Triggers, Politics and Party Tricks

by Gillian Hubble

categories: For Profit Insurance, Obama and Congress, Public Plan

Published October 28, 2009 @ 06:00AM PT

A public option “trigger” has received a lot of attention lately. Thankfully Harry Reid bypassed it for an opt-out solution instead, because it’s a proven Really Bad Idea. Since the Wonk Room's Igor Volsky thinks it's a fabulous idea to combine an opt-out public option with a trigger, let's put this one to bed once and for all. Following is a quick lesson in political science, so you can recognize this underhanded trick when you see it in future.

Consider: the intent of a trigger is to activate a remedy (a public option) in the event that certain conditions aren’t met by existing forces (private insurers.) Now, we wouldn’t be considering healthcare reform unless there were already significant, long-standing problems in virtually every aspect of our system-less healthcare. That includes $850 billion of waste every year, almost enough to pay for 10 years of reformed healthcare. The insurance reform gun has already fired. So why design a trigger to potentially address this urgent issue sometime in the distant future when things are even worse, perhaps catastrophically so?

The short answer is that doing nothing is the politically safe route. It’s a proven way to get re-elected by not rocking the boat. Olympia Snowe knows that, and probably hoped a trigger would allow her to claim she voted for a public option (what her constituents want) and at the same time kill it (what most Republicans want.) Under the trigger, a public plan would be created only if private insurers didn’t make “meaningful, affordable” coverage available to all Americans within “several years.” Believe it or not, none of these terms has been defined. So what would trigger a public option? You guessed it – nothing.

Experts have already determined that reform is no cure for 75 years of insurer discrimination. They will still try to cherry-pick by offering certain benefits or advertising campaigns that appeal to the young and healthy. Take Anthem Blue Cross’ website for its Tonik plans: “You're young. You're healthy. You're in shape." Insurers lure healthy seniors by throwing in cheap benefits like health club memberships while requiring members to pay more for expensive chemotherapy drugs, dialysis and long-term care than they would on core Medicare. This type of discrimination will intensify under reform and premiums will skyrocket if there's a threat of a trigger. Yet the trigger delays a remedy.

We’ve seen what didn’t happen with the Medicare physician payments trigger, the Medicare Part D trigger, and the HIPAA individual plan trigger. As Yale Health Policy Professor Jacob Hacker explains, that’s by design, or more specifically lack thereof. A workable trigger needs to accomplish three things:

1. Establish measurable standards for performance for a specific benefits package,
2. Assess the standard in a very timely fashion, and
3. If not met, quickly create a remedy (in this case, a public option.)

We’ve already noted that #1 and #2 aren’t defined for a public option trigger. In fact premium inflation, especially in local markets, and total out-of-pocket costs aren’t even considered. Now, let’s examine #3 – “quickly.” Has the reform process been quick so far? Nope. Will it be quick once the political cast of characters and political conditions change, to focus on other matters of national and special interest importance? Nope. Who would make the decision to pull the trigger? That’s to be determined. How would this public option work? The Senate hasn't completely thought it out. How fast could it be set up? We would potentially find out at some undefined point in the future.

Are you getting the picture? A trigger is more like a kill-switch; it kills the desired change now by promising to fix it in the future. Sorry, more passing of the political buck won’t work. The public needs a public option now, and Reid delivered in the Senate. Volsky would go one step further, by making the opt-out dependent on a trigger -- in other words, states would never get to opt out of the public plan. Sorry, Olympia Snowe, you've been found out.

Photo http://farm3.static.flickr.com/2022/2409976725_f2277403ac.jpg // CC BY 2.0