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The Opt-Out Cop Out


So, Senate Majority Leader Harry Reid and his colleagues have agreed to include a still-undefined government-run health plan in the newest Senate health-reform scheme. The big unanswered question is whether the public plan is ”robust” enough to sway liberals. Maybe so, because Senate Democrats also felt it necessary to allow States that find this particular road to serfdom intolerable to ”opt out.”


What should we make of this latest development?


First, liberals in and out of the Senate prevailed . . . for now. My guess is that this is just a temporary — but politically necessary — feint to the single-payer wing of the Democratic party. (“We love you guys; we need you; you are part of the family. And, believe us, we’ll do everything — everything! — in our power to achieve a “robust” public plan.”) But, once it becomes clear that the magical 60 votes are lacking, Reid and the president will explain to their base that it is time to move on. There’s plenty of time, they’ll say. We’ll come back for the rest later. Will it appease the leftist masses? Unclear.


Second, Maine senator Olympia Snowe is back in the Republican fold.  Left hanging out there in the ether is the murky and unworkable “trigger” proposal she favors, under which the government would not get to run a health plan of its own until various complex cost criteria are met. Thus, the next phase of health reform will be conducted on an entirely partisan basis. Until, that is, the hard Left is forced to admit defeat and agrees to move on to an alternative (but equally lethal) approach that could lure Snowe back.


Finally, don’t expect many states to successfully liberate their citizens from the government-run option.  Though details are lacking, Reid noted that in order to opt out state legislatures (presumably in cooperation with the governor) would have “to act” before 2014. This suggests that a one-vote majority of obstructionists in one chamber of a state legislature, by refusing to act, can consign a state’s residents to an eternity of government-run health care. The deck will be stacked in favor of the default option – i.e., a government plan. Cass Sunstein and admirers of his ”Nudge” theory of policymaking must be smiling.


Bear in mind that in 17 states Democrats control both houses of the legislature and the state house. Public plan, anyone? In another 24, Democrats control at least one legislative chamber or the governor’s mansion. Count those states as leaning strongly toward a public plan. That leaves a total of only 9 states where Republicans run the entire show — Texas, Utah, South Carolina, South Dakota, North Dakota, Missouri, Idaho, Florida, and Georgia.


Given the highly partisan nature of health reform, the 41 states with mixed or total Democratic control are unlikely to press the opt-out button. But, ironically, state legislative and gubernatorial elections between now and 2014 could very well become referendums on the merits of government-run health care. 


Last observation: Opting out does not result in some sort of a Milton Friedman-esque free market utopia. Residents in opt-out states will still have to grapple with all the other pitfalls of government-run health care — individual and (maybe) employer mandates, higher premiums, government designed health-benefit packages, etc.


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