One idea that has found its way into the health care reform debate in Congress is the option to “opt-out” of the public option. It would allow the states to decide whether they want to participate in a government-run health care insurance system.

But if we are to believe that health care is a fundamental right, or at least should be, then the opt-out is a bad option. After all, when the southern states decided to opt out of civil rights for African-Americans, it had disastrous consequences.

Advocates of health care reform believe that a government-operated, nonprofit insurance plan – which would increase competition, lower costs, and make health care affordable and accessible to all – is the only way to rein in the private insurance monopolies. Short of a single-payer system – which would eliminate the need for private health care insurance companies altogether – a public option is the only way to break the stranglehold that insurance companies have on the U.S. economy, and on our lives.

Insurance companies are intermediaries; middlemen who, like organized crime, demand a huge cut off the top, yet do not provide a valuable service in return. They are the reason why the U.S. spends the most money on health care in the world, yet has a health care system which is ranked 37th out of 190 countries, according to the World Health Organization.

In order for a public option to work, it must be accessible to the nearly 50 million people who lack access to health care, or those who are underinsured otherwise unhappy with their current insurance provider. If the federal government allows states to opt out of reform, it could create a segregated health care system in America. Some states would enjoy lower costs and greater access, while others, including conservative red states and the former states of the Confederacy, would continue with the shameful system already in place.

As states that once thrived on slavery and sharecropping, much of the South opposes union formation and workers rights today. And they suffer from some of the lowest educational, social and health standards in the nation. For example, Southern states rank among the lowest in terms of quality of health care. Furthermore, eight of the ten states with the highest infant mortality rates, and the ten states with the highest poverty rates, are in the South.

It makes sense that southern states would provide some of the most fervent opposition to health care reform. After all, they have the worst track record of taking care of their most vulnerable citizens and they are the most enthusiastic supporters of states’ rights. With a green light from the federal government and the Plessy v. Ferguson decision, the South opted out of civil rights and opted into a legalized system of Jim Crow segregation and domestic terrorism against black folks. It took legislation, federal troops, and a movement of countless martyrs to reverse that policy.

Although the Republican Party has become a weakened regional party over the past few elections, it still enjoys much popularity in the South. Through its Southern Strategy, the GOP converted disaffected white voters from Democrats to Republicans. They accomplished this by appealing to a white fear of African-Americans, and rejecting federal social welfare programs on the grounds that people of color would benefit the most.

For years, this race card strategy worked. But with moderates fleeing from its ranks, the Republicans have been reduced to their hyper-conservative core, which is united in a hatred of government, and disdain for the president. In that spirit, earlier this year, a number of Republican governors declared they would reject President Obama’s economic stimulus funds. Similarly, the GOP and its corporate lobbyist allies attempted to stop the health reform train through a misinformation campaign, tea partiers and town hall tomfoolery.

Some have suggested that the opt-out option is a clever way to bait Republican governors, whose voters will demand a public option once they see how great things are in the states that adopted it. However, this strategy is risky. With 44,000 people dying each year from lack of healthcare, there is no more time to waste.

If the government wants a universal health care system, it must mandate uniform standards for all Americans. History shows that states often cannot be trusted to act in the best interests of its people.