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Tilting at Windmills

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June 3, 2009

TRIGGER TROUBLE.... The latest talk from the Hill is that health care reform could include a public option, but only at some undetermined point in the future, if certain conditions "trigger" the option's necessity. Sam Stein reports:

The Obama administration and Senate Democrats are debating a health care reform outline that will insist upon a public option for insurance but leave open the possibility for it to be kicked in via triggers.

Multiple Democratic sources tell the Huffington Post that the White House and key members of the Finance and Health, Education, Labor and Pensions (HELP) Committees are in the process of hammering out key principles on health care reform.... One of the components will be music to progressive ears: that any bill includes an option publicly run health insurance coverage. But it also comes with a caveat that could engender opposition from that very same constituency.

A trigger would pave the way for public option to come into place only after certain market conditions are met -- mainly if private insurance companies are unable to achieve various metrics for coverage within a certain time frame.

As the argument goes, the public option would improve the system by lowering costs, expanding access, and using competition to improve efficiency. But, "centrist" Dems who have ideological problems with this argue, if we pass a reform package and private insurers can lower costs, expand access, and improve efficiency on their own, we wouldn't need a public option. It's better, they say, to wait for the system to get really awful before utilizing a public option to make things better.

This, not surprisingly, is not going over well with supporters of real reform, who are right to see the trigger as a mechanism to effectively kill the public plan.

Indeed, the closer one looks at a possible trigger, the worse the idea sounds. If lawmakers agree that a public option would necessarily improve the overall system -- and they must, otherwise there would be no need for the trigger to kick in when things got even worse -- then why deliberately delay implementation of the part of the policy we know would help?

Igor Volsky had a good item on this the other day, explaining, "[I]t's unclear why we're bending over backwards to give private insurers the benefit of the doubt ... yet again. ... Health reform isn't about protecting private industry; it's about adopting policies that are most likely to lower health care costs. A robust public option -- the Kennedy proposal -- is likely to score well even with a conservative CBO because it will be able to use its inherent advantages (lower administrative spending) and Medicare leverage to negotiate lower prices with providers and lower health care spending."

Steve Benen 8:00 AM Permalink | Trackbacks | Comments (38)
 
Comments

Is Obama in the process of proving himself to be a DLC/DINO/Corporately Owned/Rethug Lite?

It is always necessary to attempt to counter the corporately owned dumbocraps like Evan Bayh who have a vested interest in preventing a public option. I had misgivings about Obama because he would not endorse single payer, but for him to sell out to corporate interests and help kill a public option is dispicable.

Every morning I thank my god that John McCrap is not president.
Every morning I thank my god three times that Billary is not president.
I am not thanking my god that Obama is president.

From secrecy issues to refusing to investigate the crimes of the Bush administration to continuing the uncontrolled funnel of money down the rathole of the New York financial institutions and now to selling out the American public to corporate interests instead of real health care reform; Obama is proving to NOT be the change we need.

For real change, maybe Feingold & Sanders in 2012!

Posted by: AngryOldVet on June 3, 2009 at 8:18 AM | PERMALINK

Seriously, it's better to do nothing this year than pass an insulting joke of a "reform".

Volsky is just being polite. It's crystal clear why they're doing this- they're being handsomely bribed to do it by the health insurance industry. Until we find some way to break our political culture of legalized bribery, the people's business will continue to get shoved aside in favor of handing out even more goodies to our owners.

Posted by: Steve LaBonne on June 3, 2009 at 8:24 AM | PERMALINK

The current issue of the New Yorker contains an article by Dr. Atul Gawande called "The Cost Conuncrum," which explores the issues confronting national health with great insight. In the end, he suggests that the source of funding is not so important as the process of change, which must come from the bottom up, being led by physicians and the providers themselves, who also create as well as have the potential to solve problems. He suggests that patient oriented health care systems like the Mayo Clinic and a consortium of hospitals in Boulder, CO provide models for low cost/high quality care. On the other hand, McAllen, TX shows what a train wreck medical care can become. Worth a very careful read. - Ted

Posted by: Ted Lehmann on June 3, 2009 at 8:25 AM | PERMALINK

The private insurance companies have already proven in no uncertain terms that their system is a failure. There's no need to test that concept. This trigger idea is a total sell-out and will not work. I've heard that the administration wants to reform health care without being "disruptive." You can't fix it without disruption- that's nonsense.

