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Rockefeller Warms To Public Option Opt Out; So Do Conservative Dems

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Sen. Jay Rockefeller (D-WV)

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Earlier today, Sen. Jay Rockefeller (D-WV) told me something somewhat unexpected. "I'm looking very much now at this opt out public option," he said, "not opt in but opt out--so you start out with a public option, and if you don't like it you can opt out....that has a sense of freedom."

Why unexpected? Because here's what he told me just last week: "I don't start out favoring that," he said. "You know, opt out is sort of like trigger. It sounds good, it makes people feel good, but the question is, Is it good? And I don't think it really is. If it's the only way you can get the votes, then that's a decision that will have to be made over my head."

That's a pretty notable change, and reflective of the political appeal of the opt-out proposal within the Democratic party. Rockefeller and other senators have come to believe that, in addition to being more likely to get the votes needed to pass in the Senate, it's also a policy fix that will have almost, if not the same, impact as a fully national public option.

This afternoon, Rep. Anthony Weiner (D-NY)--a very visible public option advocate--said he could back an opt-out clause. "I would accept and would be open to the idea, after the program's up and running a couple years, if a state wants to opt out, if they want to leave 25, 30, 50 thousand of their citizens without that choice," Weiner said. "I dont believe it's gonna happen. So i would accept that kind of an opt-out thing." Rockefeller likewise believes that, once consumers purchase in to the public option, they'll raise hell if their state governments try to take it away from them.

And it's not just public option enthusiasts who are sounding off positively about the concept. Here's what Sen. Ben Nelson (D-NE) told me earlier this week: "while there's support for public option generally, generically, when you start talking about it specifically as it relates to states being able to opt out or opt in, have their own, the support overwhelmingly goes up to 76 percent."

Again, the opt out is gaining steam politically, but it's still very young from a legislative perspective, so it would be easy to overinterpret statements like these. Let's just say that we probably haven't heard the last of it.

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59 comments

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October 21, 2009 6:11 PM   

I'm confused: would the opt-out be a Schumer style "level playing field" option, or a Pelosi Medicare + 5%?

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October 21, 2009 6:21 PM    in reply to Connor

Two different things. The Schumer vs. "Medicare + 5%" debate is about how a public option would be funded and how much it would reimburse providers. The "opt-out" clause would simply enable a state to decline to offer the public option to its citizens (regardless of how it's structured).

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mcc

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October 21, 2009 6:52 PM    in reply to DB55

Well -- how about this. Is the HELP bill Schumer-style or "Medicare+5%" style? And if the HELP bill has a Schumer-style public option and the Finance bill has no public option, doesn't that imply the merged version will contain a Schumer-style public option regardless of the presence of the opt-out?

...'course if the Senate passed a version with a Schumer-style public option and an opt-out, and the House passed a version with Medicare+5% rates and no opt-out, and then those were merged into a "compromise" bill with both Medicare+5% rates and an opt out... that seems like not such a bad outcome?

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October 21, 2009 7:29 PM    in reply to mcc

IIRC...
Schumer's level playing field is primarily about the public option operating under the same rules and being self-funded (from premiums).

Medicare + 5% is about reimbursement rates to providers.

You could easily mix and match and in fact even the Medicare + 5% will almost certainly do that by giving something extra to rural providers who have very low Medicare rates and making sure primary care providers and providers who take care of younger folks are adequately taken care of (which is a departure from Medicare).

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October 21, 2009 9:40 PM    in reply to mcc

I think they would go the HELP PO with an opt out clause and MAYBE......if we are lucky a Medicare +5 with an opt-out clause. We will probably end up with negotiated rates with an opt out in the end though. It's all in the details though. Will it be up for a few years before you can opt out? What kind of PO will it be? Will it be by referendum or legislature or something else? That remains to be told.

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October 21, 2009 11:59 PM    in reply to mcc

The HELP bill is Schumer-style.

It requires the HHS Secretary to negotiate payment rates to doctors for the public option.

The payment rates would be the local average or less.

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October 21, 2009 6:29 PM   

If the opt-out will draw more votes, bring it. Blue Dogs can comfortably vote for the final bill with public option with opt-out, then let the state officials take the credit or the heat for 86'ing it.

