There has been a knee-jerk resistance to triggers on the part of many Democrats that was useful at first, and I agreed with it, but now, it is possibly the way to go, as opposed to nothing at all.

Clearly there are more problems with reconciliation than we thought, so it looks like it may not even be a last ditch option.

The real priority is good-enough policy on a good timetable. Good trigger is better than bad non-trigger, obviously.

The problem with this is that the type of "strong" trigger being envisioned here is not on the table and the reason its not on the table is the same as the reason that the public option that is on the table is so weak. The Senate does not have the will do do anything that will inconvenience the insurance industry. There are all sorts of proposals that one could put forward to strengthen the health care coverage system. But if the Senate were really interested in pursuing any of these possibilities we wouldn't be having a discussion about the weakness of the public option in the first place.

If private firms can be convinced to cut costs or face a public option I hope the way they cut costs isn't by delivering inferior service.

I just learned a colleague with a lump on the back of her head was mis-diagnosed by Kaiser doctors for three years before they finally began treating her tumor correctly. She should have been in treatment years ago, or in a different job, but her family depends on her salary so she can't make any career moves that would jeopardize her coverage. She continues to work despite periodic seizures that leave her unable to speak.

This is the kind of person for whom a public option would be perfectly suited. So the availability of a public option is not an abstract ideological deliberation -- it means real treatments for real, hardworking people.

There has been a knee-jerk resistance to triggers on the part of many Democrats that was useful at first, and I agreed with it, but now, it is possibly the way to go, as opposed to nothing at all.

I don't agree with this. The "trigger," especially as it is currently being discussed is entirely worthless as a policy proposal. Its intended value is to appease the proponents of a public option and allow left leaning legislators to save some face on getting rolled on this. But I have yet to hear of anyone falling for this, so even as a political solution, its worthless. What I have said is that if we are going to trade away a public option, it should be for something real like better subsidies or stricter regulations, not some imaginary policy to make the insurance industry promise to play nice.

The basic problem with all triggers is that during the time the trigger is being tested, insurance industry advocates will be working full-time to undermine them (because they're being paid) but the level of grassroots advocacy will almost certainly trail off, because unpaid activists can only maintain their level of pressure for so long. I agree that if we pass reasonably strong health care reform, it will never be repealed because people will like it, but triggers are easy to weaken because they're just a promise, and don't create any kind of constituency. (Not to mention that if there are triggers, I'll be frickin' retirement age before any of this takes effect, and I didn't get into this fight just to keep getting screwed by insurance companies until I'm old enough to go on Medicare.)

"A strong version is necessary because there is little else in health reform that can be counted on to contribute significantly to cost containment in the short term," the authors write.

As Somerby repeatedly points out, we pay up to twice as much as everyone else in the industrialized first world and get less. Screw containment, we should be hammering away a health care cost REDUCTION. All we are doing is locking in the Health Care Industries profits.

It's like talking about war in Washington. One side says we can win one way, the other side says we can win another way and no one is saying "We shouldn't be at war at all."

I don't think we should be letting the wealthy shear the rest of us for another five years. 45,000 people die every year due to lack of health care.
Single payer should have been put in place a long time ago.
The trigger, unless it triggers TODAY, is death sentence for too many.

If private firms can be convinced to cut costs or face a public option I hope the way they cut costs isn't by delivering inferior service.

Of course it will. There are only two other ways to cut costs, and the free market works against both of them. You can cut long-term costs by paying for better preventative care and coordinating care better, but, that means paying up front for savings later, and in our fragmented system, "later" means a different company is likely to get the savings. So a company that doesn't make that investment is more profitable, and is rewarded by the market. The second way is to reduce profits, which the market will punish. So they'll take the only route that market competition rewards in health care, which is to try even harder to avoid paying claims.

* First, any trigger would have to be triggered one minute after the bill is signed into law, as the for-profit private-sector health insurance corporations will not reform themselves. "Voluntary" is not in the corporate dictionary.

* Second, this stuff about having a stronger Public Option with a trigger is nonsense. Once you agree to a trigger, it will get watered down even further.

* Third, as to Tim's "What will stop insurers from dumping expensive undesirables into a public ghetto?What will stop insurers from dumping expensive undesirables into a public ghetto?"

Ah, the law ?

Most companies that already provide health insurance coverage for their employees would be exempt from the Healthcare Exchanges, which is the only place the Public Option would be offered.

As Mr. Rogers would ask, 'Can you say reconciliation boys and girls ? I knew you could'.

