...just on the face of it, this sounds like a compromise reformers could embrace because I suspect many, probably most states would opt in, providing a plenty large enough pool to get to the bargaining power that is essential to make a public option work.
Part of my assumption here is that you'd have relatively few states opting out and they'd tend toward lower population states, likely clustered in the South and mountain states. So I suspect that a substantial majority of the population would be in opt-in states, providing the bargaining power that would make the public option threshold viable. And if the public option works, one would think the people in opt-out states would quickly become pretty envious of the folks in states who had the option.
Think of it this way. A robust national public plan with nitwits like Rick Perry refusing to participate in the plan (even though Texas really could benefit from it). Put another way: they could, in a figurative sense, invoke the 10th Amendment. This, of course, wouldn't be very popular and I suspect that anyone who opts out won't be in office very long once voters get a whiff of how much money voters in other states are saving.
My question remains: will this public plan be available to everyone, or just the uninsured, small businesses and the self-employed?
Oh, and by the way, before we go any further, can we shit-can the "Opt-out Public Option" name? "Public option" is ambiguous enough -- now we're looking at the added awkwardness of the term "opt-out."
Give us Freedomcare!