Public Plan “Trigger” Mechanism: Half a Loaf for No Reason
Progressive health care reform advocates want a robust public option in any health insurance exchange. Insurance companies don’t like that idea. And Senators love compromises. So it’s not surprising to learn that Senator Max Baucus (D-MT) is trying to find a compromise approach. In particular, the Finance Committee is reportedly looking at a “trigger mechanism” for a public plan: “Under this proposal, the public plan would be created only if private insurance companies had not made meaningful, affordable coverage available to all Americans within several years.”
In the sense that there’s disagreement about this issue and it would be convenient to find a compromise, it’s clear enough why this is appealing. But as Igor Volsky argues, it’s not clear what the merits of this proposal are supposed to be. As he says “Health reform isn’t about protecting private industry.” If a public plan would be brought in after a “trigger,” presumably that’s out of a belief that introducing a public plan would succeed in helping to bring affordable coverage to all. But if a public plan is likely to succeed, then why not just bring it into play? There’s no legitimate need to balance the public interest against the parochial interests of for-profit insurers.
As far as compromises go, this one doesn’t strike me as too horrible. But a really good compromise balances two legitimate considerations. This is just lopping off half the loaf for no real reason.
36 Responses to “Public Plan “Trigger” Mechanism: Half a Loaf for No Reason”
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June 2nd, 2009 at 11:34 am
Sure there’s a reason. That reason is known as ‘bribery’.
June 2nd, 2009 at 11:38 am
This is just lopping off half the loaf for no real reason.
Ladies and gentlemen, the world’s greatest deliberative body!
June 2nd, 2009 at 11:39 am
No, it’s to keep pushing the public plan down the road so it never occurs after this round of reform is over. With tigger mechanisms it gives the private industry enough negotiating room to prevent a plan from ever coming into being due to regulatory capture and being able to change the trigger rules down the road.
Prevention of a public plan at all costs has been the industry goal for the last 50 years.
June 2nd, 2009 at 11:41 am
Republicans deride the phrase “moderate Iranian” as “one who has temporarily run out of ammunition”.
Similarly, “Compromise” is what Republicans temporarily do when they have temporarily lost both Houses of Congress.
Stomp the motherfuckers into the ground. Pass Laws which will stand into the decades to come so long as the Democrats can muster at least 40 Senators.
Do NOT do what Bill Clinton and the Democratic Congress of 1992-1994 did: Piss away major opportunities in the name of caution, compromise, and cowardice.
June 2nd, 2009 at 11:42 am
how about we phrase this trigger the way it would really work, not in terms of years but death. if the private insurers don’t offer affordable coverage for all before 250,000 people die because of lack of insurance then we’ll have a public plan option.
June 2nd, 2009 at 11:46 am
Surely that’s a “soft kill.” The insurers would be glad to drag their feet on reform and then argue that they really HAD reformed, see, and that the “improvements” just weren’t being measured fairly by whoever.
That’s not a compromise, that’s a maneuver to protect the powerful.
June 2nd, 2009 at 11:49 am
If not for the Senate, the hard-left, near-socialist crazies in the House would have already overrun civilization. I prefer to defer to the world’s only remaining, greatest, deliberative body, as the Lords are now completely emasculated.
June 2nd, 2009 at 11:55 am
“Modernization” under Bush meant contracting government functions to the private sector. The CEA report uses modernization. The players at the table have a long history with private industry. That reform is twisted to accommodate their needs is not surprising. However, it’s deeply disappointing.
http://stateofthedivision.blogspot.com/2009/05/for-profit-health-care-reform-club.html
June 2nd, 2009 at 12:02 pm
Isn’t this just the Democratic “moderates” solution to everything?
June 2nd, 2009 at 12:02 pm
not too bad of a compromise?
are you kidding?
can you imagine how ambiguous, and open to interpretation the “trigger” language will be? it will be so vague and squishy that they will be able to avoid the trigger, or end up arguing about whether it should kick in for decades.
which is exactly the game plan.
sometimes compromise is good. sometimes it is not so good and is merely a means to no end.
this is a means to no end. at least that is what the insurance companies want. they want this “compromise” to simply allow them to drag the issue out, year after year after year.
putting this kind of “trigger” mechanism in place is an ingenious way to make certain that the country will spend the next 20 years arguing about whether the trigger should be pulled.
and maybe in 20 years, the crisis atmosphere will have subsided enough so that they can better fight public opinion, which overwhelmingly wants this type of public option.
any idiot should be able to see the real strategy.
June 2nd, 2009 at 12:02 pm
Compromise? Not getting a public plan is billed as a “compromise”?
June 2nd, 2009 at 12:08 pm
Re Myles at 7: “as the Lords are now completely emasculated.”
————-
Not literally. Although the day is young.