I get your general point. It - might - be possible to get the Senate to vote for a bill containing a much stronger public option if it's only triggered by a general failure on behalf of private Healthcare corporations to meet certain benchmarks within a predefined time-period.

But that would just mean that the 'focus of debate' on Health Care Reform would switch to the nature of the trigger mechanism, and the usual suspects will be there saying that the only trigger they'll accept is one that never, actually, gets pulled, because, y'know, that would mean the introduction of the same public option they already oppose, and the MSM will be calling it good news for Republicans.

Which changes the current situation how?

Enjoying your imported Canadian drugs?

Oops! Nobody pulled the trigger. Nobody ever has pulled one in one of these laws.

And what was that enormously high bar, that had to be passed for us to import those drugs? (Which are often made by the same manufacturers as domestic drugs - and in the same factories!)

They have to be officially declared safe, that's all.

Truthfully, I'm ready to kill the damned bill and see if enough of us can be bothered to take to the streets 60s style and demand Medicare for all. I suggest candlelight vigils surrounding congress and continuous readings of the names of the dead along with citizen accounts of their horror stories.

We can DO this!

I think it is worth pointing out (for the umpteenth time) that the very weak public option that remains in the Senate (and even the House) bill is a compromise of a compromise of a compromise of a compromise by liberals from a single payer system (which itself is a pretty moderate scheme in just about the entire developed world except in the US). Even with it, I think it is a close call whether the current HCR is worth passing--it combines a few useful reforms (i.e., barring denial of insurance for preexisting conditions) with a giveaway to health insurers. At least the weak public option creates a framework that might be built on and strengthened in the future. Without the public option, or only a trigger that will assuredly never be pulled, I do not think the bill should be passed on policy grounds--it's enactment would serve no purpose other than saving political face for Obama and, to a lesser degree, Democrats in general.

Charlie Brown eagerly lines his field goal kick...

Face it folks: Liberals have lost big time here. So lets not be naive: Does anybody really expect Joe and company to allow a robust "trigger" football to be kicked?

Please.

More blunt honesty: The field isn't tilted fair. The insurance companies have bought the 3-4 votes they needed. And they decide what football gets kicked and what football gets pulled back. So lets not be naifs. Forget the "robust trigger." It's DOA. Why? Because Joey's team owners say so...

You and I?
We are the niggers in this "democracy." They are the owners of it.

We are just dog-shit dumb liberal fans that should send more money to the DNC, sit in the stands, and help the home team hang on to its majority. That way, Joe Lieberman can stay suited up and play "Chair" on his favorite Senate committee...

Same old football.
Same old game.
You go kick that ball nigger...

The only way anything will even change is if you and I tell EVERY democrat who asks you for money:

"No. Not a penny. Not until Joe is no longer a Senate Chair. I will not tolerate funding a party that allows Joe Lieberman to kill the public option AND sit like a God on a democrat committee. I want Joe's head on a platter, or fuck the democrat party forever..."

Foks, it's time to say FUCK YOU to the Democratic Party...
In the only language a crime family under$tands...

I am peaking on negativity!

Health care reform is going to end up like 'credit card reform', which ended up as passed legislation for which Obama and the dumbocraps could claim victory. Unfortunately, the credit card reform ended up being gutted and virtually worthless for working americans.

Health care 'reform' is probably going to get passed in some form. Obama and the dumbs will be able to claim victory. It will be worthless or postponed until forever and will have lots of goodies for corporate amerika and politicians. It will be virtually worthless for working americans.

Americans do not need 'victories' for Obama and the worthless dumbocraps! We need a victory for working americans and I do not see that happening.

F*ck them all!

Still missing the larger point here...a public option...no matter how weak...opens the door for gov. involvement in the HC ins. idustry. Plus it could be expanded later if "creaming" or dumping occurs.

I've been writing all along that a "trigger" option is no PO at all no matter how strong for it will never...ever get pulled. The proof is that we are already at the point where a "trigger" should have been pulled and Priv. ins. is just now getting one for in the future. hahahahaha.

I am still awaiting and answer to why Medicare's budget isn't being expanded to cover all of us and being a budgetary issue could be passed via reconciliation with a 51 vote majority.

With everyone covered by Medicare we could focus on fixing any problems with it and also get it to cover dental since its size would allow for it.

Then pre-existing, caps etc wouldn't matter and private ins would no longer profiteer from our health care.

They(opponents and private ins.) will do anything to stop even a watered down version of a PO to keep that door closed to gov. involvement in the HC ins. industry. Trigger...what a joke.

