The Snowe Job, and Why a "Trigger" for a Public Option is Nonsense

I was just on the phone talking with a reporter for a national media outlet who referred to Senator Olympia Snowe's idea for a public option "trigger" as the "centrist position." Whoa. When the mainstream media start naming something as "centrist" the game is almost over because just about everyone with any authority in our nation's capital wants to be at the "center."

Let me back up a step. The public insurance option has become a lightening rod for Republicans, hate radio jocks, Fox News, the Wall Street Journal's editorial page, and lobbyists for the health-industrial complex who accuse the White House and Democrats of planning a "government takeover" of health care. Anything that has the word "public" in it is always an automatic target for their rants. But most Democrats understand that a public insurance option is essential to control healthcare costs and expand coverage -- both because private for-profit insurers now face so little competition in most markets that only the prod of a public option will force them to lower costs and extend coverage, and also because a nationwide public option would have the scale and authority to negotiate lower rates with drug companies and healthcare providers, thereby pushing private insurers to do the same.

The White House is looking for a way to be in favor of a public option but also get enough Blue Dog Democrats -- many of whom hail from swing districts and states, and therefore need some cover -- to vote for it. One such cover is a Republican Senator from Maine, named Olympia Snowe. If she votes for the bill, Blue Dogs can calm their constituents -- who have been worked up into a lather by the right -- by saying "you see? Even a prominent Republican senator is voting for this."

So will Snowe play ball? It depends. Her idea (evidently encouraged by Rahm Emanuel, the President's chief of staff) is to hold off on any public option. Give the private insurance companies a period of time -- say, five years -- within which to make changes that extend coverage to more people and also drive down long-term costs. If those goals for coverage and cost aren't met by end of the five-year grace period, kaboom: the public option is triggered -- which will force such changes on the insurance companies.

The beauty of Snowe's proposal is that it seems to offer Blue Dogs a way out and liberal Democrats a way in. Nobody has to vote for or against a public option. The public option just happens automatically if its purposes -- wider coverage and lower costs -- aren't achieved. And the trigger idea seems so, well, centrist.

The problem is twofold. First, it's impossible to design airtight goals for coverage and cost reductions that won't be picked over by five thousand lobbyists and as many lawyers and litigators even if, at the end of the grace period, it's apparent to everyone else that the goals aren't met. Washington is a vast cesspool of well-paid specialists who know how to stop anything resembling a "trigger." Believe me, they will.

Second, any controversial proposal with some powerful support behind it that gets delayed -- for five years or three years or whenever -- is politically dead. Supporters lose interest. Public attention wanders. The media are on to other issues. Right now the public option is very much alive because so many Democrats care deeply about it, with good reason. But put it off for years, and assign it to the lawyers and lobbyists I just mentioned, and you can kiss it goodbye for ever.

If the idea is to have a public option waiting in the wings in case private insurers blow it, why wait for it at all? If it gets lower costs and wider coverage, it should be included right from the start.

What worries me isn't just that the mainstream media are calling Snowe's trigger "centrist," but that the White House might see it as an easy out. "I continue to believe that a public option within that basket of insurance choices would help improve quality and bring down costs," the President said Monday. Fine. But he hasn't yet said the public option is essential. He hasn't threatened to veto a bill lacking it. There's even reason to believe the White House has quietly encouraged Olympia Snowe to pursue her "trigger."

The best way to give Blue Dogs cover is for the President to explain clearly and boldly why the public option is essential to health care reform, and why he's ready to veto any bill that doesn't include it. That's also the only way to give the nation a good chance of getting true health care reform. Hopefully, that's what he'll do Wednesday evening.

Otherwise, we get a trigger to nowhere.

Cross-posted from Robert Reich's Blog.

Comments

[ReneeB]

Olympia Snowe is not the problem. Blue dogs are the problem. We can all do something about that. Like what is happening with Joe Wilson and his opponent who is now raising a ton of money - we need to "influence" Blue dogs the way all of Washington is influenced- with donations. If someone would take the time to publish all the Blue dogs who are up for re-election, and links to their campaign sites - believe me - many of us will contribute. They need to be shown that the rest of the democrats are counting on them to get a public option NOW.