June 2nd, 2009 at 12:10 pm
and maybe in 20 years, the crisis atmosphere will have subsided enough so that they can better fight public opinion, which overwhelmingly wants this type of public option.
any idiot should be able to see the real strategy.
Your argument is logically fallible. If the “crisis atmosphere will have subsided enough,” then it means healthcare has been solved, and therefore a public would be unnecessary and only a gratuitous liberal exercise.
If, however, the crisis atmosphere has not subsided enough, then it means there would be a need for a public plan, that the public would demand a public plan, and there would be a public plan.
You can pick one or the other; not both.
June 2nd, 2009 at 12:15 pm
That’s known as “kicking the can”.
The trigger in this compromise will be when congress passes a law enabling public health care.
That was the 1994 plan, right? It worked great.
June 2nd, 2009 at 12:15 pm
Baucus is the most important man in the Senate when it comes to health reform. This is really, really discouraging news.
June 2nd, 2009 at 12:24 pm
What is “several” years supposed to mean? That could be another decade and a half of shitty health care policy.
I wonder how likely real health insurance reform would be if congressional health plans were eliminated. My guess is that would be a real trigger mechanism to actually pass universal care and not these piddly half-the-loaf measures.
June 2nd, 2009 at 12:25 pm
Your argument is logically fallible. If the “crisis atmosphere will have subsided enough,” then it means healthcare has been solved, and therefore a public would be unnecessary and only a gratuitous liberal exercise.
If, however, the crisis atmosphere has not subsided enough, then it means there would be a need for a public plan, that the public would demand a public plan, and there would be a public plan.
You can pick one or the other; not both.
that is a ridiculous argument.
it assumes that there are only two possibilities at play here. (not so coincidentally, the two options you pose. how convenient!) and that the lack of a “crisis atmosphere” would mean that the health care problem in this country had been solved.
ridiculous.
obviously you don’t know anything about the history of health care in this country.
the “crisis atmosphere” has been building for decades now, but it has only come to a head at this point.
the problems have been present for decades now, but the citizenry has only now come to the point where pressure is too great to ignore.
one of the best things this country’s lawmakers do is pass legislation just good enough to take that pressure off, without truly solving the underlying problems.
the drug benefit passed under bush is a great example of that practice.
essentially, a bill was passed that addressed the problem sufficiently enough so that public pressure subsided somewhat. at least enough so that lawmakers could continue to ignore the issue as much as they pleased.
but the problems with overpriced pharmaceuticals continue.
they want to go the same route with this “trigger” mechanism.
pass something that will alleviate some of the pressure and allow them to argue that things are working and possibly getting better.
and meanwhile, the underlying problems will remain.
June 2nd, 2009 at 12:27 pm
Myles,
Greed doesn’t have to be logically consistent. Just look at what the oil industry is doing. They know that we are either already at or near peak oil-production capacity and that therefor there is a finite limit to how long their business model will remain viable. So, what do they do? Do they seriously invest in alternatives? No, they buy up and sit on energy-saving patents and spend ungodly amounts of money corrupting our politicians and polluting our airwaves with global-warming denialism so that they can continue to extort record profits out of an increasingly energy-hungry world.
In the long run, it’s a recipe for disaster at the corporate, national, and global levels, but the current executives can’t lift their snouts out of the trough long enough to care.
I’m not sure that the private insurers think they can fight a public plan forever–they probably just want to fight it as long as they possibly can so they can soak up as big a chunk of the “slop” as they can–but, we shouldn’t delude ourselves into thinking that, given the amount of bribes, er, I mean “campaign contributions” that they can throw around, they can’t push that inevitability horizon out a looooong way.
June 2nd, 2009 at 12:28 pm
“Several years.” That’s awesome.
Baucus–“I’m such a shitty senator”
June 2nd, 2009 at 12:57 pm
There are 80 US Senators who think the moral of the judgement of Solomon is that splitting a baby in half is a good way to please two mothers. Max Baucus is one of them. The point of legislating isn’t to cover your ass. It’s to govern well for the most people. Boy oh boy do I hate the US Senate. Solomon was pretending to make a horseshit decision that would destroy the very thing he was charged to achieve. Sadly, Max Baucus isn’t pretending.
June 2nd, 2009 at 1:14 pm
Baucus single-handedly took single payer off the table in research forums. Wouldn’t even invite advocates to hearings. Went so far as to BAR advocates from these types of hearings. How the fuck could anything he do be considered compromise?
June 2nd, 2009 at 1:14 pm
Does that mean that, since the WATB right always cries a lot more, they’re the real mother?
That would be consistent with their knowledge of the ACTUAL bible, in which instance the left (with its willingness to concede everything) is the real mother.
June 2nd, 2009 at 1:45 pm
He’s apparently too scared to face his hard-left, near-socialistic constituents. Good thing we have patriotic citizens like centrist Dem senators and Myles to save us from our own totalitarian medical fantasies!