Posted by: Betty on June 3, 2009 at 8:25 AM | PERMALINK

Private insurance is a failure in all respects. It does not provide universal coverage. It interferes with the doctor's ability to provide services to the patient. It is way too expensive. It burdens providers with time consuming, unnecessary paperwork. It adds no benefit to the provision of medical care.

We are being asked as a society to prop up a wasteful, debilitating industry that actually is costing American citizens their lives. We are paying more for one of the least successful medical plans in the developed world. It is a disgrace.

Posted by: candideinnc on June 3, 2009 at 8:28 AM | PERMALINK

What a disappointment. Another case where the starting point should have been single payer and the end should have been a plan that recognizes the Medical Insurance industry has to go the way of fossil fuel and a public option as the way to ease it out.

Posted by: Jeff In Ohio on June 3, 2009 at 8:31 AM | PERMALINK

Why isn't the progressive blogosphere petitioning the legislature to eliminate congressional insurance packages? If our congresscritters were forced to deal with the insurance industry the way the citizens were, you could be damned well assured they would hurry up the process of getting to a single payer, government operated system. We need to give them the incentive to do the right thing rather than coddle them while we suffer all the pain!

Posted by: candideinnc on June 3, 2009 at 8:38 AM | PERMALINK

I thought the victory in November assured our nation that new safety regulations and inspectors were being changed in Mining. However, with all of the cave-ins, I, now, wonder. First, there was the Credit Card cave-in, when the Sanders Capping Amendment was defeated by the so-called Democrats. Now, it has been reported a massive Single Payer cave-in has occurred. Hmm, a little cave-in on photos, another one on Gitmo, geez, a cave-in a day routine. And, somewhere, a meadow lark sitting in a June is bustin' out all over meadow softly chirps, "Mr President, you won, you won". But, it appears that chirp is fading away and a Tin Ear is morphing at 1600.

Posted by: berttheclock on June 3, 2009 at 8:58 AM | PERMALINK

candideinnc said:
Why isn't the progressive blogosphere petitioning the legislature to eliminate congressional insurance packages?

I've suggested that Congress should have a lottery, where a percentage of Congresspeople equal to the percentage of Americans without health coverage are are removed from Congress' government-funded coverage each session. With 46 million Americans lacking coverage, that would mean 77 Congresscritters would get a sudden lesson in what health insurance in the "free market" is really like.

But the chance that Congress will limit their own benefits is about the same as, say, Republicans beginning to act responsibly.

A better solution would be to write letters and use call-in shows to pressure "journalists" in the corporate-controlled media to start asking members of Congress who opposed publicly-funded health coverage two questions:

-- Why do support socialism by accepting government-funded health coverage instead of being a good American and buying health coverage in the open market?

-- Why do you inflict "inferior" health care on your own family?


Posted by: SteveT on June 3, 2009 at 9:00 AM | PERMALINK

Sounds like the health insurance industry is succeeding in 'buying most of the seats' at the table.

This is a plan to keep our health care as sick as possible, just this side of terminal. In order to maintain a 14-17% profit margin, those of us who do not have the same coverage as John McCain and Ted Kennedy will have our healthcare even more strictly rationed with no healthcare choices at all

Posted by: bcinaz on June 3, 2009 at 9:06 AM | PERMALINK

Personally, I support the notion of a publicly-funded, "single payer" scheme for the US.

However, it's not entirely necessary to do this, and perhaps the German model would be something to aim for: Germany achieves near-universal coverage with a mix of private non-profit and for-profit insurance funds (okay, the majority are non-profit).

Check this out for more info:

http://economix.blogs.nytimes.com/2009/04/17/health-reform-without-a-public-plan-the-german-model/?pagemode=print

Posted by: JM on June 3, 2009 at 9:14 AM | PERMALINK

We have the best congress money can buy.