Incidentally, I could be wrong about this but the President's description of the public option was a nonprofit, not government org. And, I thought I heard him say that only people who do not qualify (can't afford) any other policies through the exchange could apply. This to me sounds a lot like qualifying for many other things based on ability to pay. That is already VASTLY different than the Public Option I was hoping would be there - so my small business could "choose" the public option if we want. (There's only 2 of us here!). But it sounds to me like the public option the Pres. outlined would not apply to us because we can buy other insurance - we just have to pay enormous premiums (for what?).

Bottom line: Stop talking about Joe, Sarah, Olympia - Start sending money to Blue Dogs up

[Billl]

The only way to have meaningful health care reform is to control how money is raised to pay for care, (a national sales tax is superior to anything), and costs of delivering care must also be controlled, (a civilian version of the VA is unapproachable here), using both government advantages will be required for true reform.
Using a national sales tax would allow us to pay as we go for health care in a fairer and much less expensive way than using private insurance.
Governments superior results while caring for veterans through the VA Health Systems, without killing anybody’s grandmother, demonstrates that government knows a lot about caring for people. see Phillip Longman’s book Best Care Anywhere, Why VA Health Care Is Better Than Yours.
A dual system that would offer everyone the choice to use either free public care from a new civilian VA style system, or alternatively to privately purchase and use private care, offers the best reform solution.
Health care could be distributed free to everyone requesting public care through government hospitals at a fraction of the costs spent now by taxpayers to private systems, and the new system would produce true savings of hundreds of billions of dollars annually from the $2.5trillion spent last year, and no one would be left without care.
Going back and forth between free public, and user purchased private care would provide unlimited choices, ultimate freedom, and always free public care would be available when it is needed or desired.

[Pinkie e]

Not one dime...NOT ONE DIME I tell you .... will come from the national deficit to pay for this HC bill. It will all be funded by the savings we get from fraud and waste in the present system." That statement alone should be enough to scare the hell out of us. Will we hear any criticism from PBO's personal guard dog media..MSNBC CBS ABC NY Times etc. Of course not and that's even scarier !

[PaxEterna]

4 years for a limited plan of last resort for those who don't have employer based coverage sounds like a trigger to me, and one on an empty gun.

[WeMustSpeakOut]

Yet ironically, the gun is loaded and poised at the roughly 80,000 people who will die from lack of coverage during that time.
Score another one for the corporate government. People? Zero.

[BarryS]

1. remove the antitrust exemption. break them up [or better still. if they don't themselves, indict convict and imprison their BOD and execs.]

2. call their bluff: 1 year to solve the problem [i.e everyone covered, no recisions, etc, etc.] - or - single payer & they are out-of-business.

I bet they take the billions and go to .... where can they go?, everywhere else has a real healthcare system.

[mergina]

Wasting precious time and resources on this Health Care Debacle is NONSENSE. Get America back to work. Oh, the president DID offer up a sentence or two at the beginning of his speech about THE EVER GROWING NUMBER OF AMERICANS BEING SENT TO THE UNEMPLOYMENT HEAP didn't he. How nice of him. Too bad there are not CORPORATE HANDLERS insisting on getting America back to work rather than OURSOURCING AND INSOURCING OF CHEAP LABOUR.

[1tourist]

He is working full time, and can actually do more than one thing at a time.
Spending 24/7 on the economy will not get you a job this week.

[XME]

If you call it "nonsense", you must be one of the fortunate Americans who can get health insurance.

[amorando]

I don't think anything on the table so far will do the job, the job being universal coverage for less cost. What if the private insurance companies have to keep people who get sick. That means their costs increase. But still most of the sick will be without private insurance because the private insurance will still go through employers and the sick aren't working. So we will still have cherry picking by the companies.
The president says the government will buy into insurance for the people who can't afford it otherwise. These people will tend to be sicker, which is going to cost the government a lot of money. All in all it comes out to spending more money, not less.
The solution to cover everyone and hold down costs is to treat health service as a utility, like a commnities electric company. It doesn't matter then if a private company or a public one provides, the government would make rules about how it conducts business. One could do this by community or by state or for the whole country. What is coming out of the politics of the nation is not going to work. It is just going to be stimulus of government money for private insurance companies.