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October 21, 2009 6:45 PM   

I think an opt-out would be a good compromise. I think it will be difficult, to say the least, to get all but the most nutwing of states to actually opt out.

While this might mean people in South Carolina and Oklahoma will be screwed, it might serve a more beneficial purpose of demonstrating the economic value of a public option.

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rwc

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October 21, 2009 9:59 PM    in reply to agio

and maybe after they get screwed they'll wise up and vote out the nutbags. This could make the red countryside more blue and improve life in more ways than just health care.

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October 22, 2009 3:54 PM    in reply to rwc

I doubt people in the states that are likely to 'opt out' will learn anything, but if that's what it takes to get blue dog democrats off the fence, let's do it.

If the population of the opt out states wake up & realize they've been screwed by their representatives, they can vote them out. Meanwhile, the states that are happy to 'opt in' will get the health reform their population needs.

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October 21, 2009 7:13 PM   

210 votes - latest Progressive Caucus count for robust public option

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October 21, 2009 7:15 PM   

OPT OUT = COP OUT

No public option no bill!!!

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October 21, 2009 7:28 PM    in reply to johnmccsf

Perhaps. But if it gets the PO through the Senate. . .

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October 21, 2009 8:43 PM    in reply to agio

Jeez - Look at the states and Gay marrage, for example.

Can you imagine if civil rights legislation had an opt out?

Easy to pass? Perhaps, but today half my friends still wouldn't be able to sit down and eat with me at a Subway in Birminham.

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October 21, 2009 8:19 PM    in reply to johnmccsf

Not sure it's the choice, but I'd take a robust PO with an opt-out than a weakened PO any day of the week.

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October 21, 2009 9:05 PM    in reply to johnmccsf

I strongly support the opt-out, and I'm am four square behind a seriously robust public option (*would actually prefer single-payer).

It would not only be able to allow a more robust PO in the final bill, but would pay political gold for progressives and Democrats for years to come. Witness how many GOP Gov. and legislatures folded like a bad card table with stimulus check.

I am drooling at the prospect for a red-state Gov. or legislature to have to try and sell to their constituents why they need to deny them the choice in coverage other states have. Quickest way to ensure red states go the way of the dodo.

And just a reminder, Medicare, which is no a political third rail was a national opt-in program from the get-go.

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October 22, 2009 12:25 AM    in reply to Lestatdelc

Sounds a little bit too rosy scenario to me.

I am not in support of pushing the fight out into the states perhaps because I live in one of those states where I see it becoming a political football. This is a cop out in my opinion and I detest the idea that would have to figh for my health insurance choice based on which way the political power swings on a given year.

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October 21, 2009 7:26 PM   

O.k have an opt-out, I have no problem with that. But only if the congress and senate make it so the public option is medicare for all and nothing less than that. Then the states can decide if they want to opt out of that.

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October 21, 2009 7:34 PM   

So who's in charge of the opt out? The respective state's governor, or their state legislature, or their representatives in the U.S. congress?

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October 21, 2009 8:10 PM    in reply to SkippyFlipjack

Everything I've seen on any opt-out option leaves it to the states, be that by referendum, governor's decree, or state legislature. In any of those cases, it provides cover for blue dog senators to vote for it because they can say to voted to protect their state's rights and state economic concerns, without having to do something as stupid as actually opting out of a cheaper and more effective program that would save everybody money.
The analysts, so far, have all said that only a few southern states, at most, and MAYBE Texas, would even consider opting out, and even if they did, they would opt back in pretty quickly.
Ironically, the states most likely to opt out are the states that most need a cheaper, public option, but then again, maybe this is just what they need; a real teachable moment for the people to realize, finally, that government isn't the enemy, only poorly run Republican-style government.

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October 22, 2009 8:36 AM    in reply to Mr.E.

Which somehow reminds me of the Churchill quote about "you can count on Americans to do the right thing, after they've exhausted all the other options"
:-)

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October 21, 2009 7:38 PM   

This is awesome news.

A strong public option with an "opt out" clause guarantees Republican disarray. It guarantees anyone who votes against it is going to look really stupid to the voters. Contrary to the image the Republicans tend to project, they really aren't that stupid.

