I'd be more optimistic about this "opt out" option if the Democrats as a party, and the party leadership and Obama, had shown the slightest sign of grasping how to actually, you know, benefit from such a strategy.
We went over this at the time of the Stimulus debate. We should, of course, have had an "opt out of the stimulus" clause at the congressional (not the state) level. Simply put, if your congressional representative refused to vote for the stimulus money your district should have been debarred from receiving any monies under the program until such time as a newly elected representative gave your district's assent to the program. That was a totally easy call to make and the Dems should have made it. And they should have threatened to make it at the Senate Level, too.
I'm for a "public option" with an "opt out" clause--but of course in real life every single true public option that's been floated has an "opt out" clause called the *&^%% private insurance system. If you, as a family or an individual, think you can do better on the private insurance market you can opt out of the public option right there and just stick with what you know. Good luck with that, and all, but zei gesundt, bubblichiki.
We know the public option (the imaginary good one) is the best thing for the country as a whole and there is no reason to allow either republican or democratic representatives to stand in the way of the option and still pretend to any form of morality, principle, or even good government policy. That's number one. But if the Democrats feel, for whatever reason, that they must allow some of their membership to vote against the public option specifically and delay a national public option the democrats have to grasp that that is a purely strategic move. And like all strategic moves it could be a better or a worse one. In other words--half a public option/opt out public option is a tool to get somewhere. And that somewhere is a national public option/medicare plus five or whatever you want to call it. Anything that stands in the way of that short or long term has to be judged in terms of whether it is preventing that.
Allowing states *on behalf of their suffering citizenry* to opt out *as states* except to please reactionary, pro-industry hack is, as usual, bad strategy as well as bad policy. From the Democratic/strategic point of view there ought to be only two reasons temporarily enable the capture and rape of those captive populations by allowing an "opt out" public option.
1) You might want to do it simply to get the bill through with a big enough/national enough public option that the states where it obviously works will be some kind of "object lesson" for the failed states and their populace. In other words you accept some damage to the citizenry for a short or long term. Its a kind of, covert, polite way of saying "ok, see if you like it when your representatives don't deliver for you and ours do deliver for our constituents." Me, I'm not anti politeness as such but I also hold no brief for mere politeness for its own sake. It also makes the suffering citizenry responsible for figuring out what is going on and voting the bastards out down the road. That's ok, but if the Democrats handle the propaganda/explanation side of things as badly as they did with the stimulus the citizens of the opt out states will continue to be as ignorant of health care issues as the red states are of health care policy in France and Switzerland.
2) Your second objective might be to do just this but *faster*--in other words--you are intending to heighten the contradictions for voters and their representatives in the red states/opt out states by actually showing them the consequences of their intransigence now. That's my preferred strategy because I think its the best way to get good health care reform to all our citizens. The correct long and short term Democratic strategy has to be to get the best bill for the most citizens they can and if they can't to, if I may use some Rovian language, to *&^% up the opposition as it has never been &^$^^%$ before until their position becomes untenable *as fast as possible.*
So, by all means float an "opt out" provision--but it shouldn't be done at the level of the states but a straight up quid pro quo: senators and congressmen should be told they and their constituents will be unable to access the public option unless they vote for it now. The public option is a *goody* just like the stimulus was. The way you get people to support political goodies is by threatening to withhold the doggie treats and to let the doggies know just who is hiding the bikkies.
Catapult the propaganda and the "opt out" provision is good. Handle it with the usual Democratic modesty--or stupidity--and it will be just another strategic failure.
**Edited to Add that of course Dean gets what needs to be done on every level--political, partisan, and also in terms of actual people's health care needs. Of course you want to speed up the pay off for the voters, not push it off until they forget who did it for them and why.
This is why I'm always absolutely aghast at the Democrats' continued inability to grasp that in this current situation, where whatever the Democrats are for the Republicans are against, the *better* your policy prescriptions the more partisan advantage they bring you. Its possible both to craft the best policy and also to push the hardest for the best policy without endangering your political future in the slightest--as long as you make clear to the voters what the payoff is for them right away.