Snowe's Public Option Trigger Won't Work

Jacob S. Hacker: History Is Against The Notion That This Compromise Idea Is The Solution

(The New Republic)  Jocob S. Hacker is the Stanley B. Resor Professor of Political Science at Yale University. His works include The Great Risk Shift: The New Economic Insecurity and the Decline of the American Dream and Health At Risk: America’s Ailing Health System and How to Heal It

---

As closed-door discussions continue in the Senate, the idea of triggering the public health insurance option is once again on the table. Advocates of the trigger cast it as a compromise that will attract the support of the small number of conservative Democrats who have expressed reservations about the public option, as well as Republican Olympia Snowe, who has proposed a trigger. But to be a compromise between public plan skeptics and the majority of Senators who support a public plan because it is central to ensuring affordable coverage while limiting the budgetary costs of reform, a trigger must have some prospect of working-and a trigger inserted into the two Senate bills now being merged would not.

A workable trigger would, at a minimum, need to achieve three goals: (1) establish a reasonable and measurable standard for private plan performance that sets out clear affordability and cost-containment goals for a specifically defined package of benefits, (2) assess this standard in a timely fashion with information available to policymakers after reform legislation passes, and (3) if this standard were met, quickly create a public health insurance plan that would effectively remedy the situation.

The modifier “quickly” in the third goal is crucial: Runaway health costs are a grave and growing threat to federal and state budgets and to the health security of workers, their families, and their employers. Waiting longer than absolutely necessary for affordable coverage is certain to cause great harm. Indeed, it might actually compound the current crisis. Without an imminent threat of public plan competition, private insurers are likely to raise premiums in anticipation of the implementation of reform-as suggested by AHIP’s recent prediction of big premium increases if reform passes. Delaying a public plan may also jeopardize the cause of reform itself, because requiring Americans to buy unaffordable coverage has the potential to provoke a political backlash. (Polls show that Americans are more supportive of a mandate when they know they will have the choice of a public plan.)

In short, we cannot wait for a public plan-and one of the biggest problems with a trigger is that it virtually guarantees we will have to.

The problems, however, do not end there. Consider just a few of the other serious difficulties:

• None of the trigger proposals that have been floated contains criteria for triggering the creation of a public plan that concern both affordability of coverage and the growth of premiums over time. It is simply not enough for coverage to be defined as “affordable” for a given share of the population. To judge private insurance successful in restraining costs, premium inflation would also need to be restrained. The triggers on the table do nothing on this score.

• The proposals on the table also assess affordability based on the price people pay after receiving assistance from the federal government. This means that efforts to help people afford coverage, perversely, reduce the chance of a public plan that will rein in costs for individuals and taxpayers.

• The triggers under discussion assess whether affordability standards are met at an aggregate level, such as within states. Yet local markets vary greatly even within states. If some markets have very high premiums or runaway costs, a trigger might not be pulled if other markets in the state have lower premiums or experience more modest growth. Residents of a high-cost, low-competition area would, in effect, be held hostage by an overly aggregated measure.

• The triggers being discussed all focus on the premiums people pay, rather than their total out-of-pocket costs. As problematic, they are vague with regard to what is affordable-that is, what package of benefits is required. Within the exchange, the Senate bills create new rules for coverage that are relatively strict, though still leave too much room for tailoring benefits to shift costs to high-risk patients. But outside the exchange, in the employment-based market from which most Americans will continue to receive coverage, the bills are much more lax. The Finance Committee bill, for example, sets a standard for minimum coverage that is substantially less generous than the typical employment-based plan today. There is every reason to think plans will simply cover less or shift more costs onto patients to meet the affordability standard, since, again, the standard concerns only the individual premium, not total costs.

• None of the trigger ideas under discussion envision the creation of a national plan built on Medicare’s infrastructure, the only public plan option that has been shown by the Congressional Budget Office to produce substantial savings.

All this is not surprising in light of the history of trigger proposals in health care and other policy areas: As is well recognized, triggers are generally designed to create political cover, not effective policy.

Less well understood is that some of the key difficulties with triggers are intrinsic to central characteristics of the Senate health bills. In particular, the Senate bills, unlike their House counterparts, leave an enormous amount of responsibility for the regulation of private insurance to the states-which for the most part have not had the wherewithal or will to take on large private insurers.

The Senate bills also have much weaker regulations of private insurance plans outside of the exchange-the plans on which most Americans will rely after reform. At the same time, the Senate bills lack strong requirements on private insurers to provide data that could be used to assess whether a trigger should be pulled. Ironically, these characteristics make a public plan without a trigger especially vital in the Senate, where, of course, the public plan has also been more controversial.

Added to the Senate bills, a trigger would represent a backdoor way of killing the public health insurance option that a majority of Americans (and U.S. Senators) support. It is way past time to trigger real competition for private plans that have failed to ensure affordability or cost restraint for decades.

