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Not So Trigger Happy
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?
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?
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I think we need to understand the "trigger" isn't about them (the recalcitrant Republicans). It's about us (the noisy progressives who want a public option). It's a head fake to make us STFU. We're being gamed.
In the end, there's not going to be a public option. None.
September 9, 2009 10:04 AM | Reply | Permalink
Exactly. No matter what happens they'll tell us they have the trigger in place but that private companies have "solved the problem." By the time it's time for a trigger debate the public will be onto another issue anyway.
September 9, 2009 10:17 AM | Reply | Permalink
There already is a a public option called Medicare. It is in desperate need of reform and is widely supported by both parties.
Why force a new and expensive public option through Congress when a "head fake" can take that joke off the table as a way of passing the comprehensive health insurance reform we need in addition to a public option?
The trigger is indeed a salve to the "progressive" left's ego, but it will become moot just as soon as democratic Congress and the Obama administration turn toward Medicare reform as a way of cost-effectively delivering the public option this country needs, not to mention that it is likely the only way to save the venerated program as well.
That seems more like a win, win, win strategy to me rather than a win, lose, lose many on the left are advocating, but then again I prefer Sun Tzu to Soupy Sales.
September 9, 2009 10:44 AM | Reply | Permalink
jason, I think you need to review your Party's actual track record on Medicare. As far as I'm concerned, Republicans do not support the program at all. Actions speak louder than words.
September 9, 2009 11:00 AM | Reply | Permalink
I am clearly not talking about the "leaders" of the GOP. Why do you keep insisting on that I am?
The majority of Americans, left and right, support Medicare which is why it is still around despite politicians who would see otherwise. Same with Social Security.
Did you have a different thesis to offer on my observational "truism" or are we good now?
September 9, 2009 11:33 AM | Reply | Permalink
Jason, you said Medicare was "widely supported by both parties," so one would naturally assume that included the party leaders. Had you said by "followers of both parties," or something similar, that would have been clearer.
September 10, 2009 1:35 PM | Reply | Permalink
I think it is widely supported by both parties, both the party leaders and their constituents, or else it would have already been gutted and thrown on the side of the road.
Especially bleeding as much red ink as it does.
However, I don't disagree that many conservatives and independents probably think we could provide the same social services in a more cost-effective manner.
I will try to be more clear and think I usually am when asked to refine my thoughts.
September 10, 2009 1:41 PM | Reply | Permalink
God, Destor. I can hear the lines of BS from health insurance companies now:
If allowed to reform, we promise that every American that lives in poverty and can't afford health insurance will be able to get access to health care through the Medicaid program. This should allow us to cut down on paperwork, and pass those savings on to you in the Medicaid program.
If allowed to reform, we will no longer give reasons such as pre-existing conditions as a basis for a claim denial. In fact, we will no longer give reasons at all if we should choose to deny a claim, resulting in much less paperwork for everyone, and we will pass those saving on to you after you find a new insurer.
If allowed to reform, we will offer you Doctor choices. We will even choose them for you, resulting in much less anxiety on your your part and much less paperwork for everyone else and pass those savings on to you in the form of bonuses for our CEO.
See how much progress we're making in keeping your health care at the forefront of our business model?
September 9, 2009 11:21 AM | Reply | Permalink
Sorry. Not a reply to JEM. Supposed to be a stand-alone comment, but the paperwork must have gotten screwed up!
September 9, 2009 11:22 AM | Reply | Permalink
:O)
September 9, 2009 11:30 AM | Reply | Permalink
It's not a salve, it's an insult. How dumb do they think we are? Answer: Dumb.
September 9, 2009 6:46 PM | Reply | Permalink
The trigger is a scam. What's worse is the notion that they could get away with having mandates requiring us to purchase insurance from the very companies that brought us the status quo. Outrageous.
So, I suggest if they are going to play the sick game of using a 'trigger' for 'appearances sake', we should insist that a 'mandate' also have a 'trigger' and only go into effect if the public option triggered is sprung.
But I am wondering whether a mandate to purchase health insurance... something you need because you 'exist', you cannot choose not to have a body as you can not to own a car... is constitutional.
September 9, 2009 10:15 AM | Reply | Permalink
The game's already over. There is no public option worthy of that name in any of the bills going into conference. Waxman gave the last one away to the blue dogs - no piggy-backing on medicare rates. I.e. in effect just a glorified co-op.
Now its just a question of how much subsidy we provide to the industry - Snowe and the moderates want more, for the obvious reason that the industry wants more. Provider and insurance rates will rise accordingly. And Liberals are caving. It's a catastrophe.
September 9, 2009 10:27 AM | Reply | Permalink
Exaxctly right Obey. It is a catastrophe. Which is why it is imperative to kill whatever piece of shit bill they are going to try and screew the people with. If they pass some limp dicked faux reform it will hurt Democrats and our country far more than simple failure to pass a bill. Now, if they could just pass a straightforward set of regulations eliminating the previous condition exclusions and so forth that would be okay, but the whole subsidy thing is bullshit and has been bullshit since the word go.
