In today’s New York Times, Paul Starr proposes a compromise that “goes to the heart of conservative and libertarian objections.” “[L]et individuals opt out of the new insurance system, without a penalty, by signing a form on their tax return acknowledging that they would then be ineligible for federal health insurance subsidies for a fixed period — say, five years.” During that period, if the opt-outer changes his mind, “they would face a market much like the one that exists now” and would have no guarantee of coverage.

Starr argues that giving Americans the choice of opting out of the mandate would address conservative anxiety about too much government meddling in the health care system while still getting more people into larger risk pools:

If this provision were added to the legislation, people without coverage through a group or Medicaid would have three basic choices in 2014, when the law goes into effect. They could use the new insurance exchanges to buy guaranteed coverage, receiving subsidies if their incomes were within four times the poverty level. They could take the five-year opt-out. Or they could refuse to do either and pay the annual penalties under the bill. (The legislation exempts them from penalties if the lowest-cost plan in the exchange exceeds 8 percent of their income or their income falls below the threshold for filing taxes.)

If softening the mandate could capture some Republican votes or win concessions for progressive priorities like the public option, it may worth considering. But since opponents of reform are likely to characterize any health care plan as a government-take over, giving individuals the option to opt out of insurance makes little sense.

The opt-out choice will attract younger and poorer Americans — the very same people who don’t typically buy insurance (either because they think they don’t need it or they can’t afford it) and leave insurance pools with a disproportionate number of sicker people who buy coverage because they need it. Insurance premiums will increase as a result and the government would have to spend more money on affordability credits.

Then, there is the five year period. Americans that choose to opt out of the mandate will forgo preventive care or annual check ups for up to five years, meaning they will enter the health care system sicker and more expensive — just like uninsured seniors who enter Medicare and end up spending 50 percent more than previously insured Medicare beneficiaries who also had chronic disease. Some of the uninsured will also wind up in hospital emergency rooms, where insured Americans will pick up the tab for their uncompensated care, but most significantly, Americans who become seriously ill will not be able to receive government assistance with their health care bill.

Starr is rightly concerned — despite Massachusetts rather positive experience with relatively low fine — that the Senate bill’s low penalties “compared to the cost of insurance” could encourage some Americans to remain uninsured. But allowing more people to go without coverage would exacerbate that trend, not avoid it.

Also, it’s worth noting that the Senate bill already allows states to opt out of the individual mandate if they can “demonstrate that they can meet the criteria — particularly on cost containment, improving the delivery system” of the federal standard. That of course, is a relatively high bar and quite different from what Starr is proposing.

Over the last few days, Republicans have repeatedly cited Sen. Robert Byrd’s (D-WV) opposition to passing comprehensive health care reform through the reconciliation process as proof that Democrats are skirting Senate rules to “ram through” unpopular legislation. Republicans reason that if Byrd — the Senate pro tempore and an architect of reconciliation — believes that the process cannot be applied to reform, then Democrats — who no longer have a supermajority in the Senate — should “scrap” the existing legislation and “start over” on a bipartisan basis:

- SEN. LAMAR ALEXANDER (R-TN): “As Senator Byrd says, running health care through the Senate like a freight train is an outrage because it basically turns the Senate into the House, into a majoritarian institution.” [The Atlantic, 3/04/2010]

- SEN. MITCH MCCONNELL (R-KY): “The man who wrote the Byrd rule is Robert Byrd. He said so as recently in the last twelve months that it should not be used for health care.” [Washington Times, 2/25/2010]

- SEN. ORRIN HATCH (R-UT): “Less than a year ago, the longest-serving member of the Senate, West Virginia Democrat Robert Byrd, said, ‘I was one of the authors of the legislation that created the budget ‘reconciliation’ process in 1974, and I am certain that putting health-care reform . . . legislation on a freight train through Congress is an outrage that must be resisted.” [The Washington Post, 3/01/2010]

But as it turns out, Byrd doesn’t oppose using the reconciliation process to pass a small package of fixes to the Senate health care bill. In a letter to the editor published in Thursday’s Charleston Daily Mail, Byrd writes that it’s appropriate to use reconciliation on a package that reduces the deficit.

“I believed then, as now, that the Senate should debate the health reform bill under regular rules, which it did,” Byrd wrote. “The entire Senate- or House- passed health care bill could not and would not pass muster under the current reconciliation rules, which were established under my watch.” “Yet a bill structured to reduce deficits by, for example, finding savings in Medicare or lowering health care costs, may be consistent with the Budget Act, and appropriately considered under reconciliation.”

So now that “the longest-serving member of the Senate” has endorsed the Democrats’ strategy, will Republicans abandon their campaign against majority rule? It’s unlikely.