[jxknowles]

The trigger was a joke. Snowe thought this was a bone she could throw her voters as healthcare costs continued to spiral out of control. The entire group of GOP lawmakers, Ben Nelson and Joe Lieberman should be ashamed of themselves.

[noloyalisti]

We are now a desperate 3rd world country and have to do something just to get stated. What we really need is non-profit universal single payer. A public option will go a long way toward getting us in the right direction toward that goal.

[Ferrell-2]

Every new input to this monster healthcare bill, whether it be public option or whatever, seems to exascerbate costs and enormous management problems. I still think Congress should start all over and just take more time so as to get this thing right and not worry about reelection problems. It now appears the Dems are going to push through something, even if it's wrong. Makes no sense to me at all.

[noloyalisti]

Remember that this Snowe is a Republican. She backed invasion and occupation for big corporate profit. She mindlessly backed the Bush Crime Family and their illegal activities. She is against women's rights, civil rights and human rights. Obviously.

The public option is a HUGE compromise to big business. We should have universal single payer health care with NO profit. Health care is too important and too necessary for EVERYONE for people to profit from it.

[auntc3]

I am telling you, the ONLY WAY TO GO is the Public Option. The insurance companies bottom line is profits. Insurance companies are run like WALL STREET, I bet if you investigated the majority of them you would find, outregeous salaries on the top, perks, bonuses on the top....and the employees from the middle down held tight in place.
Their bottom line is "PROFIT". I know this goes on. I saw expense reports and sheets showing one year $50,000 bonus and very high salaries..this is just rampid in business, the status quoe...those on the top scam, and the middle and lower employees scrammble. It has to stop. The only way you are going to get a handle on insurance premiums is 'THE PUBLIC OPTION", YOU WILL GIVE THE MIDDLE AND LOWER CLASS AN OPTION OTHER THAN JUST NOT HAVING ANY HEALTHCARE AND TAKE YOUR CHANCES AND GO TO THE EMERGENCY ROOM. YOU HAVE TO DO SOMETHING NOW BECAUSE SOON BOOMERS WILL BE AMOUNG US...AND THE PROBLEM WILL JUST ESCULATE...MOST LIVE ON THEIR CREDIT CARDS...AND THAT MY FRIEND IS THE GODS TRUTH.

[dragon8me]

We will have health care reform. The question is in what form? I think all the crazyness thats been hapining is a good thing. If for no other reason, it's forced congress to work for a living for once. They may actually get something right for a change, though I sometimes doubt it's possable. It won't be perfect, it will need adjusting over time, but they will pass something, but with all the debate and with Obama wanting Republicants on board, it will be at least a more thought out bill.

[dragon8me]

Just another thought on that. If congress didn't spend so much time campaigning, they might get something done, and if they didn't "play politics" (toe the party lines) they might actually be willing to work things out in a reasonably way.

[R_C_Jackman]

Obama says the important thing is "choice and competition". So why not have more choice and competition? Let's allow both public and private insurance companies to operate across state lines. That will create a lot of choice and competition.

[zia-2009]

My friends, this is an opportunity of a lifetime to make it right. For the last 100 years, we had been trying to make Health Care for All possible in this great nation of ours. We became a Great Nation not by our wealth alone, but also the process and practices that we put in place. In 19th century, we were no-where. But in next century, thanks to FDR we ensured that we took care of our fallen and poor, we took care of the disabled and hungry and homeless. And then it happened and we became the greatest nation on Earth where everyone on earth wanted to be an American. We did not bring the fall of Soviet Empire by sheer might, but the prospect of a free life beyond the iron curtain helped our cause. We did not make the world come together on 9/11, but the shared prosperity of the Clinton years made others feel really sad for us. We did not bring a coalition of force in 1st Gulf War by handshakes and under-the-table dealings, but the shared threat made all of us to pitch in. Friends, we can still rise to the occasion and make Healthcare a reality.

[AngeLobueMDMPHBSPharm]

As a 72 year-old physician who proudly delivers and receives Medicare services, I strongly believe that Medicare for all Americans is a MORAL issue, not an economic, social or political football to be used to further divide this country on ideological grounds. The prevention of suffering and death are foundations of all honorable religions and philosophies and it is time for America to demonstrate that it continues to be an honorable country devoted to the right to a life without suffering, liberty and the pursuit of happiness for all of its citizens.

Respectfully and compassionately submitted,

Ange Lobue, MD, MPH, BSPharm
American Board of Psychiatry and Neurology
Academy of Television Arts and Sciences
[e-mail]

[dragon8me]

AngeLobueMDMPHBSPharm Your not a Texas Doctor are you? I need a new one, bad. Mine just "retired" and left a lot of people without a Dr willing to write a prescription for pain meds. We only had 1 pain Dr in a county of about 50,000 and the nearest is about 100 miles away.
I agree, we should have "universal care" not "uiversal coverage". They shouldn't be forcing people to "purchace" insurance. They should be providing it.