Bravo Schumer. Maybe your best move ever.

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October 21, 2009 7:44 PM   

Let the Rethuglican states opt out of the public option - along with Medicare, Social Security and federal highway funding. Even better, let them opt out of the union entirely. We could use a few less states sending idiot rednecks to the Senate while soaking up tax dollars, and the birthers/deathers/tenthers/oathers/teabaggers could all GTFO.

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October 21, 2009 7:54 PM   

I'm fine with an opt-out. An opt-in or a trigger would be a disaster. Triggers are kicking it down the road indefinitely, and Opt-In requires proactive action to participate. This is a compromise that in the end won't matter because no state will ultimately opt-out and -- as a long shot if they do -- it would be a year or two at most. Because state legislators would have to take PROACTIVE ACTION to deny their people choices...

That may be less than ideal for those states who have total wingnut Governors and legislatures -- but they voted them in and they can vote them out. In fact, politically its brilliant because it has the potential to actually break the back of a lot of the more extreme wingnut factions of the Republican Party.

But remember:

- Medicare as originally passed -- to get it through -- was opt-out. How many states don't have Medicare now? Zero.

- For all their grandstanding about not taking it, what did Gov. "No Stimulus!" Jindal and Rick "Secession!" Perry do? Oh, yeah... bellied up to the trough. That's because:

- Republican state legislators aren't going to be as willing to fall on their sword for the ideology. And they'll feel the heat from their local constituency if they turn it down. If not immediately (most likely as there is widespread support even in red states), then when they figure out they are getting reamed vs. their neighbor states. Might even wash some of the crazy from their party.

- It'll drive prices down because with the outside possibility of Texas, none of the biggest pop. states, nor the entire NE/Midwest/Pacific West states will opt out. That's a huge pool. And again, it'll be a short term opt-out.

- Even for the theoretical state that initially turns it down -- drive down prices. Because AFLAC will know that the PO is just a vote away in that state, surrounded by PO states. If it works, prices are lower in the rest of the U.S., and that's a Sword of Damacles hanging over the insurers.

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October 21, 2009 8:13 PM    in reply to Ian Tepoot

Word.

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October 21, 2009 8:36 PM    in reply to Ian Tepoot

I can almost guarantee Missouri and Kansas will be out.

Ky, Nc, Sc, Gc, Al, Ms, La, Ak, Ok,

at least.

Sorry to be so negative, but these places just could care less about the uninsured.

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October 21, 2009 9:13 PM    in reply to Bass Ace

May be true - but a couple of voting cycles (and education) the 'constituents will understand their rights and their responsibility as voting/contributing members of society

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October 21, 2009 9:18 PM    in reply to Bass Ace

I doubt it. I bet there is not a single state that would vote to opt-out. Hell, lock at all the bluster about refusing stimulus funds? They folded like a bad card table.

And this put them in the position of having to try and sell to their voters that they should not have the same choice other states have for buying health insurance.

Good luck with that. Not a single politician who wants to be elected or re-elected would make that argument.

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October 21, 2009 11:50 PM    in reply to Bass Ace

Would that be true if the opt out required a public vote rather than simply a vote by the legislature? And add Texas to that list. Pretty much the entire Confederacy.

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October 22, 2009 2:08 AM    in reply to Bass Ace

NC? Last time i checked NC voted for Obama, and has a dem governor and a dem senator. and its 8 D and 5 R in congress atm. Don't lump us in with freakin SC.

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XL

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October 21, 2009 8:55 PM    in reply to Ian Tepoot

I hope you are right! I did not realize that Medicare had an opt-out provision. I still believe it is a dangerous precedent.

There is also another political consideration about the opt-out provision. The red states that opt out will not get the benefit of health care reform and will not have any reason for change their votes from the party of no. Things will not change in their states (expect for the worse), they will not see that other states are better off than they, and so will naturally blame that other party, those democrats who are wasting, Wasting, I tell you, taxpayer money for the General Welfare

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October 21, 2009 9:14 PM    in reply to Ian Tepoot

Actually Medicare was opt-in, not opt-out. So this is even better than Medicare was when it was initiated and would pay political windfalls if any red state was stupid enough to opt-out. It would quickly become a blue opt-in state.

