For future political gains, I have a notion that insurance reform with an opt-out option is superior to one with a mandatory adoption by all states, and I'd like to know of flaws in this notion.  Let's assume it passes Congress and is signed into law in this form.

1.  As a a reflexive action, these states will opt out:  Idaho, Utah, Nebraska, Kansas, Oklahoma, Mississippi, Alabama, and South Carolina.  Maybe South Dakota and one or two more.  All states with either low populations or lots of people in poverty.
   
2.  Those states remaining in will form a "plenty robust" public option to have clout.  Let's assume again that the PO will have the desired effects where it is in force, and insurance companies will be greedy enough to screw the people in opt-out states--if not, my argument is weakened.
   
3.  This is the trap that Republicans have waiting.  People in the opt-out states will see that others are enjoying benefits that they cannot get, and their governments will have to ignore them, try to make individual collectives (too small to be effective), or opt back in.  Any choice is good for Democrats.  A mandatory opt-in would allow Republicans in those states to bitch forever.

Today I learned, from the Diane Rehm NPR show how small a deal the public option really is.  Estimated by the CBO to affect only 10M - 12M Americans since, if you have employer-based insurance available, the "collective pool" is not available to you, and the PO is just one choice in the pool.  So (rhetorically), what's the fuss?

There's more...