Christopher Russo, M.D.
University of Michigan Medical School '94

States should be able to opt out, and not have to pay taxes if they opt out, certainly. But a detail would have to be included, prohibiting, then, people in those opt-out states from buying insurance elsewhere (in other states, that is). Otherwise critics may rightly suspect some states may prefer to opt-out and leave (force) those with little recourse to rely on buying insurance from other states (whose systems would use federal money as well as have subsidized or otherwise cost-reduced “insurance” available to all). It is a variant, in other words, of a “race to the bottom” scenario — in this case, opting out of the federal public system but (with a wink and a nudge and even the open encouragement of it by their own states' own public service personnel), to have people who need help and could benefit from a public system in their own state, to resort to getting insurance from other states with public systems, if interstate purchase was allowed.

Nobody sane expected Medicare (or Social Security) reform and rescue before attempting something much more ambitious and larger in scope like health care for more people, did they? (Or believed the vows by Obama and anyone else who said reform was needed and would be done)

Note that the foregoing should be done with so many “grand” things people want the nation to do (which they presume should be done by the federal government).

And note the more fundamental issue here, which is that government health care proponents are failing to try to get this kind of thing done by state governments, where they should be looking always first before ever considering the federal government. But a federal approach, it is going to be. This “opt-out” (or an “opt-in” superior alternative, for that matter) is obviously adding another measure of incrementalism to the (already-incrementalist) current effort in order to progress through opposition (which makes prompt universal federal health care, replacing the private insurers, impossible).

What this is (“opt-out”) is an added qualification on the public option and certainly the public option remains alive at this time.

We'll have to see what comes of this. I'm not sure Medicare is a good comparison because it is universal with no opt out. There is also the issue about how premiums would be set and paid for within an opt-out public option. My cynical hunch is that Congress is counting on those, “young invincibles” in particlular, who will pay the fine because it is cheaper than purchasing insurance, with that revenue then being used to fund, at least in part, the subsidies for others.

For now, the “opt-out” proposal is an interesting idea. How it would, or could, be implemented is where the rubber will hit the road.

Good luck with that. You can make that true on the face of it, but medicare funding shows the problem. Medicare is running in deficit, and it's general funds that have to make up the difference.

We agree that this does not solve all the problems. But, it looks like some sort of health bill is coming our way, and this could be an improvement over what we were talking about two days ago.

It will all be in the details as you point out. States that opt out should be able to opt out cleanly, without having to pay for those that don't. Like you, I'd like to see Congress do something that didn't involve a bow and a courtsey to the insurance industry.

IMO

It is laughable to hear Democrats talk about wanting to create jobs when they are wanting to shut down private medical insurance, manufacturing in the U.S., the oil and gas industry, and most segments of the private sector.

(broken record)
Very few in Congress have the cojones to face down the insurance, pharmaceutical, healthcare, and tort lobby with tough regulation. Of course that would CURE the problem and bring down costs immediately, instead of drastically changing the system and forcing us trillions of dollars further into debt.

The state opt-out sounds interesting as long as the states that opt out don't have to chip in to pay for those that don't. If that's the case, and Congress refuses to address the issues above, then I'm in.

I will — I'm rather excited about this myself.

I'm trying to figure out now how the insurance industry will attack to kill it or use their lobbying power to “revise” it to their advantage. If something like this gets through clean, it could actually force insurance companies to rein in premiums and could, potentially, have an impact on underlying health care costs…two elements missing in the current proposals in Congress.

Kathy, please keep us current as more details become available.