The Semi-Public Option

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The big news today is that Harry Reid decided to include a public option in the version of the health care reform bill that will come up for vote in the senate.  A big win.  Plus, the version he included is the “opt-out” public option — the one that starts as a national program, but individual states can opt out of if they’re stupid they have objections.  Also a win, relative to the “triggered” public option or “opt-in” public option.

Nevertheless, I think Josh Marshall gets carried away in this post:

But by making it an opt-out rather than an opt-in, you start with a truly national program. That’s the key. The default is everyone is in. Even if you had 1/3 or even, conceivably half the states (or half the total national population in however many states) opt out, you’d still have enough heft to make it have the desired effect. And presumably you’d have by far most of the population in the program.

I could definitely be wrong about this, but it is my understanding that the public option being proposed — whether it’s triggered, opted into, or opted out of — will not have everyone in by default, nor will it ever have anywhere near “most of the population” in it.

The public option being proposed is available only to those whose employers do not offer a private insurance plan, and who cannot afford to buy a private plan on the individual insurance market.  Even with all the states participating, it’s going to be quite small.  It will be a “national program” like Marshall says, but the default is not “everyone is in.”  Only a small percentage of people will even be allowed the opportunity to get in.

That’s a problem, because one of the keys to making a public option work is the ability to negotiate better rates with providers, and you can’t do that if you don’t have enough policyholders.

Am I wrong about the nature of the public option they’re voting on?  Is it available to the general public, or at least a bigger chunk of it?  Anybody know?

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