Those that want a trigger for the public health insurance option are saying, "Let's give the insurance industry one more chance to clean up its act." We've been there and done that, fifteen years ago.
That was the same argument the insurance industry made in 1994 and we've seen what happened since. Premiums are rising four times faster than wages. People are going bankrupt at the rate of one every 30 seconds due to health care costs. 95% of the insurance markets around the country are anti-competitive. And 14,000 losing their coverage every day.
They didn't clean up their act last time, and they won't this time. And this time, an individual mandate will require us to purchase insurance from these very same companies while we're waiting for the trigger to be triggered, if indeed it ever is.
When the idea of a "trigger" for the public health insurance option was floated a few months ago, I and others explained why the proposal was not a public health insurance option and not health care reform. In fact, a trigger would be nothing but a win for the insurance industry because it serves to kill the public health insurance option outright. The case is the same now that it's being floated again.
Why? There are a multiple reasons.
1. By any rational measure, triggers have already been triggered
Finally, given the depth of our health care crisis, with bankruptcies every 30 seconds due to health costs, 95% of the insurance markets around the country being anti-competitive, and 14,000 losing their coverage every day, haven't requirements to trigger a public health insurance option already been met?
Chuck Schumer put it best when he said (emphasis added):
"Some who have been skeptical of a public plan have been calling for a "trigger," that would introduce a public plan some time down the road if certain conditions were met. Today's report [on the non-competition of insurance markets] blows away the idea that we should wait for a trigger. Today's report seems to suggest that any reasonable criteria for triggering a public plan has already been met.
After all, if we were to write a trigger into comprehensive health care reform, what would it look like? The main criteria would be market share and premium price. This report today shows that in many states, both conditions have already been met. Premiums are high, and either one or two insurers dominate the market. As we've seen with Medicare part D, a trigger option has so far meant no public option at all."
We already have skyrocketing prices. Insurance is already unaffordable. Insurance companies are already gouging us for more and more money while denying us for more and more care.
Trigger conditions around the country have been met. These companies need some honest competition. And the only way to give it to them is a national public health insurance option, available everywhere on day one.
2. Triggers as proposed would make the public health insurance option non-functional
The proposal for the trigger indicates that:
...a new government corporation would offer health insurance in any states where affordable coverage was not readily and widely available from private insurers. The corporation would not be part of the Department of Health and Human Services, although federal officials would serve on its board.
The public insurance plan would be offered in any state where fewer than 95 percent of the residents had access to affordable coverage.
For example, in rural areas with few choices for health insurance, the situation is stark. People will be forced to buy unaffordable insurance from the only option (private plans) available in their area, all because their state doesn't meet the requirements for a triggered public health insurance option. It's discriminatory.
And, this fragmentation means the public plans created under this proposal wouldn't have the clout to compete with private insurers. Think about it: Private insurers are national mega-corporations, with huge amounts of cash and predatory business practices. They already collude with each other and with providers to drive out smaller players or force them to play by their rules. How would a state-based public option be able to take them on?
3. Triggers will never be triggered
We've tried triggers before. In fact, we have a trigger in place in the Medicare Part D program. It hasn't done anything to stop big PhRMA from gouging seniors:
[Medicare Part D] didn't help a large minority of the senior population deal with drug costs because of the massive "doughnut hole" problem. There are millions of seniors caught in the so-called doughnut hole, where thousands of dollars in annual prescription drug costs must come directly from their individual pocketbooks, or they will go without the often life-saving medications.
The legislation had a "trigger" built in to supposedly protect consumers and taxpayers against huge cost increases in the program. If the bills became too large, a "public option" would kick in and tell Big Pharma what's what. Unsurprisingly, that threshold has not yet been reached.As a result, Big Pharma got a big windfall (a whopping $3.7 billion in the first two years alone) from Medicare Part D.
The trigger may be set up so, in effect, it never happens, similar to the Medicare Part D trigger that would have created a public prescription drug plan - but never did. The threshold would be low enough that it could be easily, and superficially, met. Throughout those "several years," the insurance plans would receive all of the uninsured who enroll through a National Health Exchange, pocketing what we can hope are generous government subsidies, with very few changes to their behavior.
Plus, that trigger will be set at a lower level than current conditions, allow the insurers to make even more money at your expense. It's a win for them, but not for you.
The trigger will never be triggered. Instead, the trigger proposal is a plan to kill the public health insurance option outright.
A trigger for the public health insurance option would create underpowered public plans that would be swallowed whole by the insurance industry. A trigger would also tell the insurance industry the exact minimum level of care and service they need to provide (a level worse than they provide now) before they face competition, giving them incentive to stay at that level and no better. That trigger will never be triggered - instead, it will kill the public health insurance option. But most importantly, a trigger wants us to wait for our crisis to worsen before we fix it.
That's not a compromise. That's not even a rational proposal. Waiting for the crisis to get worse does nothing but help the insurance industry at the expense of our wallets, our health, and our lives.
The trigger kills the public health insurance option. It is not health reform. It should be rejected.
