Work on health care reform mostly has moved behind closed doors now in Congress, but occasionally the sausage makers poke their heads out to deliver a scrap of information.

One of the most distasteful bits to emerge is the so-called opt-out provision for the public insurance option that Senate Majority Leader Harry Reid, D-Nev., proposed last month for the Senate version of a health reform bill.

Inclusion of the opt-out clause would be akin to consciously deciding to stuff E. coli into the sausage links.

As yet, few details on the proposal have been shared with the public. No one knows, for example, exactly how states would opt out. Most observers think that it would take action by state legislatures and approval of governors. Another possibility is a public referendum.

The opt-out provision could leave the country with a patchwork system. Political observers rate Arizona and Texas as two likely candidates for opting out.

The Arizona Legislature already has placed a measure on the 2010 ballot that would allow the state to opt out of the entire health reform package being drafted in Congress.

Opt-out decisions from Arizona and Texas alone would remove more than 30 million people from the public system.

Would people with serious medical problems be tempted to move from opt-out states to those that offer the public option?

Consider the problems that would ensue if a person with the government option would move to a state that opted out. Would states be tempted to establish residency requirements for the public option?

If the government plan encountered problems in supporting itself through premiums alone, the federal government would be tempted to dip into general tax revenue, or add to deficit spending, which would leave opt-out states subsidizing the other states.

As the Journal Star editorial board said in July, a better alternative than including a public option in the health care reform legislation would be to merely include a "trigger" mechanism that would authorize a public option if private insurers failed after reform to reduce costs and expand the number of Americans with coverage.

The trigger is supported by Sen. Ben Nelson and Sen. Olympia Snow, R-Maine, among others.

There's little doubt that the U.S. health care system is in need of reform, but flawed ideas like the opt-out provision would make it even worse.