Adding to Josh Marshall’s point here, the general idea of a national public option with a state opt-out option seems to me like a potentially fine idea.
Here is the deal. Even if only two-thirds of the States opt in, government should already have a big enough pool to swing most of the muscle that a national public option would offer. I cannot ignore that the deal will suck for people in Texas and the deep south. Temporarily setting aside that unfortunate minority, and assuming that conference negotiators can exorcise the devils that live in details, the plan could be a lifesaver.
The most encouraging point for me is that the system will likely work like a one-way ratchet. States can always opt out at the beginning, but pols in a state with a solid public option would eat nails and walk on glass before seriously trying to get rid of it. Over time positive press and occasional progressive wins in the state House would move holdout states towards accepting the public option as well, and at that point they’re in for good. Rising progressive candidates will certainly make opt-in a plank in every major race, and a powerful one if the plan doesn’t suck. If a few hardcore states hold out indefinitely, the issue will have grown a lot less controversial and the Federal government can finally take the decision out of their hands.
Look at it this way. Even if states could opt out of Social Security, Medicare or Medicaid, do you think that any would?
Naturally this model takes for granted that the President will sign a bill that delivers affordable, non-discriminating healthcare. If Democrats pass some dynfunctional compromise cooked up by Susan Collins then they might as well let he whole thing fail and start over whenever voters give Congress back to them.