Thanks for this Mason.

I am a native Kentuckian myself and fortunately for my parents, my uncle was an MD.

The whole rationale for the Public Option is Available to all nationwide from Day 1.

Opt-out is NOT available to all nationwide from Day 1.

Agreed. Great diary, Mason.

I can’t even believe we’re talking about risking health care coverage for those in red states — some of the poorest states — just because it’s a shrewd “political tactic.”

This isn’t where we started with health care reform. And it sure as shit is not the “Democratic dream” that has inspired us for so long.

The wonks and their cost curves can get bent.

Absolutely great post.

Opt-out cop-out = racism at its core.

“We’ll pick you up later” is a lie. No one will pick up the red-state residents who get left by the side of the road by their easily-bought-off corporatist legislators and officeholders.

It will ruin the Union. Lincoln would roll over in his grave to know another Illinoisan President was even considering this evil idea!

Opt out… “a prescription for bankruptcies, homelessness, and suicide.”

We have got to stop this plan.

I don’t have a voice.

I am just going to keep repeating these points:
Barack Obama: “There are no red states or blue states; there are only the United States of America.
Pledge of allegiance: “one nation, under God, indivisible…”

Congress, please listen to Alan Grayson and do the right thing to save American lives!

I can’t agree. The whole cherrypicking analysis misses the point. We already know that insurers will be able to do this without a strong public option. Insurers will ONLY be able to do this if the red state citizens ALLOW themselves to be opted out. The fact is, we know that a majority of the citizens of ALL states, red and blue alike, support a public option. But in the red states, they haven’t been fighting for the PO, even if they say they support it in opinion polls. A majority of those citizens have elected Republicans who have stonewalled HCR every step of the way, and the red state citizens have allowed it to happen, either by complacency (failure to vote) or outright hostility to HCR. If red state citizens want the PO, they should be prepared to fight for it, ie create groundswells of public outrage, and force their legislators to stay opted in. It will be another battle for those progressive Dems who live in the red states, but the opt out provision gives them an enormous, historic organizing tool to throw out the Repubs. Time for citizens to take some responsibility.

I think racism is an under-reported issue here. Virtually the entire South could opt out, plus a few Western States. That keeps markets fragmented, which plays well for the insuresters, who already have state and regional monopolies and their local statehouses and insurance commissioners hustled.

More importantly, a no-cost opt-out would have a disproportionate impact on minorities and the poor. That might be an interesting basis to challenge the legislation, though it would run up against states’ rights claims. The plain facts are that it would work a manifest injustice that further segments America regionally and between the haves and have nots.

As for placing a price tag on opt-outers – to pay for the costs their opting out imposing on the national scheme – while fair and appropriate, it could be like trying to collect state liquor taxes from moonshiners. It would be a political field day for the Right, courtesy of the Democratic majority in both houses.

If this goes through in anything like its present form, the Democratic Party will have become like those tapes that sent Jim Phelps and Ethan Hunt on their impossible missions: they will self-destruct five seconds after they deliver their message.

Well written! Very sad to see how many nominal allies of ours consider this a Crappy Compromise They Can Believe In (TM).

I think racism is an under-reported issue here.
Are you serious?

By all means, let’s create more purchasing opportunities at the state level for the insurers and their lobbyists.

I’m with you Mason. I live in Texas. Nuff said?

On behalf of the folks in my native Red State of South Carolina, thanks Mason.

Exactly what will happen.

EDIT IS NOT WORKING PROPERLY – LINE RETURNS ARE BEING LOST

(it really sucks for us who can’t spell right on the 1st 2nd or 3rd try)

Elections have consequences. We won. The republicans really can’t say jack, well they can but, it really doesn’t matter. When they were in power for all those years, I don’t ever recall HEALTH CARE a major platform. Deregulation and pollution laws were loosened though. Hawkish invasions of countries that had no business being invaded was the platform! People in the red south and mid-west should not be held hostage by these idiots. I find it very strange how some people don’t vote in their own best interest though. Education would help but, the republican states are last in that too. The people that need the most help would be left out. It’s all or all, there is no other option.

Well written.

I started out thinking that OPT-OUT “might not be so bad” but have since decided that OPT-OUT is clearly a bad idea on many levels. I have everyone who posts and comments on FDL to thank for providing the perspective to allow me to change my mind.

