An Opt-out Compromise?
The Brits got national health care in 1948, during the political tumult following the war. The Canadians got a start on their superb system in the province of Saskatchewan in 1946, with the rest of Canada catching up by 1961, on a province by province basis. You might say that the U.S. is about sixty years behind the curve. Anyhow, now, with an "opt-out" compromise promising to gain enough legislative support to make a robust public option available in most states, the question is whether it's better to follow the nationwide British method or the piecemeal Canadian one.
Tom Matzzie helpfully reminds us that when Social Security was introduced, and until the 1980s, local governments could opt out if they set up their own retirement program. Only one local government — Galveston County in Texas — ever did, thus proving Social Security's success. I suspect that the number of states choosing to opt out of a public option would likewise be few and far between, and that any opting out would very quickly opt back in.
Although proponents haven't yet clearly specified what opt out entails, the compromise should allow the public option to be strengthened, perhaps even to the point of a simple buy-in to Medicare. There are many possibilities here well worth exploring.
Posted by George Kenney on October 10, 2009 8:39 AM 
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Comments
It is interesting that you would express optimism about the opt-out provision at the same time you are presenting Richard Wilkinson's work on inequality, work that almost across the spectrum shows the U.S. to be the most unequal country in the world. What is this opt-out provision but the very expression of the inequality of our citizens, especially as we move between regions of our country.
Of course, I have long been waiting for such a provision to be proposed, although I had no idea of exactly what form it would take. (The opt-out provision will do just fine.) You see, this gets down to what the healthcare fight has ALWAYS been about from its earliest days. — The individual state opt-out will allow the South to keep from paying for the healthcare of blacks. It's ALWAYS been about that and nothing more.
And the Democrats want to pass this? They actually want to reinstitutionalize the racism they deinstitutionalized under Johnson? It will destroy the party. And they will deserve it.
[I might be mistaken. But I can't imagine that any state would stay outside the system for very long. Call the conservatives' bluff while giving them a fig leaf. That's politics. Of course it should go without saying that this compromise must involve a truly robust public option. For a very different view of things, however, see Firedoglake, where they're doing some of the finest work on the health care fight. g.]
Posted by: Benedict@Large | October 10, 2009 1:54 PM