Should the Democratic Party pass a version of HCR that mandates the purchase of insurance (even with subsidies) and does not include a very strong public option, they can fully expect to lose control of Congress in 2010.
There will be tens of thousands of voters who supported Obama and the Democrats in 2008 who simply won't be there. The economy, for those NOT on Wall Street, is still declining. Job losses have, apparently, peaked, but when will they start to decline? The war in Iraq is drawing down as planned, but Afghanistan continues to worry many.
Add a HCR failure to those points, and HCR without a very strong public option WILL be a failure, and the Democrats will be looking at a major loss of seats in 2010. A bit of pity, as they are certainly better at governing than the Republicans, but the incompetence and cowardice shown by ALL members of the Democratic leadership has been appalling.

Some serious shit is being overlooked here. Whatever this "trigger" is will have to be defined in bullet-proof legal terms. Exactly what it is that becomes active when this trigger is pulled must also be defined in bullet-proof legal terms. And one thing I have never seen mentioned is exactly how you define a measurable trigger threshold when there are so many participants involved.

If BCBS takes the challenge seriously and meets 95% of the desired metrics by the target date but FuckOff Insurance Company does everything within its power to purge its base of anyone but the young and healthy, how will a trigger punish one and not the other?

Perhaps a cap-and-trade like concept needs to be applied to the health care insurance business. Perhaps the "trigger" can be a phased (vs all or nothing) process where rules for Medicare eligibility will be relaxed in inverse proportion to the degree escalating targets are missed.

Screw it.

First of all, I haven't forgotten, and neither have many others, that the objective is Universal Health Care, not Health Care "Reform".

Secondly, there is hardly anything - *anything* - in heath care reform worthy of the name than the public option - and I fail to see the advantage of a "strong" public option attached to a trigger so weak that it will never be pulled. 'Cos that's the idea of a trigger.

Get rid of the public option, the individual mandates, the exchange, etc., and keep the Medicaid expansion, the pre-existing condition and recission bans - even though they are probably totally unenforceable - if you must, but don't call it health care reform.

Bla bla bla, ginger, bla bla bla ginger.

At the end of the day we will end up with a federal mandate to buy private health insurance. There will be no public anything, except the outrage at congress' flagrant abuse of its commerce power.

Pay or IRS lien.

Come and get me fuckers.

I don't think that could make it through the House, perhaps not even the Senate.

"A trigger means delay,"

Not necessarily, or at least no more than it already will be delayed. From what I understand, the health reform won't go into effect anyway until 2013. It is now 2009. That gives the insurance companies three years to get their acts together, so if when the bill goes into effect, they haven't reached their bench marks, public option time from the get-go.

The public option in the bill will have premiums higher than private insurance company premiums in the exchange. Exactly how is that supposed to provide competition? The whole thing is a disaster.

Also, as an aside, my daughter got her BCBS 'hospitalization only' premium today. They've jacked up the premium by about 20%. We're going to see that universally: insurance companies will hike their premiums and increase their profits before the bill takes effect. Four whole years of being screwed, assuming the bill passes. Obscene.

So take it to the streets or give up, folks. That's what it amounts to.

We would still be in freakin Vietnam if millions of us hadn't done exactly that in the 60s. Think the Feds would have ever done a damned thing about Jim Crow without MLK and millions of marchers? Labor reform was a brutal, bloody fight; it wasn't given to us by a beneficent congress.

Occasionally our lawmakers do the right thing without too much prodding - mostly when it is little stuff. For the big stuff, we have to scare the hell out of 'em - millions of us in their face - if we want anything done.

Think about it.

The one idea which has keeps occurring to me is this:

Someone gets hit by rescission, and EVERYONE covered by the ENTIRE PLAN said customer was in AND THEIR DEPENDENTS is immediately and permanently eligible for Medicare, regardless of age.

It will be an inevitable, slow destruction of the insurance industry as it currently exists, while phasing it in such that there's time to build the resources to support it.

Triggers are phony; they're meant only to kill off the public option. Anyone who tries to rationalize the trigger is naive.

These companies will invest our money in finding ways to circumvent laws and regulations. Look at the credit card industry - it's been very busy raising interest rates before the Dec deadline comes. I know, because they just did this to me - and I've never had a late payment.

You're a sucker if you trust the banks or health insurance industry. And Congress is corrupt.

This is great! I've been a supporter of the public option for awhile. Mainly because I've seen the great work that it's done in Ohio and staying in the black! See for yourself. http://cli.gs/z3AtaY/