I think it’s necessary that someone writes a succinct list of reasons why OPT-0UT is really a bad idea. A list that not only points out not only the moral reasons such as your post so eloquently states but also includes the economic, legislative, administrative, corruption nightmare that OPT-OUT introduces to healthcare reform. And then send this list off to DC to the desks, inboxes, blackberrys of everyone who is considering it.

Yes.

I’m sort of a ‘black and white’ person on this whole thing: Either we have NATIONAL healthcare reform (and that includes a robust Public Option) or we don’t. Anything that allows states to opt-out means that we don’t have National healthcare reform. Anything that does not include a robust Public Option, even if national is NOT healthcare reform. My atitude is: any plan that allows opt-outs must be defeated. Any plan that does not include a robuts public option must be defeated. period.

As Lawrence O’Donnell said, you can’t have federal law that isn’t enforced on a national level.

Imagine what doors that would open. Opt out of abortion law, opt out of segregation laws, opt out of tax laws…where would it end?

Jane,

I think the “Democratic Dream” need to be reiterated. I lot of people’s motivation to action is fueled by anger at and fear of non-progressives. And sometimes those feeling get so intense that slinging mud is a lot easier than keeping eye on the prize. (I’m guilty)

How to do this? I’m not sure. Maybe a collective vision developed by contributors to FDL?

Correct.. I agree 100 percent. Forcing people to purchase insurance that have very little money, then punishing them if the don’t is not reform. What jackass wrote that up?? Oh yeah, Baucus.. Mr. $4 million dollars from the insurance lobby. DOPE!

Lisa Derrick is upstairs!
Rocket Into the Moon? This was Wrong on So Many Levels

I too live in Texas and have been commenting against this ridiculous Opt out notion since I first heard about it a couple of days ago. I have been called all kind of names because I want to prevent the rest of the country from having health care reform. I don’t believe I am selfish in this area.

If one looks at the population of this country, there are quite a few citizens living in Red States. Besides, the Red states are the ones that have the worst healthcare in the country. If one is to believe the wingnuts who comment on the Dallas Morning News website, then there wouldn’t be any healthcare issues in Dallas if we got rid of those pesky illegals who are clogging up the healthcare system.

According to most of the loons on DMN Dallas has more illegals than anywhere else in the country and that is the real problem. Kind of ridiculous but seems to be the overall belief of the wingnuts in Texas.

The Democrats have an overwhelming majority in the legislature. Just do something. Utilizing the “nuclear option” of reconciliation is the way to pass healthcare reform with a Strong Public Option. Who gives a shit if there are no Republican votes on this? Wait a few years and see how the populace feels about having accessible healthcare.

One only need imagine what this country would be like if Medicare had not ever been enacted. I have worked in healthcare for over 30 years and can’t imagine how horrible life in this country would be for the seniors without Medicare.

Democrats, show some balls and pass this.

Last week, I spoke with someone who’d just received a flu shot at a US airport. She was pleased because it was convenient and inexpensive.

This prompted a conversation about health care, and how much we are exposed to things that come from other states; therefore, health care needs to be national.

For instance, the lettuce that I just bought at the store today (in Washington state) is from California. It would like to ensure that all the people at every step through the food supply chain have access to medical care. It’s not selfish; it’s practical.

My salad dressing comes from Sandpoint, Idaho. So I hope the people who make this terrific (Lighthouse) dressing in Idaho have medical coverage, because I like to think that my food is in healthy hands before I eat it.

I doubt that I bought any food prepared, packaged, or transported from Kentucky, but the same logic holds: even if we are not in ‘the same neighborhood’, the modern era has most of us connected to the same food supply chain and the same transportation networks; who knows how sick that person next to you on the bus, or on a 4 hour air flight, might be?

My attitude on ‘opt out’ is this:
Fine. Be stupid: opt out.
It’s your ‘right’.
It’s also my ‘right’ to refuse to buy one single head of lettuce, green pepper, fish, apple, raisin, walnut, or jar of salsa from your state.

If you are too bloody stupid to make sure that your citizens aren’t coughing and sniffling all over the food supply, or coughing all over me at an airport, then you aren’t going to see one nickel of my money.

If you don’t care about **my health**, then I’m perfectly happy to be sure that I only buy from people who do. And I have no problem adjusting my travel plans to avoid airport hubs in states too dumb to master the basics of health coverage.

I don’t have a problem with states coordinating with the feds to regulate health care. But the idea that entire states can just ‘opt out’ is like announcing that they’re regressing back to the 19th century.