Yesterday, President Obama signaled his support for passing the Senate health care bill in the House alongside a reconciliation package of fixes, but pro-life Democrats led by Rep. Bart Stupak (D-MI) have pledged to oppose the Senate bill unless Congress strengthens the prohibitions against federal funding of abortion. Following Obama’s address, Stupak appeared on MSNBC and Good Morning America to argue that the Senate health care bill allows for public funding for abortion:

STUPAK: In the Senate bill, it says ‘you must offer insurance policies that will be paid for by the federal government that covers abortion.’ ‘You must do so.’…Also, in the OPM, Office of Personnel Management, policies they will be putting forth, you must pay, every enrollee must pay one dollar per month into a fund to help fund abortions.

Watch a compilation:

Stupak may have confused his page numbers, but pages 2069-2078 of the Senate health care bill clearly prohibit federal dollars from funding non-Hyde abortions. In fact, contrary to Stupak’s claim, page 2017 (lines 18-21) of the Senate bill give insures the choice of providing abortion coverage. “The issuer of a qualified health plan shall determine whether or not the plan provides coverage [for abortion].” If the carrier chooses to provide abortion coverage, “the issuer of the plan shall not use any amount attributable to any of the following for purposes of paying for [abortion] services,” the bill says, before barring insurers from using government premium credits and cost sharing reductions to finance abortion coverage.

Furthermore, the bill requires insurers to “collect from each enrollee in the plan (without regard to the enrollee’s age, sex, or family status) a separate payment” for abortion services and deposit the payments into separate “allocation” account. “The issuer of the plan shall deposit…all payments described in subparagraph (B)(i)(I) into a separate account that consists solely of such payments and that is used exclusively to pay for services other than services described in paragraph (1)(B)(i).”

Ironically, Stupak’s second concern about paying at least $1 into a reserve fund for abortion coverage was actually included in the legislation to allay pro-life concerns and ensure that no taxpayer money is spent on abortion. The $1 is coming out of private premiums, not public dollars, and is a way of ensuring that carriers have sufficient funds to cover the services they offer. But Stupak is just shifting the goal posts. First he complained about taxpayer funding for abortion and once Democrats strengthened the Senate language, he began arguing that private funds will not go towards abortion coverage. He simply can’t have it both ways.

If Democrats decide to change the Senate’s abortion language, they may have to add the provision to a separate non-reconciliation measure, but it’s still unclear that Stupak would vote for reform. On Monday, Stupak told the Wall Street Journal that “abortion isn’t the only issue that will keep him from voting for the Senate bill if Speaker Nancy Pelosi brings it to the House floor.” “It’d be very hard to vote for this bill even if they fixed the abortion language,” he said. Asked whether there was any way he would vote for the current package, he had one word: “Nope.”

Yesterday, the Weekly Standard’s John McCormack received a press release from the White House announcing that President Obama had nominated Scott Matheson, Jr — a former Utah Attorney General and gubernatorial candidate — to the United States Court of Appeals for the Tenth Circuit. McCormack noticed that Matherson’s brother, Rep. Jim Matheson (D-UT) was one of ten Blue Dog Democrats invited to the White House that evening and naturally assumed that Obama nominated Scott Matherson to pressure his brother to vote for health care reform. “So, Scott Matheson appears to have the credentials to be a judge, but was his nomination used to buy off his brother’s vote?,” McCormack asked in his late-evening blog post.

Less than an hour later, POLITICO picked up the story and by nine, Rep. Michelle Bachmann (R-MN) was calling for an investigation of the White House on Larry King Live and the allegation spread to Drudge and other conservative websites:

BACHMANN: Because today, the president offered a judgeship to the brother of a member of Congress. Tonight, the president has that same member of Congress at the White House, pressuring him to change his vote on health care. We need to have an — an independent investigation into this matter, because we’ve seen the Cornhusker Kickback, the Louisiana Purchase the union loophole. And now, the big question is, is the White House trading health care votes for judgeships? This is a pretty serious issue, Larry…. if you offer a judgeship to a brother of a member of Congress and the same night you have that member at the White House, where the president’s twisting his arm to ask that member of Congress to switch his vote on health care?

Watch it:

Of course, other than the timing of the press release announcing Scott Matheson’s appointment and his brother’s meeting at the White House, there is absolutely no evidence that the administration had set-up a quid pro quo. In fact, no less than two Utah Republicans have already vouched for Matheson’s qualifications. “I approve of that nomination. Scott is a very fine fellow,” said Sen. Orrin Hatch, (R-UT), former chairman of the Senate Judiciary Committee. Republican Congressman Jason Chaffetz also praised Matheson’s nomination, saying, “”His distinguished scholarship as an attorney and law school dean, and his devoted public service to Utah and to the United States, make him an excellent nominee. Good choice, Mr. President. Good choice.” Rep. Matheson’s spokeswoman denied the story to the POLITICO, calling the allegations, “patently ridiculous.” “Can you spell NO?” she asked.

This isn’t the first time the Weekly Standard manufactured false quid-pro-quo stories about health reform. In December, Michael Goldfarb floated a rumor that the White House threatened to close an Air Force base in Nebraska if Sen. Ben Nelson (D-NE) didn’t vote for health care reform.