Is a Strong Public Option Trigger the Answer?
Welcome back from a hopefully long, restful weekend of eating too much and catching up with family and friends. I took the opportunity to kick back and branch out my reading into other areas besides healthcare. Following Roethlisberger’s concussion, Federer’s fifth time ending the year at #1, and Tiger’s defeat by a fire hydrant and a tree, I thought about the decisions – good and bad – that led to and followed from those events. Federer gets the crown for best decisions, Tiger wins the dunce cap for worst. Then I happened upon a four-letter word: trigger. In the world of Washington, D.C., ‘trigger’ is the definition of deciding NOT to make a decision. Welcome back to the healthcare reform debate.
We previously covered why a policy trigger is a Really Bad Idea, historically and philosophically. Specifically, we discussed why a public option trigger is a cop-out, pretending to set conditions for a gun to fire when those conditions have already been met. It’s political cover for passing the buck, being able to say you addressed the problem while actually ducking it. So it should be no surprise that a “strong public option trigger” is back in the conversation as the Senate digs in for a long battle.
A new Urban Institute report says that a triggered, strong public option is better than the weak public options currently in the House and Senate bills. That’s a frightening statement. It’s saying that NOTHING is better than the crippled public options in the bills. Yes, they are non-competitive (competition being the reason we need a public option in the first place), they are more expensive that private plans, and they aren't available for years. That's all by design. But at least they're real. Either with a strong but illusionary public option, or a weak but real one, our current spineless Congressmen are waiting for someone else to make the hard decisions sometime in the future. Don’t worry; they won’t, because just as much special interest money will be showered on them.
That’s really what this is all about. Liz Pulliam Westin nailed it:
“There's nothing in the Constitution that says we have to guarantee obscene profits for businesses that chose to mislead, gouge and annoy their customers. If you get money by abusing other people, the money was never yours to begin with. If you can't conduct your business fairly, then maybe you shouldn't be in business at all.”
While she was referring to credit card issuers, the statement applies to both predatory health insurers and providers. Their sway over Congress will not diminish, and the trigger will never be pulled. Plus the premise, that triggering a public option that can set rates and really compete with private plans, but ONLY if US health expenditures reach a certain level over the next 3-4 years, is wacky. Take a look at the figure below, adapted from CMS data on US health expenditures from 1960-2007.
What is it they’re waiting for – perhaps for the line to go completely vertical? Here’s a novel idea. Insert a strong public option into the Senate bill NOW, one based on set Medicare +5% reimbursement rates, one that’s open to everyone immediately. Let’s address the cost issue head-on and use government clout to bend the cost curve in the right direction: down. As a bonus, our Congressional representatives will have to evolve to vertebrates along the way.
Take action: there are a number of current action opportunities to say 'No' to triggers. Call, fax, or sign a petition to let Obama and Congress know that using a public option kill-switch disguised as a trigger is not acceptable.
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