Say Anything Blog

Time today makes an interesting point about the “opt out” provision for states in the health care bill Senate Minority Leader Harry Reid is pushing toward a vote:

The bill that Reid intends to introduce would include a public option with a so-called “opt-out” provision, giving states the ability to decide not to offer a small share of their residents the chance to buy into a government-run health-insurance alternative. Ostensibly, such a provision would appeal to moderates, who object to the public option as giving the government too big a role in health care. But in practice, it is difficult to see why any state would actually make the decision to opt out, considering that no one would be forced to buy into the public option, and it would not cost states any additional money.

That’s a good point.  It wouldn’t cost the states any more money.  So if, for instance, my home state of North Dakota opted out of the “public option” that “option” wouldn’t exist in my state.  Which might be nice in that it would our employers from maybe deciding to switch us over to government health care, but largely it’s not much of a difference.

But as a federal taxpayer I’d still have to pay for the taxes to subsidize this “public option.”  So what does opting out really get me?

And don’t forget that Reid’s bill also includes a massive expansion of state-based Medicaid entitlements:

The broader legislation would remake one-sixth of the U.S. economy and extend coverage to tens of millions of Americans. It would create new tax subsidies to help low- and middle-income families purchase insurance and expand Medicaid, the health program for the poor. It would also create a new national exchange, where individuals and families could purchase insurance, and would mandate that nearly every American hold coverage.

Would states be able to opt-out of that Medicaid expansion as well?  As I’ve pointed out before, this Medicaid expansion would grow eligibility for the program by more than 50% in 10 US states, and by more than 30% in 33 states.

That expansion will represent a huge amount of new government health care spending, with most of it having to be sustained by the states.  And with most states in the union no better off fiscally than the federal government, is that really something we can afford?

Reid’s “opt out” is a cop out.  There’s no choice here.  Only costly new government and entitlement expansions.