Public campaign financing is the answer. Until then, our government is owned by the wealthy and the people will get only token attention.

Big money knows this and they fear it more than anything. You'll note that the concept has completely disappeared from the national policical discourse... replaced by dead silence.

Posted by: Buford on June 3, 2009 at 9:21 AM | PERMALINK

Why isn't the progressive blogosphere petitioning the legislature to eliminate congressional insurance packages? If our congresscritters were forced to deal with the insurance industry the way the citizens were, you could be damned well assured they would hurry up the process of getting to a single payer, government operated system.

Because it wouldn't matter. A number of large companies have special VIP accounts for congresscritters and others who could make their lives difficult if pissed off, as opposed to us proles. They'd get great service, and insurers bending over backwards for them, and end up wondering what all the fuss is about.

Large companies being what they are, it's fun when they do screw up and treat congresscritters like the rest of us. Then hearings start to happen.

Posted by: ericblair on June 3, 2009 at 9:23 AM | PERMALINK

I could almost support a 'trigger', if that trigger would take effect in 2 years, not 7. Then, in 2010, Democratic senatorial candidates could campaign on voting for the public option. Current Republican incumbents would lose all across the US, and there would be as many as 65 Dem senators who could pas REAL insurance reform.

Posted by: es on June 3, 2009 at 9:27 AM | PERMALINK

We have needed that health care "trigger" to be pulled, already, for a long time. The trigger proposal is disingenuous, accommodationist tripe.

Posted by: Neil B ♪ on June 3, 2009 at 9:58 AM | PERMALINK

As a republican, I am willing to support a 'trigger' that will not be decided for another 7 years - when we have a real Republican American back in the White House. Republicans will support a 'trigger' as long as we know that it will never be squeezed.

It is unfortunate that you progressives are opposed to the foundation of our American economy - corporate profits. As with everything else, health care should only be provided as long as it is profitable for corporate America. Of course, it is only logical that the VA system and Medicare/Medicade be shut down or privatized. Without the real Americans who create jobs making a profit, why should any service be provided to working people?

Posted by: RepublicanPointOfView on June 3, 2009 at 10:02 AM | PERMALINK

Best Government Money Can Buy.

We're being sold out again. Where's the outrage? Where are the demonstrations? Where is the march on DC? Bitching on blogs isn't going to send a message - thousands of irate citizens gathered in front of congress WILL. Thousands of letters and emails to our representatives WILL. Where are the organizers?! The apathy in this country is simply mind boggling. We've become so complacent it's no wonder we get sold out like this all the time. Us old 60's protesters are getting too old for this crap any more. It's time for you youngsters to wake up and get organized! The Squeaky Wheel will get oiled. Vigils in front of every State House, demanding Public Health Care NOW, can't be ignored. Make the idiotic "Tea Party's" pale in comparison. Peaceful assembly and protest is our right. Where are we exercising our collective voice?! We've got to shake loose not only our "representatives" but ourselves!

But no, we can't do that ... it's time for "Survivor" or "Oprah" or whatever other inane nonsense we're burying our collective heads in these days. It's so sad, it really is.

[/rant]

Posted by: Otolaryx on June 3, 2009 at 10:02 AM | PERMALINK

I'd like to see a healthcare plan something like the income tax code with every lobbyist getting a piece of the action. I have every confidence that Pelosi and Obama will be able to achieve such a reform .

Posted by: Luther on June 3, 2009 at 10:08 AM | PERMALINK

Seriously, it's better to do nothing this year than pass an insulting joke of a "reform".

Exactly. The "trigger" idea is backwards, anyway. Any "trigger" should be pulled automatically after some short settling period unless there were overwhelming reasons not to, instead of the other way around.

Posted by: qwerty on June 3, 2009 at 10:13 AM | PERMALINK

The parody statement by RepublicanPointOfView above actually raises an interesting point: there really is only one "political" question that Americans have to answer: Do we want to ensure that most, if not all, Americans have access to affordable health insurance?

