First let me unequivocally say I would prefer single payer over all and a robust public option for the entire country at least.
However the one public option compromise I think I can live with was reported by Sam Stein today. Some Senate Democrats are suggesting that they would add a public option to a healthcare bill where states could opt out. The details are still being worked out but the following passage talks about how the plan is progressing.
“Senate Democrats have begun discussions on a compromise approach to health care reform that would establish a robust, national public option for insurance coverage but give individual states the right to opt out of the program…
…How such a system would work is still being debated, according to those with knowledge of the proposal. But theoretically, the “opt-out” approach would start with everyone having access to a public plan. What kind of public plan isn’t yet clear. States would then have the right to vote — either by referendum, legislature, or simply a gubernatorial decree — to make the option unavailable in their health care exchanges.
For conservative Democrats — especially those from states with major private health insurance industry interests — this concession could be key, allowing them to punt a vote on a public plan to local governments. For
progressives, it would not be the hardest pill to swallow.
“It is clearly much better than triggers and [Carper’s] opt-ins,” said Richard Kirsch, executive director of the group Health Care For Americans Now. “A trigger option is a way to kill the public option and these opt ins are not effective because it leaves it up to state legislatures to set it up…”
Another Democrat working on reform legislation added, “If everyone gets a plan, and states have to affirmatively vote, preferably by referendum, to opt out. I really don’t see a lot of states opting out, for one. And, for two, you get your national [public plan] available everywhere. If a few holes start appearing, it’s not nearly as fatal as if you went with the Carper plan, which after a few years might mean 10 or 20 [state-based] public options. If you go the other way, you’ll probably have like 47 states. It’s a big difference.””
Triggers and co-ops are bullshit compromises because they would not reduce costs but this is different. While it challenges my ideals to leave millions of Americans without access to public healthcare, my pragmatic side is open to this compromise, especially if this makes the public option more robust. I think it’s a compromise I can live with because the vast majority of states will keep the public plan.
Putting my cynical political hat on, this type of compromise defines the divided country we live in today. If it takes a bill that literally creates two Americans to define what kind of country we are it could transform American thought. Mostly Southern states would opt out and the competitive advantage for jobs they have been getting for decades with lower taxes and cost of living could be turned on it’s head especially with small and medium sized businesses that are being decimated by healthcare costs. The populous in states dominated by right wing politicians who opt out of public healthcare for ideological reasons could eventually be pushed out by people who do not want to pay insane healthcare insurance rates. It would be a political experiment of monumental proportions in any case.