Opt-Out A Complicated Issue

It looks like the new darling of the liberal extremists pushing government-run health care is the "optional public option." That is, states would have the choice to participate or not. This isn't as simple as it looks.

First, how do the states opt out? Does the Governor tell them, or does it take the Legislature to do it? And though voter I&R isn't an issue in Alabama right now, can voters in I&R states speak at a referendum to opt their state out?

And keep in mind that "opting out" simply means no government-run health insurance plan for the state in question... the residents of that state would still have to pay all the taxes intended to fund the program.
http://www.politico.com/news/stories/1009/28791.html

On the surface, the public insurance opt-out appears to solve a number of political and philosophical problems. By being acceptable to progressive representatives and palatable to moderate legislators, the idea offers the obvious advantage of legislative coalition building. It is easier to sell the idea of a public option if people know their state does not have to participate. This compromise allows areas that are philosophically or otherwise opposed to the government offering a public insurance option to decline to participate in that system.

But there are serious logistical questions in terms of implementation. How do states opt out? Must state legislatures decide or can they use public referenda to allow voters to make the decision? Regardless of whether the venue turns out to be a legislative decision or a public referendum, we should expect intense lobbying and spending from those who feel strongly about the issue. States with conservative voters or strong private health insurance companies will face strong pressure to exit the public option.

And, of course, another problem raises it's head. Once the precedent for "opting out" of federal programs has been set, how far will it be taken? Can we then allow states to op-out of Medicare? What about Federal gun-control laws... can states opt-out of them, too? It's a Pandora's box.

From a governance standpoint, the public option creates a worrisome precedent for other policy areas. If states don’t like congressional decisions on gun control, climate change or immigration, will state legislators demand an opt-out? If this were 1965 and there were a Medicare opt-out, it is conceivable we would have ended up with two-thirds of the country having Medicare, while one-third did not.

With any comprehensive reform, there always are unanticipated consequences. By using a pragmatic mechanism to solve the political problem of overcoming a Senate filibuster, opt-out proponents have created a precedent they later will regret. Opponents most likely will employ that idea in other policy areas when people are unhappy with legislative decisions. The marble cake will expand in scope throughout American federalism.

I don't believe this new idea has been thought through all that well. Of course, the Democrat leadership is just looking at ANYTHING they can put together that will garner the 60 votes it needs... and right now they don't much care what goes in it. As long as it can be called "health care reform"... preferably with something they can call a "public option."

But Reid may want to go back to the drawing board with this one.