If the answer is 'no' then we just stick to what we have now.

If the answer is 'yes' then all other questions are empirical, i.e., what's the best way to achieve near-universal coverage.

My view is that we either a) "expand" Medicare to cover everyone, b) "transition" most private for-profit health insurance companies to private non-profit entities, or c) some combination of both.

Posted by: JM on June 3, 2009 at 10:14 AM | PERMALINK

All references to 'the best government that money can buy' are bogus. There was a time when that was true in the U.S. Now is it is just 'government that money can buy'.

Posted by: AngryOldVet on June 3, 2009 at 10:15 AM | PERMALINK

@ AngryOldVet on June 3, 2009 at 10:15 AM

Well, I used to think the M16-A1 was about the best tool in the box ... until I discovered the M79!

From the days when "government" was a Cadillac that Ike rode in, to our present Edsel, I suppose "best" is a rather relative term .... ;-)

Cheers!

Posted by: Otolaryx on June 3, 2009 at 10:35 AM | PERMALINK

@Otolaryx - The M79 was near & dear to my heart as well!

Posted by: AngryOldVet on June 3, 2009 at 10:45 AM | PERMALINK

Prior to the ratification of the 17th Amendment in 1913, many US Senators were elected by state legislatures, which were often controlled by the Railroad Barons. Thus, those Senators were vassels of the Barons. And, how have times changed for the public vote? Oh, those railroad types have been replaced by such as Big Pharma, Big Insurance, Big Banking and the like, eh? Max Baucus is the Blanche Dubois of the Senate.

Posted by: berttheclock on June 3, 2009 at 10:52 AM | PERMALINK

Obviously the only trigger that will push private insurers to seriously offer better plans IS the competition of the public option. Otherwise they will be quite happy to continue shedding policy holders while increasing the rates for everyone else. This is SO disappointing, but why am I not surprised.

Posted by: GB on June 3, 2009 at 11:00 AM | PERMALINK

I don't see anything wrong with this "trigger" idea on its face. If the legislation demanded that insurance not exceed a set price, gave you options of doctors to choose from, etc., then it could potentially work. And if the insurance companies don't meet these requirements, then there's absolutely no argument to be made against moving to a public healthcare plan. Sure, the insurance industry is comprised of thieves, but if they can emulate what our public plan would look like, this would be less of a headache to push through Congress. That said, if the triggers are part of this legislation, I expect the insurance industry to violate their responsibilities immediately. Which I guess would get us public healthcare.

Posted by: Andrew on June 3, 2009 at 11:26 AM | PERMALINK

One hopes that, in the "debate" that is mentioned, the Obama Administration is coming down against this. However, after reading the article in today's Wall Street Journal about how the banks managed to convince the Administration and Congress to force the FASB to water down the rules regarding "mark to market" just in time for them to report "increased" earnings, I am sure that all the foxes Obama has hired to guard all the henhouses will be busy bending over and spreading for the insurance industry also.

Emmanuel Wallerstein commented this week that, by governing from the center, rather than the left-center, Obama gives up so much in his "negotiations" with conservatives that every decision comes out centger-right. Ah yes, "change we can believe in."

Posted by: TCinLA on June 3, 2009 at 11:36 AM | PERMALINK

If you want to see just how bad things will be on health care, go read this WSJ article on how the banks derailed financial reform:

From "How The World Works" at Salon:

As presented in a blockbuster Wall Street Journal article today, "Congress Helped Banks Defang Key Rule" the case is clear. The financial industry, eager for changes in accounting rules that would boost their balance sheets, lobbied Congress intensively. In a rare display of bipartisan amity, both Democrats and Republicans in turn applied intense pressure to Financial Accounting Standards Board, directing the regulatory body in charge of accounting rules to weaken so-called "mark-to-market" accounting.

In early April, the FASB acquiesced to Congress' clear directive, just in time for the banks to goose their first quarter earnings.

Journal reporters Susan Pulliam and Tom McGinty deserve a lot of credit for nailing the story -- it is as well documented a case of big-bucks lobbyists succeeding in getting the rules changed in favor of their clients as you will ever see.