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October 21, 2009 8:31 PM   

(Sigh)

Well, I guess we'll start packing up to move.

Anyone want to recommend his or her state? Will tolerate some cold weather for good fine arts access.

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XL

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October 21, 2009 8:46 PM   

If States can opt out of a federal law what good is the law? Imagine States being able to opt out of Social Security, the 1964 Civil Rights Act, and so on. This could be a dangerous precedent, a slippery slope if you may. Wasn't there a Civil War about the very idea that we need to hang together or else we will fall apart like a house of cards?

The GOP has NOTHING constructive to say on health care. The Democrats have given them Every opportunity to participate. They have said no. Time to move on without them. Otherwise, there will be no meaningful reform.

I like what Mr. E says but many of those folks in those extremely red states live in an alternative universe and it won't matter how poor, how desperate they are in comparison with the rest of the country. As long as they have their bibles, their guns, and Fixed News, they will continue down the path of ignorance and the status quo.

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October 21, 2009 9:06 PM    in reply to XL

What nonsense. Social Security is a third rail that the GOP dare not touch. And Medicare was an opt-IN program from the get-go.

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October 21, 2009 9:33 PM    in reply to XL

While I wish medical care would be recognized as a right, it isn't right now. That is true regardless of whether this bill passes with or without a public option. What congress is dealing with is regulating markets, not protecting rights. This is completely different from civil rights.

This is allowing states to opt out of the public option and then they can compare the results in the different markets with and without the public option. If the public option is as successful as most of us believe it will be, then more and more people will demand it. Not only that, but there would be clear evidence that the public option is successful, making it palatable to a lot more people when they see we don't magically turn into Soviet Russia and that it works.

I regret that my state (Louisiana) would probably be the first to opt out, but at the same time I believe that it would be just a matter of time before people will call for changing it.

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October 21, 2009 9:54 PM    in reply to XL

Well..... let them continue to sink back into the swamp...... much better than them keeping the rest of us from ever getting to a decent civilized future.

The truth is that this may spur a dramatic upgrade in the political climate in these backwater states. Even the dumbshits will notice that they are getting screwed by their conservative republican corporate whores.

Canada phased in it's universal healthcare by starting it in the more progressive "states" and getting it later in the conservative areas after it was working well everywhere else.

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loc

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October 22, 2009 12:16 AM    in reply to XL

"The GOP has NOTHING constructive to say on health care. The Democrats have given them Every opportunity to participate. They have said no. Time to move on without them. Otherwise, there will be no meaningful reform."

..don't know if you noticed, but this IS the Democrats moving on without the Republicans. These compromises are about getting 58 Democratic, 2 Independent and maybe 1 Republican vote.

And right now it looks like it's going to happen.

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October 21, 2009 8:50 PM   

Of course there a 'sense of freedom'... it pushes this health care fight out for every state to have to continue.

Without a true public option that cuts costs and is available to 'all' Americans they can take their mandate and shove it!

I am sick of all of the gimmicks it's just disgusting.

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October 21, 2009 9:10 PM    in reply to synchronicity

SO you hate Medicare to, which is an opt-in program?

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October 22, 2009 12:22 AM    in reply to Lestatdelc

No!

They are not saying 'we' get to opt-out. This suggests that our health insurance will be a political football state by state depending on who is in control politically...

Medicare is an individual choice the state cannot opt-out of it.

They are discussing giving the 'state' the power to opt-out not individuals... it would already be a choice to purchase private or public insurance should a public option be passed.

Opt out pushes the fight for a public option out into every state and makes it a political football. It sounds like an awful idea and once again a way for congress to push the fight on into the states so they don't have to resolve it.

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October 21, 2009 9:31 PM   

I can guarantee that if Reid throws us Progressives unfortunate enough to live in red states under the bus, we will actively campaign against him.

Not a threat -- a promise.

