The Public Option Option Option

So, perhaps you've heard the buzz about a shiny, new compromise compromise in the battle for healthcare reform reform.  First, there was the notion of single-payer.  Of course, this proved to be far too unpalatable for anyone to the right of Dennis Kucinich, so then we were given the notion of the public option.  This would create a Medicare-style system for anyone who wanted to buy in.  It was certainly a compromise, but the merits of the compromise, as well as the general notion, were clear - it's publicly run and anyone can opt in.  Public.  Option.

Of course, then came the deluge of counter-offers and distortions.  It quickly became the "government option" or "government takeover of healthcare" or "Barack Obama wants to kill your grandmother by way of ripping your children to shreds and force-feeding her to death with the pieces like the Sloth guy in Se7en."  Oh, and the further compromises.  For some, the public option was still not enough of a compromise, so it needed to be sliced up into 50 parts or converted into regional co-ops or hooked up to triggers.

That gave rise to the notion in the House of the "robust" public option, otherwise known as Public Option Original Scent.  While Ms. Pelosi has insisted that the People's House will most assuredly go all robust on your ass, the floundering in the Senate, aka the Keeper's House, has taken center stage, which has pretty much looked like deja vu all over again circa 1994, with characters like Max Baucus doing their best to scuttle reform while raking in contributions from the healthcare sector hand over fist.

But, hark, what's this?  Rumors abound of Senate Democrats proposing an "opt-out" version of the public option whereby states could individually decide not to participate.  Even though the White House and Congressional leadership have little to say about the proposal, the raving, left-wing, liberal blogosphere has already given it the stamp of approval, with everyone from Josh Marshall to Ezra Klein to Nate Silver pretty much giving it the thumbs up, mostly on the basis that it gets us most of the way there and could be a likely pathway to getting all the way there.

They could be right.  However, there's one thing about the public option option that is just obvious crap, which is this:  It was already an option.  What the "opt-out" clause would do is allow states to effectively bar their citizens from participating in the plan.  Why should this be done?  Ostensibly because their politicians aren't willing to go along with Public Option Original Scent.  But the left-intelligentsia has ruminated on this and decided that the hold-outs will have to come along eventually, so it's just a matter of sooner or later.

However, there are several interesting things to note here.  One is that the public option gets its power from numbers.  The bigger the pool, the more powerfully risk distribution and collective bargaining can be leveraged.  When you shrink the pool, you inexorably shrink the effect of these tools.  Shrink the pool too much, and the public option becomes powerless.  That, after all, is the motivation behind shilling for demonstrably poor systems like regional co-ops.  Those who favor co-ops know they won't be very effective.

Furthermore, it's almost certain that the opt-out states will be red states with smaller populations and uncompetitive insurance markets, like Max Baucus' Montana.  These are arguably the people who need healthcare reform the most because they literally have as few as one company from which to purchase insurance in some cases.  You'd think the Mickey Mouse Club Freemarketeers would have knives out for such markets.  Of course, they don't, but this doesn't change that, as a matter of policymaking, leaving the people who need reform the most out in the cold isn't exactly the moral thing to do.

Then again, it's likely that this is less a matter of policymaking and more a matter of positioning, such that the process can move past committee through a floor vote and into conference where a filibuster in the Senate isn't the lynchpin.  That might be the case, but it even seems weird as a matter of positioning.  Think of it this way: The red staters that won't get on board with a public option, which is intended to give their constituents choice, will supposedly be appeased by being able to deny them choice.  Huh?  I thought the state's rights issue was all about protecting the little guy from the big, scary federal government, not telling him that he can't have something that most other citizens have been given as a matter of federal law.

Of course, it isn't lost on me that the state's rights mantra has more often been used to deny people their liberties, like civil rights and access to abortion, than it has gone to defending citizens against the trespasses of the federal government.  So, this is really in keeping with that tradition, but how do they sell this to their constituents?  You can sell denying civil rights to minorities when your constituency is mostly white and at least somewhat racist.  You likewise sell denying abortions to women if your constituency is predominantly godfearing.  But how do you tell your constituents that you're going to fight to deny them choice?

In that sense, JMM, Klein and Silver might have a point.  If this gets the votes and is a political impossibility to sell to people back home then it might end up being a win, at least in the long run.

But by this time, all of this political hokey-pokey has my head spinning.  It's started to feel like some sick version of one of Zeno's paradoxes, where we'll somehow be able to achieve our goal by constantly cutting the remaining distance in half.  After all, people are seriously talking about a proposal to opt-out of an option.  If that doesn't start to get surreal, I don't know what does.  Is Joseph Heller pulling the strings somewhere?

Seriously, I'm waiting with marked anticipation for the next compromise compromise.  What will the public option option option be like?  Anyhow, I'm hungry.  For some reason I feel like pizza pizza.