September 9, 2009 11:46 AM | Reply | Permalink
I'm pretty much for
1. creating the insurance exchanges for the individual market with the relevant regulatory protections
2. expanding Medicaid to 20 million more people (roughly everyone under 133% of poverty rate)
3. implementing cost-efficiency reforms of medicaid.
4. expanding S-CHIP.
More modest in terms of expanded coverage, but takes things in the right direction in terms of cost-controls, and holds back the subsidies and mandate goodies for the insurers which can be used as bargaining chips for another future shot at the public option.
Universal coverage 'at any price', leaving the cost-controls legislation until later, is a horrendously stupid strategy.
September 9, 2009 12:02 PM | Reply | Permalink
Expansion of Medicare sounds good but it should be a non-starter. Even as it's presently set up, Medicare will be broken in 8 short years from now -- and is already in serious need of an overhaul.
Perhaps were one to tie the overhaul into the an new form of "expanded Medicare" is possible in principle, but good luck with that meme politically.
September 9, 2009 3:22 PM | Reply | Permalink
MedicAID. get your glasses.
September 9, 2009 3:32 PM | Reply | Permalink
Yes, I stand corrected.
However, the Medicaid program is also presently groaning under costs:
and
So, again, I don't see how it can be expanded.
Sooner or later we will realize that we can't afford all of this. Whether we cut military expenditures, tax people more, restructure corporate profits, limit the types of coverage people get or whatever, something is going to have to be done to get this paid for.
I honestly don't see expanding existing programs already in fiscal trouble is going to be a reasonable solution to anything.
September 9, 2009 5:03 PM | Reply | Permalink
Medicaid has a much better cost-curve than private insurance:
http://www.kff.org/medicaid/upload/7523_02.pdf
Expanding it to 150% of poverty rate (20 million new enrollees) is estimated to cost 1 trillion over ten years. I.e. the cost of one ME war or one Bush tax cut. I don't see your problem.
September 10, 2009 12:03 PM | Reply | Permalink
A Public option trigger has as much teeth as the Congressional Iraq War benchmarks with GWB. Goalposts will be moved, progress declared etc. It's a sham and even more disgraceful because we have huge majorities in the Senate, House and President.
September 9, 2009 10:31 AM | Reply | Permalink
If there is one college course I would only take if it were taught by a Republican it'd be "How To Use A Majority 101."
September 9, 2009 10:37 AM | Reply | Permalink
I'd take that class too except who would be teaching it? Rove, Cheney, & Gingrich?
September 9, 2009 12:08 PM | Reply | Permalink
Bluebell, or Greenbell these days, I guess, had one of the funniest line's I've ever seen at TPM... Paraphrasing:
Healthcare will pass when the Dems have a majority in the Senate: 75 Senators.
September 9, 2009 3:09 PM | Reply | Permalink
My math wasn't very good there. They need 80 at least.
September 9, 2009 6:53 PM | Reply | Permalink
I think Lesson #1 would be "Have your majority comprised of Republicans." Face it, they do saluting, lock-stepping, and holding the party line WAY, way better than Democrats ever will. I sometimes think we get uneasy if we aren't disagreeing among ourselves.
September 9, 2009 5:17 PM | Reply | Permalink
No, that's not it. You're wrong. Traitor!
September 9, 2009 6:23 PM | Reply | Permalink
I think the biggest mistake the Dems made were pitching healthcare reform in terms of the "millions who don't have it". They should have targeted an active political class and scared the hell out of them. Showing how *middle class* costs have risen and freaking out the middle class would have been more effective in my view. Just as the GOP scared the dickens out of the geriatric set.
Imagine what a few graphs showing common drug costs over the past 10 years (and I bet you can even show 5 years!) overlaid on how the national average salary moved in those 5 years. Then people will understand for themselves that one curve is rising faster than the others.
Dems have to stop framing things in terms of "what's right for everybody" -- that didn't really even work in good times. They need to market the meme "what's right for you".
I know this makes some here wince with the idea that "but we are better than that as a people, we really care" -- but that's where the phrase "that's academic" comes from.
Dems too often require me to buy into their belief structure. The GOP only requires me to buy into their end result.
This is politics. Process is only relevant insofar as it gets to the desired results. This isn't the classroom, it's reality.
Do we want to win the battle or the war?
This was all perfectly predictable for months now because the Dems have had this presentation issue for decades.
September 9, 2009 3:19 PM | Reply | Permalink
Very good point. If you means test every good thing the government does out of most people's reach, you don't win new allies.
September 9, 2009 3:49 PM | Reply | Permalink
Kind of like going from "what's good for some people over there" to "what's good for me".
September 9, 2009 4:18 PM | Reply | Permalink
Exactly! I think the Middle class gets it and they have been unwavering in their support of HCR. They just don't understand how critical a public option is. Frankly, if there is no public option, then there will be no reform, just some window dressing.
Triggers? Is that like the fuel efficiency standards under Carter? We all know how excellent the result was from that. Great idea, just a loophole so big you could drive an SUV through it.
September 9, 2009 7:30 PM | Reply | Permalink