Mason:

What about all of those individuals/small businesses that won’t qualify for the Public Option even if it is adopted nationwide? Aren’t they being sacrificed to the insurance companies or left with nothing at all? How does the Golden Rule apply there?

And how do you know you will be eligible for the Public Option? What assurance do you have?

Yesterday in a thread about the opt out provision I suggested that it might be a good idea to call and write our Senators and Reps and say:

If we get an opt-out provision that weakens the public option, we will opt-out of donating to your re-election campaign, and opt-out of volunteering to canvas precincts, or stuff envelopes, or volunteer for your campaign in any way. In fact, we may just opt-out of voting for you.

We want a strong and viable public option. Its our right to have healthcare, and we elected you to get it done. If you dont want us to opt-out of the 2010 altogether, you will have that strong public option in the bill.

I want to opt out of the individual mandate if I can’t have the public option.

You ask some interesting questions, but none of them offer any reason to include an opt-out provision in the bill.

Do you have an argument why we should weaken the bill further by including an opt-out?

As a progressive Democrat who lives in a state that has a Republican governor, a Republican-controlled state legislature (which will stay that way for a long time, thanks to gerrymandering), and one Republican senator I take issue with your statement. There are progressive democrats in this state — Florida went for Obama last November — but there is also a substantial population of senior citizens who vote conservative, a large Cuban community that votes conservative, a large number of young families and uneducated citizenry who vote conservative (due mostly to Christianist propaganda) and a very powerful business lobby that owns Tallahassee.

It’s great that you are willing to let those of us who have no choice but live in these states twist in the wind while you get yours but if it were as simple as you imply then Florida would not have a constitutional amendment barring gay marriage, which was already illegal, that passed by around a 75% margin on the same ballot that elected Barack Obama president.

Change can come, as we saw when Florida went to Obama, but it is a long, hard slog. We were once a Democratic party state, with a Democratic governor and senators and state legislature. We were targeted by the Christian Coalition and the Moral Majority and they scared the beJeebus out of the senior citizens and the church goers and plunged us into economic and social hell with the other evil Bush brother and clown representatives like Mel Martinez and more than a few corrupt Republican perverts.

I just found out today that I am ineligible for our “new” long term disability insurance, which I’ve carried for 7 years, because I suddenly have a pre-existing condition and now that is a dis-qualifier. So I paid into this program for 7 years and receive nothing in return for my premiums except the guarantee that I will be bankrupted if I get sick, especially since the legislature has already cut my pay 3 times in the last 2 years and allowed every other cost to skyrocket.

I’m with Mason here and I think it is vitally important that we stand together on this and on all important issues. If you want to make the rules: I’ve got mine, screw you then things will get ugly fast.

Sing it.

I can’t understand some people’s deep-seated need to punish red-state progressives.

If You don’t want to op out start painten that state nwo before 2010.

I’m trying, after two days of reading your comments on a handful of posts here, to get clear on what you’re trying to say, exactly. I really would like to understand. So I have a request: please proofread and spellcheck before you click the final Submit button.

Thanks.

I like it.

Mason:

Please Consider My Personal Plea On Behalf Of All Of Us Who Live In Red States: Reject Opt Out

As far as I’m concerned, consider me in total agreement.

Opt out… “a prescription for MORE or UNENDING bankruptcies, homelessness, and suicide.”

Fixed it for you.

I should but I get so pissed, I just click what the hell.

lcdrrek, Just a clarification. Reconciliation is not the “nuclear option.” The “nuclear option” is a procedure for changing Senate rules to get rid of the filibuster in every legislative process. It would make reconciliation unnecessary and also moot. It also takes only 50 Senators plus the VP to pass it. See here, here, and here for background.

Good Work Mason.

Thank you for your plea for red state citizens. I am a loyal democrat but am overwhelmed in the “Red Tide” citizenry of where I live. My State of Alabama will opt out so fast your head will spin.

Selective opt out cannot be a tenable solution. Do not force people to move–in many cases giving up their jobs to do so. Has anybody taken into consideration the economic impact of spontaneous evacuation of hordes and hordes of desperate Americans searching for locales where they can get essential insurance?

I agree.

Why don’t we all stand together on enhanced Medicare for All?

Why don’t we all stand together on a Jacob Hacker-style PO?

Why don’t we all stand together to reject a House bill (HR 3200) that will leave 17 million uncovered?

Why don’t we all stand together to reject a Senate Bill (the HELP Bill), that CBO has forecast will still leave 34 million uncovered?