(also posted at the NOW! blog)
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All the opponents do is sit in the duck blind and take pot shots. They have nothing positive to add to the discussion, except in fall back suggestions which if anything, bolster the Insurance Industry stance.
The Obama administration has just done an abysmal job rolling the whole thing out. The fact of letting the Congress draw up the legislation without clear points that could have been disseminated all along, may have not been the wisest way to go about it. Especially considering the fact that they set up absolutely no mechanism with which to refute whatever complaints the Rethuglicans may come out with.
The Presidents speech on Wednesday is really breaking out to be a real make it or break it moment. He's severely boxed in. He either gives the Rethugs their victory and alienate his own constituency, or throws the gauntlet down, four square in favor of the public option.
Either way, it's going to be a very bumpy ride.
I am not against reform.
I am against this reform.
And a trigger to add the public option later, since it will not pass with that so called public option in it now, only guarantees and public option in the very near future. The idea that it would never be triggered is patently false. This reform bill mandates higher premiums from private sector insurance companies. There's your trigger.
I can tell you from my point of view that if it passes, I hope it passes with no GOP votes. Then in 3 years when everyone's income taxes will have to be raised to pay for the extra 2 or 3 trillion dollars each year in medical expenses, conservatives can point their fingers at Obama, Democrats in congress and the people who supported them, and say, "I told you so".
Everyone loves Medicare and Obama wants to make all insurance into Medicare clones. But nobody mentions that 75% of Medicare's Part B expenditures are coming from the general fund. It does not pay for itself and receives the largest government subsidy of all known subsidy programs in the history of this country.
And what the people who defend the insurance companies don't get, because they've obviously never used their insurance for anything major, is that those deductables can leave them with tens of thousands of dollars in instant debt.
If people would really get this, say by being told by a strong leader if we only had one, they'd be in the streets raising holy he.ll!
It will be too late for the reform haters to cry, when their trip to bankruptcy court or the morgue comes.
Just how long do you think they would wait before they repeal this "trigger" and we are right back where we started!
NO TRIGGER....NO DELAY.....PUBLIC OPTION NOW!!!
It's more like Quentin Tarantino.
Reform with a triggered public option the lesser of two evils--the other evil being no reform at all.
It's foolish to kill all health care reform for the sake of the public option. THAT is what is meant by "making the perfect the enemy of the good". Health care reform includes the end of the pre-existing condition fiasco, the end of the lifetime benefit amounts, the end of dropping people from insurance when they become too costly, etc. As desirable as a public option is, it should not be the sole basis for denying all the rest of the reforms to go forth. Yes it's more perfect to have the pubic option, but if we don't have the votes to get it, then lets stop the insurance companies from insane practices with the rest of the good reform measures. This is why the President won't draw the line in the sand. He knows that no reform at all is the worst scenario.
1. loosing their jobs and then being denied coverage because of pre existing conditions, resulting in bankrupcies.
2. Aging recipients reach lifetime limits on coverage and are dropped from the rolls resulting bankrupcies.
3. Have catastrophic illness and are dropped from the rolls, resulting in bankrupcies.
These things are devastating consumers and none of them have anything to do with the public option. The regulation needed to stop these insurance company practices are apart from the public option. In other words, the public option is the ICING, not the CAKE. If you think it'swise to destroy the cake because it has no icing, think again.
The public option addresses the cost issue, which is currently too high for a lot of the 47 million uninsured to get it. The public option is a great way to address that issue, but it in no way addresses the major issues facing the already insured or the kicked off the rolls folks.
You say waiting, for those who are uninsured or underinsured is not a viable option, yet, you are willing to make them do just that for a public option. Many of them are un or under insured because they got kicked off the rolls for reasons listed above. Passing nothing(which is exactly what the right wants) will cause all of the above to increase astronomically, and that is not sustainable nor acceptable.
Only items that directly affect the budget can be considered during reconciliation, so the health reform bill will have to be split into two separate bills. One with the regulatory measures in it, and a second one with the public option, mandate, and tax matters in it.
When the second bill hits the senate floor for reconciliation, republicans can raise motion after motion to remove bits and pieces from the bill. The senate parlimentarian will rule on each motion and the only way to overturn the parlimentarian's ruling is with 60 votes. This means that the bill that enters the process is NOT going to be the same bill that comes out of the process, and it will be considerably weaker and looking like swiss cheese. After all the slicing and dicing of the bill, then there is a majority vote, and the bill will very likely be so weakened, that 51 democrats won't even want to pass it.
Reconciliation is a slippery slope.
The sad thing is, he watched his own mother go through this as she was dying. I will never understand it, if he turns out to be the protector of the insurance industry.
Isn't this an oxymoron?
We should let the insurance companies regulate themselves AND pass a PUBLIC OPTION.
Then we could let the market place decide.
But NO TRIGGERS. That is just a stall ... they always say, not now, too soon, just a few more ...
In order for true reform to really work efficiently, it has to be done equally on a national basis to make those seeking insurance more immune from political horseplay by state legislators. Anything less will just embolden the right wing cause.