In my past reporting on the mark to market issue I have tried to take seriously the arguments that are made about why some changes might have been necessary in how financial institutions are forced to value the securities they own. When markets go completely haywire, and those mortgage-backed securities on your books are impossible to sell, at any price, does that really mean for accounting purposes they should be valued at zero, thus forcing you into immediate insolvency? That can be disruptive! There are no thoroughly satisfactory answers to how to resolve this problem.

But Pulliam and McGinty let the cat out of the bag at the very end of the story, where they report something I haven't seen anywhere else.

Still, many saw the new rules as a watering down of standards. That triggered a backlash within FASB. At a meeting of a FASB advisory group in New York on April 28, three of its members threatened to resign in protest, concerned that FASB had jeopardized its credibility.

Lynn Turner, the SEC's former chief accountant and a former FASB member, was one of them. He says he doesn't think the banking industry will be satisfied until mark-to-market accounting is dismantled completely. "Despite efforts by FASB to give ground to the banks, enough is never enough," he says.

Three members threatened to resign in protest! Doesn't that tell us all we need to know?

Posted by: TCinLA on June 3, 2009 at 11:43 AM | PERMALINK

Does anybody have any respect for or faith in the insurance industry besides its executives and members of congress? This is disgusting, and I'm telling you right now that if there isn't real reform with a real public option(as opposed to putting everyone on Medicare which would be best), then it's worthless and I'm not voting for Obama or the Dems next time round. I'd just as soon not vote for anyone since the country will be going to shit anyways.
Any plan that depends on the good faith of the insurance industry, including their worthless promise to cut costs, is..worthless.
Are these politicians really so dependent on the insurance industry for their re-election? Do so many of them have family members who work in the industry? What the hell is it about this particular group of scumbags that our elected officials always, ALWAYS, cave in to their demands? There has to be some sort of bribery involved, because no one else cares if they all go out of business, seeing as how their business depends on taking your money and avoiding payments for treatment at all costs, including your life.

Posted by: Allan Snyder on June 3, 2009 at 11:44 AM | PERMALINK

SO here's the question for all progressives, liberals, moderates, and independents: at what point do we actively oppose the health care "reform" bill? Do we follow the path of the conservatives from the Bush era and support something we know is bad policy for political reasons?

without a (non castrato) public option the only "stakeholder" giving anything up in this negotiation is the public (in the form of enforced mandates). in what world is handing the insurance companies a government enforced monopoly reform? how can they argue that costs will be reduced when they take away the only market option (not that's it's a good long term one) anyone has to protest costs? the problem with coverage is a problem of cost, the current proposal doesnt fix that problem and does nothing but force a tax on the public whose proceeds go to private industry.

Posted by: Pindar on June 3, 2009 at 11:45 AM | PERMALINK

Don't call them 'centrist' Democrats, even in quotes.

Call them fake Democrats.

Posted by: alan on June 3, 2009 at 12:41 PM | PERMALINK

Not a bad question Pindar, we need to ask how well all this has worked in other countries. But I'm OK with letting people pay extra to independent providers for extra coverage, as long as they have to participate in the basic system. Otherwise, the rich will quit and the system won't get funded (just like everything else would in effect.)

Posted by: Neil B ← on June 3, 2009 at 12:51 PM | PERMALINK

Rumor on the Web is that Sen. Chuck Shumer addressed the "trigger" option by stating, "all the conditions for the trigger to be tripped have already been met by the insurance industry's decades-long refusal to control costs, to provide universal coverage, and to make its insureds the focus of their business." So, as the "trigger" conditions have been met, an immediate public option must be included now.

Second, every other country in the world that makes health care a right (not a privilege) also makes it a crime for primary health care insurance to be provided by for-profit entities. The reason is that for-profit businesses must have, by their very nature and as their first and principal purpose for existing, the creation of profits FOR THEIR OWNERS. That is fundamentally at incompatible with the concept of keeping people healthy and treating them when they are sick - the ONLY way to create profits is to deny and/or limit expenditures for the care of their insureds. To my knowledge, NO ONE in the Congress is talking about this as a necessary component of reform; nor is Obama. Why????