None of these questions are intended as arguments for accepting the opt-out compromise now. What they are about instead are the following questions:

Why are we getting so morally outraged about the opt-out’s violation of “Everybody in, Nobody Out,” now, when we didn’t get morally outraged when all these other compromises came down the pike?

And why don’t we get morally outraged now about all the compromises that have been made for nothing except even more pushing from the right-wing to water down the reform?

We need to defeat everything on the table and go back to square 1. And square 1 is enhanced Medicare for All. And the first thing we ought to do in the context of pushing that is to seek a vote on S703, Bernie Sanders’ Medicare for All bill, and, along the way, force a showdown on the filibuster and use the “nuclear option” to get the 60 vote nonsense off the table for good.

I don’t mind outrage, and even fury; but it needs to be directed toward the right things, and they are all the earlier outrages committed in this process starting with taking single-payer off the table.

No need to hyperventilate

This whole opt-in/out by states business is just the latest in a whole string of cunning plans to outwit the health insurance industry that have about zero chance of getting anywhere.

The low-hanging fruit and obvious first step to health care financing reform is getting rid of the health insurance industry. Not only do they extract a fair piece of change doing nothing constructive, they distort the markets for health services in ways that cost far more, in human and monetary terms, than the direct costs of their diddling in the middle between patients and providers.

But our fearless leadership can’t or won’t bring itself to directly confronting the problem, and simply putting the insurance industry on the menu, rather than seating them at the negotiating table. So instead of single payer, we get the public option. Instead of Medicare for All, we get Medicare for Everyone Who Wants It. Of course, since Medicare for Everyone Who Wants It won’t have to run a profit, and will otherwise avoid many admin costs that the industry incurs, the story is that it will be chepaer than private insurance, people will flock to it, and we will have Medicare for All in short order anyway. The fairy tale part of the story, is that the industry was imagined to not be able to do the math that would let it see its doom in a public option that didn’t have the deck stacked against it, and would therefore let the robust public option through, where it would never have let single payer pass.

Of course, the industry can do the math, knows full well that Medicare for Everyone Who Wants It is as sure a death sentence for it as single payer would have been, and is just as dead set against it, is just as unwilling to allow its Congresscritter hirelings to let it pass. Now, to get past these obstructionists, the newer brilliant plan is to let these folks have their way, no public option, in their jurisdictions, in their red states. The idea is the same as it was for the across-the-board public option, this is a plan that our fearless leaders imagine that the other side will be dumb enough to accede to, because they won’t see that opt-in/out would quickly devolve into single payer. The idea is that we buy them off with freedom to continue to do their worst in the red states, in exchange for them giving us the freedom to implement true Medicare for Everyone Who Wants It in the blue states. The blue states will have much cheaper premiums than the red states, where the depredations of the industry will reign unchallenged, continuing the cost spiral, leading to a revolt of the voters in red states, leading to single payer nationwide.

The problem with this cunning plan is that, of course, the industry will not be fooled, and will work every bit as hard against any non-fatally-compromised version of this proposal as they would have against single payer, because this plan, if it actually passed, would indeed be as fatal for them as single payer.

Our side is only fooling itself with these more and more desperate, transparent, and ridiculous schemes to avoid the fight that has to be fought and won if we are to get change in health care financing that does any good instead of furthering the harm of the current non-system. The industry simply cannot be tricked into letting itself be led to the slaughter. We’re going to have to confront and kill the industry directly and openly because we’re not going to get away with poisoning it, or otherwise removing it by stealth and artifice. They’re better at all that Ninja stuff than our side will ever be. We just need to pull out a revolver and shoot them. And, please, let’s get around to doing so while it’s still possible to kill them in an entirely metaphorical sense, as in “put them out of business”, as opposed to the literal violence that prolonged deference to deadly injustice will eventually produce.

On the bright side Obama did say last night at HRC, “We ALL have a stake in achieving quality affordable health care.” Nothing about opting out.

I have been reading this blog for some time now and I finally felt the need to comment.

How can we be for anything other than single payer healthcare. The fact that we have signaled that a public option is acceptable makes it that much easier for them to cave on more things.

The only way to solve healthcare in this country quickly is to remove the age limit on medicare. Anything else takes too long and is too expensive.

Advocating anything less is not progressive.

Two evil people: One is named Olympia Snowe, the other is named Jim DeMint. Who’s getting more of what she wants?