June 2nd, 2009 at 2:23 pm
The reason for the lopping is clear: preservation of profit for insurers.
Plain and simple.
Profits come before coverage for Americans. Particularly poor and ill Americans.
This is where I totally part ways with conservatives. I’m fine with GM having stayed private and perhaps going chapter 7.
I don’t think the government should run airlines. I’m not too sure we should run intercity trains (though we should tax ans support intercity service the way we tax and support airports, ATC, investments in aircraft manufacturing and so on so rail can compete).
But placing private profit over public health is a non-starter. It is immoral and has to change. Baucus’s “compromise” is a sop to capitalist profiteers.
June 2nd, 2009 at 2:28 pm
This explains a bit:
http://www.opensecrets.org/politicians/summary.php?cid=N00004643
First and 4th biggest contributors are health care and health insurance providers.
His 3rd, 4th and 5th largest contributors are insurance, pharmaceutical/health care product industries then medical professionals.
I like the way he refers to his constituents as his “boss”. It seems to me that he is moonlighting on company time.
June 2nd, 2009 at 2:30 pm
…er
above I meant 1st (Schering Plough)and 4th(Aetna) biggest single contributors, and the 3rd, 4th and 5th biggest contributors by industry.
June 2nd, 2009 at 3:23 pm
Just ask Lord Baucus how many American citizens have to die due to lack of health insurance before the “trigger” is pulled, and the profits of health insureres stop being valued over peoples’ lives. Hard numbers, please, Lord Baucus.
June 2nd, 2009 at 4:01 pm
I must say, that it’s been nice to have a reasonable, quiet, substantive discussion of an important national issue without the troll-squad coming out of the woodwork to hijack it.
Too bad it took two senseless shootings by religious nut-jobs and a total reich-wing freak-out over the possibility of a Latina woman in a position of authority to keep them otherwise occupied.
June 2nd, 2009 at 4:48 pm
Sorry, but I guess I’m going to need an example of, too horrible, before even considering this a compromise.
June 2nd, 2009 at 4:48 pm
There will be no public option–we all know this deep down.
Rome Must Burn
June 2nd, 2009 at 6:12 pm
I’d be OK with an individual trigger: anyone without coverage available through work and whose income is below a certain amount (variable by state of course) would qualify for the public plan. High income people who still have to buy on the private market. But I do want to see a public plan, however limited, come into existence now. Even if all we do is open Medicaid to people in exchange for some reasonable premium based on income.
June 2nd, 2009 at 6:42 pm
All of this Senate d-baggery has almost nothing to do with what kind of plan eventually emerges from Congress. The game is how good Speaker Pelosi is at counting Senate votes for the conference report. If she can count to 50 plus Biden with a strong public option (as will surely be found in the House version), the public option is a go. If she believes more than 1/6th of the Senate Democratic caucus are timid wankers then we just might end up with Trigger or Mr. Ed or Pie or whatever the fuck contributers are whispering in that d-bag Max Baucus’s ear.
No trigger on your own public option though, eh Max? Go fuck yourself.
June 3rd, 2009 at 9:16 am
I have to take issue with this: “Health reform isn’t about protecting private industry.”
Really?
I mean sure, the protection of private industry isn’t, and shouldn’t be, the primary reason. But we’re still talking about a huge chunk of our economy here, particularly if you include insurance and pharma. Not to mention about the only reliable employment sector left.
Moreover, pretty much every intelligent person who wants a public plan to succeed (except for the ones who flat out prefer single-payer, which is valid but a separate issue), recognizes that leakage from private insurers will be a significant issue. If too many people leave the private plans, the public plan will either become unsustainably expensive OR will decline in quality. Neither of those is good for the cause of expanded healthcare.
Now none of this means the Trigger is necessarily a good idea. I would say it depends on the specificity of the terms and how Baucus intends to enforce it. Lots of discretion and ambiguity = very very bad. But it’s at least POSSIBLE to structure something like this in a good faith way. And it might be worth doing, especially if it buys us The Sixtieth Vote.
June 3rd, 2009 at 11:59 pm
[...] latest angle the insurance industry is pulling is called the “trigger“, where certain targets would have to failed to be met by private insurers before a public [...]
June 5th, 2009 at 11:29 am
[...] So the first point here is basically a red herring, but the Blue Dogs are welcome to this “concession” since nobody’s proposing anything different. The third point actually contains two different points. The point about financial stability, if I understand it, is a solid fiscal conservative argument that the public option should need to be able to float on its own bottom and finance itself out of the same premiums and subsidies that private plans work with, rather than tapping extra tax dollars. The second half of point three is this trigger business. [...]
June 5th, 2009 at 7:35 pm
[...] Public Plan “Trigger” Mechanism: Half a Loaf for No Reason – Matt Yglesias [...]