Finally, I am disgusted with guys like Wyden and Baucus and (Ben) Nelson who are actually representing the insurers, and not their actual constituents. I guess a whore is a whore; some just happen to wear $1,000 suits to screw us, all the while bleating that they work for us. Horse pucky. We need public financing of ALL elections in this country; until then, the inside-the-beltway golden rule applies: he/she/it that pays the most bribes to the politicians makes the rules. Until then, whores will do what whores do: they don't give their services away for free; they sell 'em!

Posted by: Analytical Liberal on June 3, 2009 at 1:49 PM | PERMALINK

Make no mistake...this 'trigger' is a gun to kill HC ins reform. Like allowing the same people who got us into a war to get us out. These profiteers will use lobbyists and time to drag out this debate hoping to get more conservatives in office to defeat a HC reform measure.

This is a public fiasco where our legislature is refusing to give the voters what they demand using every excuse possible to make sure no reform happens.

Their attempts at reform are laughable. The only thing they are doing is trying to figure some way to keep the profiteers profiteering without upsetting the people to riot. They are ignoring every thing that they know will work, will be successful and cost effective just to keep the profiteering going. If they put just 10% of that effort to a not for profit effort....the probvlem would be solved tomorrow.

This issue is too big affecting the entire nation's economy and social being and these worms are only trying to wiggle out of giving the peope what they want and what they know will work.

Trigger options...hahahahahahaha---recipe for guaranteed failure. "Gum it to death" til we can get another war going...or get Cheney's prayer answered and we get another attack. Are we ready to get rid of the entire senate yet...what good are they???????

Posted by: bjobotts on June 3, 2009 at 1:50 PM | PERMALINK

Posted by: AngryOldVet on June 3, 2009 at 8:18 AM

You are not alone.WTF has happened to the Obama I voted for. Is it just more hypocrisy with a smile?
I am so disappointed in this man I thought would make a stand. He has the support of the people to do it but here he is appeasing the repubs and their corporate bosses.
Claiming SP not for profit won't get through the senate when an overwhelming majority of the people are behind it and we know it would go through the senate by way of the reconciliation process if dems voted for it. The people back it, it would be the answer to our economic problems and would be highly successful...but stopped by corporate lobbyists money...and Obama is buying into it. What change is that. We can't trust but a few of our elected representatives to represent us but I trusted Obama so WTF is happening to him.

We know too much and are too invested to be pacified by calling a doomed HC INS. plan..."Reform". There is only one way to reform health care ins...eliminate the profiteers, yet our legislature refuses to even entertain that idea. This won't go away inspite of the senate's delaying tactics.

Posted by: bjobotts on June 3, 2009 at 2:44 PM | PERMALINK

To demonstrate the insanity of the senate there is a Lieberman-Graham State secrets reform bill.

Lieberman-Graham....the two biggest war hawk cheerleaders. I wouldn't use anything with "Lieberman-Graham" on it to wipe my ass. It is the name of a curse...yet Obama is supporting it.

It's like a bad dream. The people should, just like our elected leaders, should just start ignoring the law.

Posted by: bjobotts on June 3, 2009 at 3:06 PM | PERMALINK

If only there were a group of educated wealthy people who could start a national health care ins. co-op where your plan would not start until the membership year had passed so as to get enough members to spread the cost over all of us...like a people's not for profit single payer national HC ins group which our legislature is trying so desperately to prevent.

THE PEOPLE'S NOT FOR PROFIT SINGLE PAYER NATIONAL HEALTH CARE INSURANCE CO-OP.

Posted by: bjobotts on June 3, 2009 at 3:38 PM | PERMALINK

The more I hear about health care reform the more sure I am that opponents are angling to label any reform "welfare" and thus enabling defeat- if not prior to enactment than afterward.

Posted by: KJ on June 3, 2009 at 3:58 PM | PERMALINK




 

 
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