Until Bernie Sanders or Roland Burris has had enough, until one of them agrees to join the Republican filibuster, staying engaged is all we can do. Which is not to say we give in unnecessarily. There are 51 Senators on record for the 50-state negotiated rates public option. Let’s hold that and keep trying for better.

The opt-out proposal sounds like something a Rethug would propose. It is basically demonstrating the attitude, “I’ve got mine, the hell with you.”

There is one line of reasoning regarding the PO wherein it is construed to be a vehicle which will inevitably supplant private insurers. Indeed both its proponents and its opponents at a basic level know this to be true, myself included.

This reasoning is justified by the fact that if the PO is to function at all it will do so by continually providing lower premiums than private insurers. That is its completive advantage. Furthermore, it is the very nature of the PO that allows it to offer lower rates, because it functions without the expense directed to profit.

The only real question is how to introduce this option so that it remains viable, the rest of the progression to a single payer system, to the exclusion of private insurers, will occur at its pace. There is no reason that this could not be an accelerated pace.

Just one conditions is needed for viability, namely, a sufficiently large pool in which to spread risk. But, given that health costs are increasing at unmanageable levels, the PO must also undertake the role of reducing overall costs of health care services, which ultimately are covered by premiums.

The initial risk pool is comprised initially by the 47 million uninsured, with government subsidies given to those unable to meet the PO premiums. This number of participants should suffice especially if a greater number of particiapnts are initially allowed to participate.

This line of reasoning holds if in fact the PO has been shown to have an inherent competitive advantage, and empiric evidence shows this to be true. Expenses related to paying health care bills are done much more efficiently by a public entity (Medicare) than by private insurers. This demonstrates its competitive advantage and the rest of the reasoning falls in place.

Possible objections can be raised as to whether its fair that a portion of the premiums within the PO plan is assumed by all taxpayers via subsidies to its participants. Well that objection could start to be posed when all taxpayer supplied subsidies are withdrawn from private insurers.

If this analysis is correct, then the task for those who advocate for the PO is reduced seeing that it will cover a sufficiently large pool of participants which will allow it to retain its lower premiums. In part this is a good argument for not excluding eligible participants as result of any opt out provisions.

It seems to me that the defining question that needs to be resolved regarding the opt-out provision is what legal standing the PO would have. If it were to have the legal standing of medicare then it simply could not be denied to anyone who is eligible, regardless of where they live.

If the PO is passed as a government service that states can avail themselves of if they choose, then there is no point in appealing to their sense of decensy or of right and wrong should they want to opt out. After all it is precisely their sense of right and wrong that has led them to propose that states be able to opt-out.

Efforts are best concentrated on giveing the PO at the outset the same legal standing as Medicare, although this may be problematic in the sense that Medicare is an entitlement whereas the PO is not seen as such. But the PO should certainly be afforded the same legal protection to operate anywhere it chooses as is given to any other enterprise. By its very adoption it has that right. Irrespective of the fact that it is a government created and partially funded enterprise.

There are enough weighty reasons why it is a bad idea for states, and thereby possible participants, to opt-out of the PO plan. It is nearly impossible to come up with a good one, but attempts to sway people by appealing to their sense of morality is probably the least likely to succeed, because people simply are not bound to moral tenets, either they chose to adhere to them or they don’t.

Right larry91403. But, of course, we can advocate HR 676 which is enhanced Medicare for All. Take a look at the bill. It’s really great. BTW, extending medicare to all ages could be done through reconciliation. Only 50 plus one votes are needed to do it.

What is immoral and barbaric here is that we are in the political predicament where an opt-out becomes viable. That is not the fault of progressives, it did not happen on its own, rather the leadership of the Democrat Party put forth in its best incarnation a public option which will still leave 17m w/o access to health care.

What is immoral and barbaric here is what the red states have done to this country over the past 30 years. How much longer will those of us who fled red states have to be held back by the retrograde? How many people have perished under red state rule, both at home and abroad? How many good middle class jobs have they shipped away? How many cheap S. asian workers have they imported to drive down tech wages? They should be lucky that we don’t preclude them from a public option, that we’re leaving the keys to a PO on the table for them, requiring red states to take affirmative steps to opt out.

That is the poker play of calling someone’s hand and it is what you do when someone is bluffing.

Morals and barbarism aside, on the merits of the policy.

1. Any opt-out public option pool will instantly become the entity with the greatest bargaining power in the US, even if every red state opts out.

