The idea that a state has the option to opt out of anything for which there is a legitimate interest to enact federal legislation is an oxymoron. The federal government should for the most part only be enacting legislation in which it has an overriding federal interest to enact. The idea that the federal government has an interest in the public health and welfare of the citizenry of this country is well established. Yet, much of the existing legislation enforcement is predicated on federal funding, not on a federal interest per se. So any state can opt out of most federal programs by refusing federal money and so this is what the health care reform opt out option will entail. The problem with this is that people move and sick people with no insurance move quickly. Any opt out provision should include a state charge for all applicants for insurance for those moving from a state without public option to one with a public option. This is still the public option on the cheap for those states that opt out removing the “dogs” from the risk pool of any local insurance plans. It will cost the rest of the country more money for the opted out states’ decision. When individuals opt out of a group plan they are often assessed a percent of the contribution they would have paid had they opted in. If this is sound private insurance philosophy, then maybe it should be incorporated into the public insurance philosophy. Not just for this bill, but also for Medicaid in all it’s incarnations which has weak unenforced versions of this idea in place now.
This opt out option is only an issue because the single payer option was all but rejected sight unseen so early. The opt out option could ensure that many people will go without and others pay more just because they live in an opt out state if the federal law allows the state to decide how to opt out. States should not be allowed to opt out without a state constitutional amendment or referendum requiring the people of the state to vote on it. It would also be more ethical if they provided a local option of their own. I don’t agree with Paul Krugman that the opt out option will be mostly benign for most of us and maybe even be needed by some small states, and that these states will be under pressure to opt in if it works. There are states that haven’t bought into federal programs for years and there are no signs of change any time soon. How is it that the federal welfare reform law had no opt out? It is not moral to allow large segments of the population to die just because we can. I believe in everyone’s right to suicide when such a choice is individual and informed. This is not the choice of most of those that happen to live in these potential opt out states. They have been unable to enjoy many other federal programs available to date due to the failure of their state to opt in. Why would it happen now, on this issue? If you don’t think this is deeply rooted in the history of this country from the beginning, you are misinformed.
The intellectual history of the thugarchy driving the opt out option may actually flow from the middle ages where chivalry was the protection of the aristocracy. That moneyed aristocracy has always existed in this country and their values have been grafted onto our political system via a corporatism, the warnings of which go back to Andrew Jackson and even further. Today the corporate elite can make money from anything without the burden of actually having to produce a product and that money is being bundled into ever larger spheres of control. The danger in this is a centralizing power (i.e., money) that is clearly what Andrew Jackson had in mind when he warned of allowing the monopolistic control of capital to manipulate the real sources of wealth in this country. He said we would be giving up our freedom to the corporation. So the fair and equitable distribution of anything that such a monopoly as the health insurance industry has taken away would be a restoration of freedom and a move away from the existing fascism.