[max hp]

~~~~~~~~~~­~~~~~~~~~~­~~~~~~~~~~­~ A PUBLIC OPTION ~~~~~~~~~~­~~~~~~~~~~­~~~~~~~~~~­~

..........­..........­..........­..........­..........­........ WHEN DOES THE GREED STOP ..........­..........­..........­..........­..........­.........

Let our Congressional leaders clearly understand that lack of a condition-free Public Option in any successful Health Care Reform legislation will have negative consequences in the upcoming election.

Health Care Reform is MEANINGLESS without a strong condition-free PUBLIC OPTION, with clear unrestricted path to SINGLE PAYER.

A Public Option must be administered by the Federal Government.
A Public Option must be available to anyone who wants it, starting Jan 1, 2010.
A Public Option must be available to anyone, irrespective of Pre-Existing Conditions
A Public Option must be available to anyone at affordable rates.
A Public Option must be available to anyone whether employed or not.
A Public Option must be available to anyone whether his/her employer offers it or not.
A Public Option must NOT have any conditions placed on it by any private or for-profit entities.
A Public Option must NOT restrict anyone from opting in or out of it.
A Public Option must NOT be restricted from evolving into Single Payer.

A Public Option, and ultimately Single Payer, must be fully financed from federal taxes.

A Public Option must be made mandatory for ALL government employees, including Congress.

It's time the US provided basic health care to ALL it's citizens, without exception.

Don't bother to pass anything that does not have A CLEAR CONDITION-FREE PUBLIC OPTION.

~~~~~~IT'S WHAT WE WANT ~~~~ IT'S WHAT WE NEED ~~~~ IT'S WHAT WE CAN AFFORD~~~~~
**********­**********­**********­**********­**********­**********­**********­**********­**********­**********­********

[oscar99]

Here's my take on "health reform"..........it aint going to happen, just look all around you, how is it possible for something we so desprately need be so contended? I hear all the arguements against health reform and i have to shake my head " uummmmm WHAT?" I'm thrown for a loop at what I hear people saying......I have health insurance from my job, which use to be paid for , in janurary guess what ? our rates went up, my employer said we now have to help pay for coverage, so much for stimulating the economy, my take home pay just shrunk by 300.00 a month, that's a car payment, we use to get a small bonus at the end of the year, we can forget about that this year, I just don't get it, health reform is dead. ONLY in the Corperate States Of America. God bless all our CEOs........it's OK I don't believe in god, LOL.

[live by the golden rule]

It's because empty spaces ( in states with low populations )are overrepresented in the US Senate.

[DaveCarroll4]

I don't mean to get off topic... I think health care in general works with this article. I'm sure someone will correct me if I'm wrong. That said, I'm not a whiner and do not believe I have posted this personal info previously. In August of 2007, I was stricken down by relentless "Migraine" headaches... real migraines where at some points you pray to die to be relieved of the pain. They continued for 7 months, but 30 days after this began, my company had to replace me. 30 days after that I no longer had health insurance and Cobra was over $700/month, when Disability insurance was $1300/month... you do the math... after over a year of disability, paying $50 office visits to a really good doctor who eventually got me well, though he discovered that I had Emphysema, and was diabetic. I'm 59 and by September of 2008 there were no jobs to go back to. I'm a Drug Counselor and the field depends largely on Grants. Needless to say, I went bankrupt and have $25,000 dollars of debt I still can't pay on. I'm working my way out of it, starting my own Sober Living Home, (God sent me a very special friend), but at 59 I'm starting over, with no real hope to ever retire. So, I want health care for my 34 year old son, to have, no matter what his financial situation may be. No Triggers... Health Care Now!