[chevyhotrod]

Ange,
Medicare, Medicaid, Social Security is going broke, what happens when the systems completely runs out of money? Just like the mortgage industry did last year. What happens then? Our federal government cannot just continue to print money. If they were to collect enough taxes to pay for it, it would double my tax burden and between the Fed, State and local taxes they would collect 110% of my income to pay for this. Liberty and the pursuit of happiness for all its citizans????? Is this what you call Liberty?? Is this what you call happiness?

dragon8me;
Now I know why you post what you do. Wait until doctors retire all over the country because they refuse to accept Medicare and Medicaid patience?s. Want to see a train wreck, it's coming, and you will be part to blame, because people believe that free healthcare from the federal government is going to solve the problem.

[ianlou]

The Trigger for a Public Option was tripped several years ago by the behavior of the Health Insurance Industry.

They put the last straw on the camels back a long time ago.

[sjc_1]

A trigger says that if nothing else works and it gets SO bad, we might do what we should have done all along. It is a last gasp attempt at keeping the situation in the hands of those that profit the most from the present situation.

[toddlarado]

No real reform can be done without the Public Option. If you have no faith in the Government then start voting for more Politicians like Obama or shut up. Americans forget that they vote for the very same people they call incompetent and have no trust in. That's kind of like pissing on your own judgment.

[rightbehind]

Of course it won't. The only thing that will fix this is the robust public option. Single payer would fix it all. We could get rid of the worthless republican created HMOs that eat up 1 of every 3 dollars spent on health care and provide no service at all to the patient.

[charles123456789075]

How can a public option cut costs? To enforce it, the Fed will hire thousands upon thousands of very expensive czars and mini-czars, each assigned to various aspects of hospitals and clinics to monitor every dime spent. Trillions will be spent on a new government agency for Federal oversight, yet the quality and access to everyday healthcare will be reduced drastically. Governments can never run creative and productive programs efficiently, they merely want to tax more to gain more control. If governments ran society well, we would all be moving to Cuba and Venezuela. Castro and Chavez promise the 'ultimate' government run healthcare option that the democrats in Congress are seeking.

Charles Jackson PhD. Computer Science

[Justathought52]

Here ya go..read it and realize you've been BSed by the right wing and insurance monopoly for too long now..the Gov CAN run things well unlike your claim in your post...Medicare for all!

this morning I was awakened by my alarm clock powered by socialist electricity generated by the public power monopoly regulated by the US Department of Energy. I then took a shower in the socialist clean water provided by the municipal water utility. After that, I turned on the socialist radio to one of the FCC regulated channels to hear what the socialist National Weather Service of the National Oceanographic and Atmospheric Administration determined the weather was going to be like using socialist satellites designed, built, and launched by the National Aeronautics and Space Administration. I watched this while eating my breakfast of socialist US Department of Agriculture inspected food and taking the socialist drugs which have been determined to be safe by the Food and Drug Administration.



At the appropriate time, as kept accurate by the socialist National Institute of Standards and Technology and the US Naval Observatory, I got into my socialist National Highway Traffic Safety Administration approved automobile and set out to work on the socialist roads build by the socialist local, state, and federal departments of transportation, potentially stopping to purchase additional fuel of a quality level determined by the socialist Environmental Protection Agency, using socialist legal tender issued by the Federal Reserve Bank. On the way I deposited mail to be sent out via the socialist US Postal Service and dropped the kids off at the socialist public school.



If I get lost, I can use my socialist GPS navigation technology developed by the United States Department of Defense and made available to the public in 1996 by President Bill Clinton who issued a policy directive declaring socialist GPS to be a dual-use military/civilian system to be managed as a national socialist asset.



After spending another day not being maimed or killed at work thanks to the socialist workplace regulations imposed by the Department of Labor and the Occupational Safety and Health Administration, enjoying another two meals which again do not kill me because of the socialist USDA, I drove my socialist NHTSA car back home, on the socialist DOT roads, to my house which did not burn down in my absence because of the socialist state and local building codes and socialist fire marshal's inspection, and which had not been plundered of it's valuables thanks to the socialist local police department.



I then got on my computer and used the socialist internet which was developed by the Defense Advanced Research Projects Administration and browse the socialist World Wide Web using my graphical web browser, both made possible by Al Gore's socialist High Performance Computing and Communication Act of 1991. I then post on freerepublic.com and Fox news forums about how SOCIALISM in medicine is BAD because the government can't do anything right.

[chevyhotrod]

Justathought,
Medicare, Medicaid & Social Security are going broke. Trillions of dollars of unfunded mandates, the train wreck is coming and you and your government engineering will be the cause.

All the departments you speak of waste millions of tax payer money. Government is the most inefficient of all.

One example; US Department of Energy, was founded for one purpose and one purpose only. To reduce the amount of foreign oil. 30 years later, 30 billion budget, 100 thousand employees and we are more dependent on foreign oil than ever. Ya, that works.

wake up and get your head out of the sand. Our government is taking over, they are the problem, not the solution.

Government corruption can be measured by the amount of taxes confiscated from it citizens.