2. The presence of a 2/3 public option is a big enough pool that it will drive prices down in non opted-out states

3. The lack of profits from non opted-out states will drive down insurance profits

4. The insurers will then seek to compensate those losses by raising premiums in the underregulated opted-out states

5. After insurer greed makes it so that nobody can afford health insurance in the opted-out states, then the red states, having been exposed to the discipline of the market, will sheepishly repeal their opting out at the behest of the business community.

The opt-out is only worth pursuing if:

1. HR676 fails

2. The national public option fails

3. The national public option is watered down to do more harm than good

4. Opt-out is traded for a more robust PO

It is quite possible that the opt-out, over a few years, if the trade off is a stronger PO for opt-out than would otherwise arise for national PO, will result in a better PO covering more people over a relatively short time than other possibilities.

We’re being served up a big steaming shit sandwich by the Democrats on this, with the worst being an individual mandate absent any public option. That, IMHO, has a 60% chance of being signed into law and a PO about 40%. Combined with the Citizens United case, the Wall Street bailouts, this health insurance welfare bailout will do more to entrench corporate dominance than we can imagine, a one-way door to serfdom under corporate owned democracy. If the way to stop that is with opt-out, then that should not be dismissed shrilly, out of hand.

Its sometimes corny, sometimes nutty, it can be brown or greenish brown. But if you eat fiber on Christmas eve, he might come to your town.

No matter what the tradeoffs are here, the sandwich is still filled with shit. This is a question of chose your fecal poisons, your turd of choice, which hopefully tries to chart a course which facilitates the jump to something better when the opportunity arises.

Given the shitty sandwich being served up, I’d still prefer to see the PO and IM cancel each other out, business practices reform be enacted without an IM, and the momentum built for Medicare for All to do this right through a sustained, organized campaign.

Why is there no solidarity on the part of red staters for the blue staters to move foward, why are they holding us back again? Why does solidarity only happen when the result would be that we’d all be held back?

I couldn’t agree more with the underlying gist of this article. For those who seem to support progressives standing up to a Repug-controlled state goverment, I respectfully remind you all of what happened in our state (Florida) in Nov/Dec. 2000. Our legislature is seriously gerimandered to guarantee Repug control. When we voted for Gore, the state (controlled by governor baby Bush) aided and abetted GW’s theft. How could any of us forget this?

The ‘opt out’ plan would leave 14 million of us in this state – where registered Dems and Repugs are roughly balanced – to our fate. I understand that given Florida’s status as the elephant’s graveyard we are seen as (generally) covered under medicare. However, this is a right to work, service/tourism based state where there is little manufacturing and many small business’s that do not provide health coverge. We have been one of the most cruelly affected states by the financial bust (many critically depending on retirement incomes decimated by 0% interest rates, collapsed housing prices and imploded IRA’s). At the same time, the non-medicare covered are subject to the zip-code discrimination of the every rapacious private insurance comanies. We need some form of robust P.O. in our state!

If support for the public option is > 2/3 nationwide, including Florida, and Florida state Republicans successfully opt out while other states are thriving opted in, then what impact might that have on the political calculus in Florida?

You miss the point. Insurance companies can only do this if a state’s citizens ALLOW their elected leadership to opt out. My point is that the responsibility needs to be placed squarely on citizens. So if it’s true that a majority of the population in, say, Alabama, wants the public option (which they do), then they need to ACT like they want it and organize for it, which they have not been doing up until now.

I surely do not mean to dis the progressive Dems in red states who have worked very hard for a progressive agenda. Although you mention several blocks of conservative voters, the evidence shows that even those groups do support the public option. They’re just not acting like they do. Overall, red state citizens have made some choices, either by not voting at all, or voting in ideological opposition. I share the sentiment that there are likely very few state governors and legislators who will dare to alienate the electorate by opting out. But if they try it, I think the Progressive Dems have an amazing opportunity here, use it!

Wrong! Wrong! Wrong! Unless you care more about politics than you do about people.

The whole idea behind the bill of rights was to protect the minority from the tyranny of the majority.

What a great idea it would have been to let some states opt out of the bill or rights.

I don’t want to be subjected to the tyranny of the majority of the people of my state.

And there is this constitutional question of equal protection under the law.

If there were a bill pending which would make access to health care a civil right, you might have a point in making the civil rights analogy.

States get to pick and choose how to implement all sorts of federal mandates. Some even opt out of welfare.

Opt-out might actually be the fastest route towards full public option.

Sometimes, policy outcomes are counterituitive. I think this is one of those cases.