THERE ARE A LOT of ideas being floated as supporters look for a way to get health care legislation through the Senate - some good, some not so good.
One is entirely unacceptable: Senate Majority Leader Harry Reid's state opt-out provision for the so-called public option.
We would find such a plan objectionable even if our General Assembly were not likely to be among the first in line to try to opt out of the provision that has become one of the chief targets of Republican opposition.
That's not because we are convinced that the public option is essential to health reform. The idea behind the public option - an uneasy compromise between Democrats who wanted a Medicare-style single-payer system and those who wanted to maintain the private insurance system - was to help contain costs. That's something that pretty much everyone agrees is essential, whether the government gets more involved or not. Or at least they agree until the cost-containment measures start to affect them personally or (in the case of politicians) until they see it to their political advantage to say otherwise. Frankly, we'd be better off if the Congress would focus on more direct ways to contain costs, by actually reforming the delivery of health care; clearly this can be done, as the list is long of countries that spend less per capita and have much better health outcomes than the United States.
Rather, we object to a state opt-out because such a central component of such a significant piece of legislation needs to apply to the whole nation - or not at all. That's something we should have figured out by now.
Consider two major federal health programs - Medicare and Medicaid.
Both are funded entirely or mostly with federal tax dollars, which come from all Americans. Medicare is a truly federal program; older Americans receive the same benefits whether they live in South Carolina or Connecticut.
Not so with Medicaid, a state-federal mix; the benefits are much more generous in some states than in others. So, for example, South Carolinians help pay to provide more extensive medical care for poor New Yorkers than poor South Carolinians ever will receive. That does not make sense - yet it is a mild version of what Sen. Reid has in mind for the public option.
It's one thing for South Carolina and New York to make different decisions about how long to incarcerate cocaine dealers or thieves or how high to set their sales taxes or a thousand other things that are rightly state issues. It's quite another for states to determine whether to participate in a significant federal program. What's next? Letting states decide that seniors within their boarders won't be eligible for the Medicare drug benefit? Or for Medicare at all?
If the public option is as essential as Democrats say it is - or as dangerous as Republicans say it is - then it needs to be available to all Americans or to none of us. And if it's available to none of us, then the Congress had better make sure it comes up with something that will help contain the escalating costs of medical care - preferably something that will be more certain than this to work.