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October 21, 2009 9:38 PM    in reply to melior

I live in Louisiana and I would applaud him. If the votes aren't there, then they aren't there. This is much better than a trigger and as long as they make the option strong, we get to prove ourselves to be right. The delay sucks, but it has its positives too, because if anything goes wrong with reform they can't use the public option as a scapegoat unless it actually looks like it is hurting the markets that have it.

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October 21, 2009 10:04 PM    in reply to melior

Your Red States are throwing EVERYONE under the bus! I am tired of the veto power the small ignorant states have over all other civilized Americans. It can only help to turn Red States Blue if they have to have it thrown in their faces with facts on the ground. Medicare for Everybody!

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October 21, 2009 11:32 PM   

Matt Jones: You said it, sir!

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October 21, 2009 11:35 PM   

Opt-out itself should have a trigger, as Weiner suggested: all states are in for three years THEN any winger governor or legislature who wants to 'opt out' can tell their voters why. I predict no state will do it. Just like the stimulus bitchery ... they screamed 'socialism, but all took the money and bragged about it on top of that.

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October 21, 2009 11:35 PM   

IF there has to be a compromise, this is one I can live with. It shows confidence in the public option and calls the bluff of all these redneck Confederate governors, who will either back down or commit political suicide. A million times better than trigger or co-op.

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October 21, 2009 11:43 PM   

OK. If there is an Opt out included in the bill, then for a state to opt out should require a public vote. It's the public who gets hurt by not getting access to Medicare Part E.

Here in Texas the State Legislature will approve an opt out and force it down the throats of the people. Making it a decision that requires a public vote would then bring all the voters who need it out to fight to stay in the pubic option.

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October 21, 2009 11:45 PM   

rockerfellor is for a opt-out? really? hmmmmm. i don't like a opt out. i see red states opting out that need it the most. namely the southeast. i wonder if a penalty will be installed if you choose to opt out? what about residents that want to opt in but their state opts out. then what?

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loc

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October 22, 2009 12:28 AM    in reply to neesy08

Move.

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October 21, 2009 11:57 PM   

What would the conditions for an opt out be? Also, what would the cost to a state if they opt out? If uninsureds get covered by Federal Medicaid dollars, or by free care dollars at ERs, don't expect me to be happy about kicking into that pot if I'm from a participating insurance reform state.

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October 22, 2009 1:00 AM   

Want to repeat something I picked up when the opt-out first floated - if states can opt-out, then the final bill must have an individual opt-in. Choice, the American way. Let the statehouses secede, take their state government apparatus out of the picture, but give the people the choice to individually buy into a public option. Watch purple turn blue overnight.

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October 22, 2009 1:14 AM   

If the only way to get a strong public option is to allow the former slave states to opt out, so be it.

People in those states may wish to contact their own state's elected officials, rather than whining about other states.

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October 22, 2009 1:24 AM   

Opt out is bad policy unless the public option operates, as Weiner said, for a number of years first. Then, opting out will be far more difficult. Still, it's bad policy. What we need is one national uniform policy.

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October 22, 2009 1:42 AM   

I can't believe that he's backing out of the public option. He's not backing out of the public option.

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October 22, 2009 4:28 AM   

Opt out is fine. But as many have suggested, there ARE moral concerns. Most of the states that are likely to "opt out" contain huge proportions of their populations that need reform the most (working poor; lower middle class; disenfranchised; powerless).

Are we really willing to throw these people under the bus, tap an individual mandate on top of their asses, and give them NO PO to fall back on? In effect, throwing millions into the pit?

I'm ok with it, if its the only way to get it done.

But it smells a little like Katrina to me.

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October 22, 2009 8:40 AM   

I can't figure this out, but it definitely seems to me that "opt-out" is just the public option (whatever that may be) plus the added political bonus of daring the Retardicans and Blue Dog Republocrats to "opt-out" at their own political peril.

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October 22, 2009 8:58 AM   

TX 7th Congressional District Rep. John Culberson is running a poll on his website: http://culberson.house.gov
When I discovered the poll yesterday it was running 3 to 1 against the president's plan. Now I'm proud to say it's been reversed. Please go to http://culberson.house.gov and make sure it stays that way.

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October 22, 2009 10:07 AM   

Something is better than nothing. At least with some kind of public option we have something to build on.

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