Bill Nelson's Health Reform Dyslexia

Merely to satisfy one Republican and the handful of Blue Dog Democrats left in the Senate who are not nuzzling too deep in the hog's trough of health insurance campaign contributions, over the past couple of weeks two compromise ideas have been floating around Washington, presumably to satisfy the 70 percent of Americans who want a public health insurance option while making it possible for politicians to claim otherwise when they're confronted with the remaining 30 percent.

One path to compromise is the so-called "trigger" option. Under this, there would be no hope of universal health reform for years to come, under the best of circumstances, and probably never.
The other is the so-called "opt-out" option -- everybody gets it, unless they're stupid enough to elect a state government that "opts out."

Today, Florida Senator Bill Nelson was asked which he prefers. His answer suggests he has a bad case of Health Reform Dyslexia. He got it exactly upside down and inside out:

[T]o argue that a trigger is preferable to the opt-out seems entirely wrong. With the latter, there would be a national public plan that gives consumers a choice. With the prior, there would be no public option at all until some arbitrary point in the future, when private insurers have failed by some arbitrary measurement.

Or put another way, with the opt-out, it's possible that some states would refuse to let residents have a choice between competing public and private plans. With the trigger, it's definite that everyone would be denied a choice between competing public and private plans for some indefinite period of time.

This bears repeating: Congress on a number of occasions has enacted a half-step toward reforming something and then added a "trigger" to mollify reform advocates. In no case has the trigger ever been pulled. The legislative "trigger" is merely a congressional slight-of-hand to make you think you can have it both ways.

The "opt-out" alternative isn't problem-free, either. It looks too much like the Missouri Compromise, enacted to satisfy both abolitionists and slave holders. The criticism, in those antebellum days, came down to a fundamental point of fairness, justice, and equality: either everyone really is created equal, or they're not; latitudes and state boundaries should have nothing to do with it.

So, too, with health reform. Either everyone in America should be entitled to quality medical care, or not. Allowing Mississippi, Florida, Texas, and such -- basically, the old Confederacy -- to "opt out" not only invites terrible inequality, it will endanger the rest of the nation's population when the next epidemic comes along.

Germs and viruses have no respect for state boundaries or political preferences. The opt-out option makes no more sense than does providing police and fire protection only to those who can buy it.

Neither "compromise" is reasonable. Both should be rejected in favor of true health reform -- a strong public option. But if we have to have one of them, Florida's own Bill Nelson has it exactly wrong: the trigger would deprive all Americans of a basic freedom. Only the "opt-out" compromise gives all Americans a true choice.