prefer to send their children to private schools instead. Oh hell no, The Party of Choice simply won't abide that.

    Posted by Citizen_Carrier at 10/27/2009 @ 7:16pm | ignore this person | warn this person

    --Reid may end out being smarter than I thought. CitizenCarrier doesn't want to pay for public schools; and doesn't want his governor to feel pressured to participate in a program that will provide health care to poor citizens!

    boo-hoo!

    Posted by urmygyro at 10/28/2009 @ 10:04am

25. Because this isn't about choice or competition. It's about getting a foot in the door towards socialism.

    Posted by Citizen_Carrier at 10/27/2009 @ 7:46pm | ignore this person | warn this person

    --yeah, medicare has destroyed america!

    Posted by urmygyro at 10/28/2009 @ 10:06am

26. "Yep, it just isn't nice to raise ideological, political, and economic reservations when something as billed as being strictly for "helping the poor", is it?

    Because you aren't supposed to ask questions like, "How much is this going to cost, really?""

    like that hasn't been asked REPEATEDLY by anyone who's paying attention! the CBO just did a study which stated, unequivocally, that healthcare costs will continue to rise unless.......the govnt steps in.

    and do you actually want to talk COSTS, carrier? how about those two WARS, dude?!

    Posted by darladoon at 10/28/2009 @ 10:41am

27. Ok everyone, lets calm down and go to our corners. The fact is, you are both right and you are both wrong. Citizen_Carrier, you are right when you talk about this bill being something of a farce, in that it doesn't seem to contain any real change to the current system and does not seem like it is going to do much to save on costs. I agree that health care should be available across state lines, as long as that would make it less expensive for consumers. I also believe it is reprehensible in this country that we have people who cannot afford health coverage or people who work for companies for years and years then get sick and find out their health coverage is not good enough to help them when they need it. It simply shouldn't happen in a nation that bills itself as the world's moral compass. You cannot claim to be a moral person, spiritually or otherwise, unless you think about the way you treat the least of your society. In terms of avoiding paying for health care for others, nothing we do, including doing nothing, is going to avoid that. We already pay for it in increased healthcare costs as well as Medicaid. What do you think happens to all those people who get irrevocably sicker because they don't have the health coverage to treat their illnesses before they become acute? They become completely disabled and end up on Medicare. Also, when people go to the hospital and charge up $1000-$5000 for a simple emergency room visit because they cannot afford health care, do you think they are paying that bill? No, the hospital eats it. Did you know that all providors recieve a check each year from the government for something called "uncompensated care"? This is to make up for all those ho don't have insurance and can't pay their bill.

    Posted by bhibsen at 10/28/2009 @ 12:53pm

28. I will say that the right's answer to this, which is to expand available service areas for insurance companies and to reform torte laws does not seem to me to do anything to address the issue. Torte reform is not going to help someone like me, who works freelance and does not have health coverage even available to me, let alone available at a remotely affordable cost. Most people cannot afford $400.00 per month for health coverage, let alone the $1000-$1500 most plans cost. This means that the cost of those people's care gets passed on to everyone else in the form of higher costs to compensate for the uncompensated care. We cannot afford not to change the current system and we cannot claim to be a world leader if we cannot provide for our own citizens' and legal residents' most basic needs.

    Posted by bhibsen at 10/28/2009 @ 1:05pm

29. "Is AIG not now a "government-run insurance company," and doesn't the $185 billion of taxpayer money tossed at that sorry enterprise add up to more than twice the yearly cost of the health reform package?" (From Robert Scheer's article: Lieberman Twists the Knife)

    That just occured to me. Doesn't the Government own AIG? Why don't they just use their newly purchased insurance company to provide coverage for everyone? Problem solved! LOL

    Posted by bhibsen at 10/28/2009 @ 1:09pm

30. You cannot claim to be a moral person, spiritually or otherwise, unless you think about the way you treat the least of your society.

    Posted by bhibsen at 10/28/2009 @ 12:53pm

    Well said.

    Posted by BlackFrancis at 10/28/2009 @ 4:28pm

31. Posted by Citizen_Carrier at 10/27/2009 @ 10:11pm |

    Quit cursing the darkness and light a candle already...

    http://thomas.loc.gov/

    Posted by snowball777 at 10/28/2009 @ 12:30am

    He won't read it but he will probably keep repeating that the dem "leadership pointedly does not want this healthcare bill up on the internet for the public to see".

    Posted by BlackFrancis at 10/28/2009 @ 4:45pm

32. That bill isn't going to be the one voted on after the Senate and House get together in conference committee, iron out the details, and then vote on.

    The controversy behind that is whether or not they will post that final bill to be voted on 72 hours before the vote so it can be reviewed and the public has a chance to react to it.

    Posted by Citizen_Carrier at 10/28/2009 @ 4:52pm

33. "You cannot claim to be a moral person, spiritually or otherwise, unless you think about the way you treat the least of your society"

    word! so, so true. i know i've told myself this 1000 times, but when you really think about it....it really resonates.

    and this is precisely why antisocialist is a misanthropic, fraudulent christian.

    Posted by darladoon at 10/28/2009 @ 9:38pm

34. Check out Joe (2006 election/Universal Health Care) Lieberman and his non -support of the public option. Go to web site Open Secrets and see who has bought him.

    Posted by whatozz at 10/28/2009 @ 9:57pm

35. so, what is the republican plan to tackle the problem?

    just die. and die quickly.

    Posted by darladoon at 10/28/2009 @ 12:40am

    As I've said before, Ebenezer Scrooge is the perfect personification of the GOP (so is Mr Potter from It's A Wonderul Life}. What does he say, "if he is going to die, he'd better do it and decrease the surplus population." Then again, Dickens was a socialisitic commie sympathizer.

    I find it ironic that the people who claim to be God fearing people and claim to be followers of Jesus are the first ones to slam the door shut on their poorer brothers and deny them any chance to have a seat at the table. The GOP and the bluedog democrats are a bunch of hypocrites pretending to side with "the people" while serving their corporate masters.

    If "the people" are stupid enough to re-elect these bastards, then I guess we deserve what is coming our way (60 hour work weeks with no benefits, increased insurance premiums [someone has to pay for all this lobbying the insurance industry has been hammering away with full scale and it sure as hell won't be the insurance industry], reduced minimum wage, scaling back employee rights anyway and everyway possible....and the list goes on and on.

    We should have a new pledge of allegiance...here goes;

    I pledge allegiance, to the flag of the united international corporations, and to wallstreet, for which they stand,one business entity without oversight, made of Monopolies, indivisible, with greed and huge profits for the few. Amen

    Posted by Wolfgang1 at 10/29/2009 @ 12:17pm

36. I pledge allegiance, to the flag of the united international corporations, and to wallstreet, for which they stand,one business entity without oversight, made of Monopolies, indivisible, with greed and huge profits for the few. Amen

    Posted by Wolfgang1 at 10/29/2009 @ 12:17pm

    Sorry, This was supposed to go with the Centrists--Corporate sellout thread.

    Posted by Wolfgang1 at 10/29/2009 @ 1:16pm