Bernard Avishai's post "Cooperatives: The Best Public Option" was really surprising to me, especially given Avishai's reputation as a business and systems thinker. Avishai admonishes liberals not to demand a single-payer style public health care option because size isn't all that matters in business. He's right that size doesn't matter in business. TPM can beat the New York Times to a story, for example and spend a lot less money doing it. News Corp. spent gobs of money on Myspace because Rupert Murdoch realized that a start-up could do what his empire couldn't.  Google didn't start out a behemoth.

So yes, Professor Avishai gets it. Upstarts can kill giants. This isn't new, it's just part of business and it's arguably easier now that barriers to entry in certain sectors have fallen. So, it is true that a small health insurance company could, if it found a way to deliver better care at lower prices, take on an insurance giant, but only if that smaller insurance company were going after the customers of the giants. A small company would take meetings with human resources executives and try to convince big companies to switch. Our upstart insurance company would fight tooth and nail every day to get new contracts. Our small insurance company would gladly take business from everybody. That's how competition works.

The public option has described by Barack Obama isn't open to all customers of health insurance.  It's only open to people who aren't already getting insurance through their employers -- part-time and lower wage workers or the self-employed. It's a "public option" mostly for people who have no other option. These people, lets remember, are uninsured.  So they are not customers of Aetna or United Health of Blue Cross. When they sign up for the public option, the insurers don't lose customers because these people are not buying anything from them. This is why McDonalds doesn't worry much if a vegan restaurant opens up next door. The vegans who go there were never going to buy food from McD's anyway.

So no, it's not about size, it's about accessibility. The way to bring competition to the private insurance market is to bring in a public option that is in constant competition with the private insurers.  Everyone should be able to tell their insurer "if you don't lower my premium, or offer better coverage... I'm walking" and they should have an alternative they can buy from.

If we passed a law that said that people can only eat at Burger King if there's not a McDonald's within three blocks of them then I don't see how you can meaningfully claim that Burger King is competition. This public option with health care is far worse than that. If you're already in the private system you can't leave for the public one. So it's not competition at all.

Professor Avishai, you really should answer this basic question: are we in competition if I can't take your customers?

The public option "trigger" has emerged as the great political cover-move of the health care debate where the government only extends publicly run health insurance to the middle class if private industry fails to offer more care at better prices. What the deadline is, we don't know.  How private company progress will be measured, we're not sure.  Our betters will work all of that out for us. One thing we do know is that it will create a sub-industry of lawyers and lobbyists who will be paid huge sums to make sure that whatever happens, the trigger is never pulled.

Politically, the trigger is a smart idea because it screams "We're being reasonable."  It will strike many on the left and right as fair.  Lets give private industry a chance. But we've already given them 30 years of chances and the situation's gotten worse.  Why do we need a trigger now? Shouldn't the industry have realized, for the last 30 years that the trigger of public health care has always existed because we could have created a public program at any time?

Every trigger supporter needs to answer the question: why more time now? It's not a perfect analogy but were this trigger really like the trigger of a gun, nobody could get away with abusing the gun owner the way that private insurance companies have abused the American public without the trigger finger getting itchy.

Just pull the trigger.  How many chances are these recidivists supposed to get?