[Ed Salter]

I sympathize with you completely , this is why we need a public plan or universal healthe care or whatever you call it. I have what have been classified as morbid migrains for years and forutnatley I work at a university and have excellant benefits but if I didn't I know I wouldn't survive. In and out of the emergency room so they can give me fluids and meds. Try to hang in there and I don't know if you have ever tried it but I now take Relpax. I was part of a clinical trial with it and it's the best thing I've takend in 40 years of migraines. I hope you can get it. All the best to you and I hope we get the health care we dserve. If we can bail out the banks, we can have quality and affordable health care for all Americans.

[PhilipTaylor]

Trigger makes perfect sense if you want another DECADE of Industry Price Gouging!

(5 to 9 years at least)

[sueinmn]

Whats crazy is the insurance companies want their profits, demand their profits. They refuse US choice to go elsewhere and buy it cheaper. The Reoubs push capitolism, competition. Where is the competiton then? Monopolies need to be broke down to avoid cornering the market. We use to see this happen! But my point is having my choice to remain with them or leave! They dont allow us to leave as they have made sure their is no where to go! So Republicans, get on your bandwagon to promote competition! Then they outsource for the cheapest labor to even enlarge the profits margin.
Point being made is choice and competition. Such hypocracy all around.

They want you to work for peanuts but you must pay in gold and assure their is no competition.
Hypocracy at its best!

[Doubledoot]

Just listend to the Pres speech : He said the changes wouldn't take effect for 4 years. That's a long time to continue to allow insurance co's to kill people isn't it ? I first wanted a Universal Health Care System run by the government but now I don't . Then I wanted to just lump everything into Medicare and be rid of the insurance companies : now I don't. What I'd like to see now is the gathering of every Healthi Insurance CEO into one room at the white house and tell them :You have a job if you want one and so do most of your organizations. We are combinding you all togerther into one company. That company will be running the nations health care system. We are creating a health care oversight committee to oversee you : we will arbitrate grievence & monitor you. Your job : make certain everyone receives the best possible health care at the most affordable rate possible. There will be some weeding out of employees as needed. We want the most efficient streamlined health care industry in the world and the best care. There will be no big profits and no big bonuses but you will be paid fairly. There will also be no other health insurance company for you to go to work for. Buck stops here and your it ! Health Care is too important to leave either to the for profit insurance/ health industry or the Federal Gov. PERIOD

[tuttlemsm]

Once again, Reich is right and the rest are rong.

[DaveCarroll4]

You know, I think one of my comments didn't make the board because of some F*o*u*r letter words, and when it comes to this discussion, I think the Insurance companies really deserve to be identified with nothing but... 4 letter words. Let's get real, the "Trigger" is a "kill the deal in the long run" move, being crafted for the Insurance companies benefit. I happen to know someone who paid health insurance premiums for years and years and was denied a procedure that cost her, her life. This is happening day in and day out. God only knows what the real numbers are on uninsured who have died because the only way they can see a doctor is in an ER, where they are not looking to solve long-term problems... stabilize and release... that's what an ER is for! As far as Government run options goes... I, fortunately after giving 4 years of my life to the U.S. Navy (1967-71), was saved by the VA in 1995. I'm pretty damned grateful to Government run health care, myself. Most of the industrialized world provides universal care for its citizens at remarkably less cost than our, so-called, system. It is shameful, that the corruption in our Government is so ingrained that you can count the people it kills, on a regular basis. Congress is set on continuing the murder, at this very moment. I would not enlist to serve the country I now live in!

[CTtransplant]

Good to see ya, Dave! Pretty sad shape we're in in that regard, aren't we! Great post!

[oscar99]

point well made, I tell my sons not to join the armed services. We're in quite a spot .

[noneIn2008]

All undocumented workers must be covered, all people in the USA are people. Your place of birth does not make you a non-person

[Martampa]

First we must take care of Americans then we can worry about others at a later date.

[noneIn2008]

Why discriminate against one group of people? Let's cover everyone, except..........The status of your papers should not make you a non-person.