The writer here blames insurance companies for people experiencing bankruptcy, to which I reply how? Is an insurance company responsible for changing the laws of nature? No, and this being the case, how is anyone responsible for the misfortune that occurs in someone's life due to that which is inherent in this universe, entropy? I find this chidlish wailing against others for the misfortunes of life to be not pitiable, and frightening in that people will take their frustrations of life out on others, and claim victimhood.
Grow up people! Tragedy will occur and yes we are powerless to do anything about it. All an insurance company is responsible for is what they mutuallly agree to with whomever has entered into a consensual business transaction with them. An insurance company and for that matter a doctor is under no obligation to provide any more than that which both parties agree to as an even exchange of property/service.
The other problems are cost shifting from medicaid and medicare under paying for services. Private insurance must pay higher rates when medicare only pays 80%. A public option would be similar to medicare and may actually make private insurance more expensive.
The AMA is a giant medical cartel that controls the supply of doctors. Ask why socialized medicine countries have MORE doctors even though they are certainly paid less. We need to let through more med students and build more med schools. Help MD's get through school with less than 250k in debt.
Non profit hospitals are allowed to keep millions in profits and have in some cases billions in cash; while paying their executives millions in salary. Hospitals also use their friends in congress to outlaw private doctors hospitals because big hospitals hate competition. Few hospitals will give you a straight answer when it comes to prices for services. They have different rates based on insurance, cash, medicare, uninsured etc.
This issue is much more complicated than "greedy" insurance companies. Tort reform (even Howard Dean admitted lawsuits cost the system significant money).
A public option can't squeeze much from 3% margins. This won't change no matter how loudly the left screams about profits.
That's a false picture. They are so "small" because billions of dollars every year are spent on advertising, "administrative overhead" like plush retreats to the Caribbean, and LOBBYING>
That part of the plan has been dead from the beginning and one more speech from Obama is not going to change anything. Unlike you, our President can count votes and he knows what is possible and what is not. Why do you continue to push this dead horse down the road hoping it will get up and run again. The Public Option is dead, get over it and let try to salvage some insurance reforms out of this!
The rest of this bill is on very thin ice, no one has come up with a tax plan that will pass to pay for this thing either so any heath insurance reform has very little chance to pass in any form this year and the more you cry over your fantasy of a public option, the harder it will be to get anything done...Again!!!
Or take an all or nothing approach out of spite and let people continue to suffer. It's all up to fellow democrats now. We can get this thing done. The public option is done; get over it.
"Chances are unless the economy comes back strong we'll lose significant seats in 2010. Liberals like myself urge progressives to calm down and settle for the greater good."
Yup, let's keep them backstabbers, er, Blue Dogs and DINOS, in Washington DC for they are all dems, don't you know!
The President NEVER promoted a public option because he never intended to ask for one.
A strong leader could have easily explained this plan to the people (and indeed the latest polls show folks overwhelmingly support a public option when it's explained to them), but Obama, apparently, always knew he'd be settling for an insurance friendly bill.
This problem is not going away, and putting a bandaid on this massive head wound will only keep the pain going with no cure in sight.
It's time to take a stand. If Obama won't do it, we'll dump him in the primaries, and find someone, Dem or Independant, who will.
Without a Public Option, you are delivering more to Private Insurance.
Without a Public Option, we are at the mercy of Private Insurance.
Without a Public Option, there is NO COMPETITION.
Without a Public Option, there is NO COST CONTROL.
Without a Public Option, there is MORE CARE DENIED.
Without a Public Option, we will be worse off than we are today.
Without a Public Option, we bend over - AGAIN.
Without a Public Option, the US is doomed to mediocrity.
No Co-ops, No triggers, No mandates, No tax gimmics. A Public Option is not just a good idea, it's a NECESSARY REQUIREMENT. Anything less is unacceptable.
I have NO DESIRE to contribute to the Insurance companies' profits. I won't stop anyone from doing so, but don't FORCE me into it.
WHY IS THAT SO HARD TO UNDERSTAND?
If we get nothing done I will put the blame where it belongs; progressives who are selfish.
With public opinion heavily on his side, before he allowed the debate to be taken over by the ignorant among us, it should have been realatively easy to promote and pass a public option.
No, neither I or any other progressives will accept the blame for this unnecessary policy debacle. It's Obama's cross to bear.
1) The trigger essentially is a FLAT TAX that sends 12.5-15% of your income to insurance companies. At current threshold levels as proposed by Senator Snowe, nobody gets the choice of a public insurance plan until at least this amount -- 12.5-15% of income is exceeded. All an insurance company has to do is keep the premiums under that level.
2) To do so, insurance companies can cut benefits at will, such that physical therapy or diabetes equipment isn't covered, for example. In other words, you will be MANDATED TO BUY LOUSY INSURANCE.
3) Lousy insurance + flat tax = recipe to poison the public option. Were such legislation to become law, the resulting fury building over a few years would predictably be spun by the right and our corporatist media as a failure of public health care, setting us back decades.
The Trigger on the Public Option POINTS THE GUN AT THE PUBLIC OPTION.