Have you been trying to understand Senator Harry Reid’s opt-out plan, the latest wrinkle in the health-care debate? I’ve been looking all over for an explanation of how it might work. Supposedly, states will simply be able to opt-out of government-run health care. Sounds like a win win, right?

The Senate passes legislation with a public option but, if you don’t like it, you opt out. The single-payer left is happy. The anti-single payer right is happy. What’s not to like? But Michael Franc explains that there might be a catch:


[D]on’t expect many states to successfully liberate their citizens from the government-run option. Though details are lacking, Reid noted that in order to opt out state legislatures (presumably in cooperation with the governor) would have “to act” before 2014. This suggests that a one-vote majority of obstructionists in one chamber of a state legislature, by refusing to act, can consign a state’s residents to an eternity of government-run health care. The deck will be stacked in favor of the default option — i.e., a government plan. Cass Sunstein and admirers of his ”Nudge” theory of policymaking must be smiling.


Bear in mind that in 17 states Democrats control both houses of the legislature and the state house. Public plan, anyone? In another 24, Democrats control at least one legislative chamber or the governor’s mansion. Count those states as leaning strongly toward a public plan. That leaves a total of only 9 states where Republicans run the entire show — Texas, Utah, South Carolina, South Dakota, North Dakota, Missouri, Idaho, Florida, and Georgia.


Given the highly partisan nature of health reform, the 41 states with mixed or total Democratic control are unlikely to press the opt-out button. But, ironically, state legislative and gubernatorial elections between now and 2014 could very well become referendums on the merits of government-run health care.


Last observation: Opting out does not result in some sort of a Milton Friedman-esque free market utopia. Residents in opt-out states will still have to grapple with all the other pitfalls of government-run health care — individual and (maybe) employer mandates, higher premiums, government designed health-benefit packages, etc.