Instead of offering states to opt out -why not.......

offer two kinds of public option, a very robust one and a watered down one, -a lot like the difference between Schumer's and Rockafeller's versions.


Take the Rockafeller version, beef it up, tie reimbursments to medicare and all the big, populated, Liberal states will snap it up.

Then offer the less populated states (read: states of blue dogs that are hesitating because tying the reimbursments to medicare would major league screw their hospitals) the watered down Schumer version that would still give people in those states a public option that is weaker but doesn't threaten their local hospitals. After all, it's kinda pointless to insure everyone by bankrupting every hospital in the state -dontcha think?

We gotta realize that the economies of these sparsely populated states are very insulated and work somewhat differently, for example a lot of these states have not been effected as harshly by the economic downturn and just take a dollar to San Francisco CA and see how far it goes and take that same dollar to Billings MT and see what it buys you -the difference is dramatic and should be taken into account. What would work for us in our more populated states may not work -infact, might have disastrous unintended consequences- for smaller states. If some of these Blue Dogs aren't lying through their teeth and are being honest about the possible threat of super low reimbursement rates towards their local hospitals, then we have to solve this problem, because if we don't we are left with two choices, either accept a way watered down version of the PO for everyone, or force a strong one on the smaller states in a way that creates headaches for them -and would make it harder for Democrats to win in the Rocky Mountain states, just when we are starting to make inroads there.

I fully accept that I don't have all the info that I need to stand completely by these statements, maybe there are some people in smaller states that can help clarify this. If I'm wrong, hey, I'm wrong, but maybe this is critical to solving the problem.

I understand and am exceedingly grateful for the passion people are showing for pushing through the best PO we can get, at the same time, we shouldn't be misguided by our passion into ignoring real problem areas with what we are trying to do and getting them fixed.

So, if a state opts-out, do they receive, up front, the equivalent federal funds that would of been used for exchange subsidies?

It would essentially provide a framework, very similar to Canada's, for true liberal states that cared about their people to provide single-payer and cover everyone.

If a state wouldn't get federal funds for doing an alternative, why the hell would they, in their right mind, opt-out letting citizens into the exchange? And why would the federal government do that with a "national" reform?

Molly Ivins used to call Texas the "National Laboratory for Bad Government," but believe me, it has rivals for that title.

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still a lot of details, but Ed Schultz has been talking a while about small states having a problem with tying reimbursements to medicare, that's the main opposition coming from the Blue Dogs (or if you want to cynical/honest) that's the last fig leaf they have left to cover the corporate whoredom. We take that away from them, there are no more excuses.

I think this could be a way to get a REALLY REALLY robust PO to put out there for a few years as an example until everyone else follows suit.

The red states would NEVER go for the strong option. So their residents would continue to suffer.

The GOP isn't stupid enough to fully opt out. Even if their constituency is stupid enough (they vote GOP after all), they'd lose too much business to states with the cheaper, public insurance option.

are calculated. Geesh! Talk about a complicated system!!! I see why small states & rural hospitals could go out of business though if a large majority of their patients are on a plan tied to Medicare rates. Check it out if you have the time & patience. It's a PDF file 20 pages long and very detailed.

http://www.oig.hhs.gov/oei/reports/oei-09-00-00200.pdf

Basically, the larger the hospital system is the more beds they have & the more patients they treat & the better prices on EVERYTHING they can negotiate...drugs, tech equip costs, supplies...well, everything. The small rural ones get stuck with higher costs on all those things and because one of the factors used in calculating those rates is the local wage rate, they get slammed again!

I asked the same question you did about the medicare rates. If a program like the PO based on Medicare rates would put your hosp's out of business, then CHANGE THE MEDICARE RATES!!

and there has been some discussion of that. Don't know if any of the 5 bills include it yet.

We can still let states opt out but we shouldn't make them be hurting hospitals if they decide to accept the option...