Health Care: Of Triggers and Timing
As Kate notes in her story today, yesterday's defeat of the public option by the Senate Finance Committee has focused a lot of attention on the next big test, which is Senator Olympia Snowe's amendment to put the public option on a "trigger"--that is, to establish one only as a fallback if private insurance companies fail to create a market for affordable coverage.
However, I am told the Snowe is considering the possibility of withdrawing that amendment from the Finance Committee deliberations, and waiting instead to offer it when the bill reaches the Senate floor. Here's why:
Given the intensity of yesterday's debate, both sides are pretty entrenched at the moment. However, outside the heated atmosphere of the committee room, there have been some tentative signs of growing support for the trigger proposal. As we noted last week, Senate Majority Leader Harry Reid has called it a "pretty doggone good idea"--albeit insisting that his preference remains a public option. And over the weekend, former President Bill Clinton also praised it on "Meet the Press," saying: "Now, the one Republican who's come up with a good idea is Senator Snowe."
The staunchest advocates of a public option continue to insist that a trigger is a bad idea, because it would never be pulled, or even constitute a serious threat to the insurance industry. Speaker Nancy Pelosi has said that in her caucus, a trigger is viewed as merely "an excuse for not doing anything.”
But the Obama White House has made no secret of its belief that the trigger could be the compromise on the public option that the President has been looking for. And should the public plan be defeated on the Senate floor--as now appears likely--some of its supporters may be willing to give the trigger idea another look, especially if President Obama decides to explicitly support it. (In his health care speech before Congress, he cited it as one of several "constructive ideas worth exploring.")
One thing to watch closely: The Congressional Budget Office has yet to weigh in with its appraisal of the trigger idea. It's "score" would give us not only an idea of the costs, but also some independent appraisal of the likelihood that (1) a trigger might actually be pulled, resulting in the creation of public plans in some states and (2) whether the trigger would be a credible enough threat to private insurance firms to assure that they engage in geniune competition in places that now lack it.
In politics and legislating, timing can be everything. It may well be that by waiting, Snowe would give her "trigger" a better shot.
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"The Congressional Budget Office has yet to weigh in with its appraisal of the trigger idea. It's "score" would give us not only an idea of the costs, but also some independent appraisal of the likelihood that (1) a trigger might actually be pulled, resulting in the creation of public plans in some states and (2) whether the trigger would be a credible enough threat to private insurance firms to assure that they engage in geniune competition in places that now lack it."
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Why isn't the CBO releasing this report? Has Baccus kept it from sight for some purpose KT?
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I am still on the side of first allowing free market to work by reform to the State to State insurance, opening up competition first. Along with Tort Reform, I believe the market will respond and respond to the point of driving down the cost of Healthcare insurance, period.
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Then if these two measures do not work, then release the demons on the left and put a trigger in place. Bills can be amended, after they have been passed.
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Baccus seems to want to totally gut the insurance programs out there before first attempting a less intrusive measure first. This is where I believe the great majority of Americans are so unsure. For the most part, we like our insurance that we have now. Why risk losing it all over some Democrat folly that will implode upon itself in the next 5 years or so. Then instead of 12 or 13 million without insurance, it will be ALL OF US.
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By the way, did you take this test Karen?
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http://www.theadvocates.org/quizp/index.html
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Be honest with yourself Karen, I am sure you will be enlightened!!!-
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Along with Tort Reform, I believe the market will respond and respond to the point of driving down the cost of Healthcare insurance, period.
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lol?
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What possible incentive does the market have of driving down costs? No, really. What we have seen from the market is double-digit premium growth across the board with zero credible explanation as to why prices are rising higher than inflation. Or why we pay almost double than all other industrial nations for care nowhere remotely close to doubly effective.
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The healthcare "market" is nonexistent. -
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redraven937:
What we have seen from the market is double-digit premium growth across the board with zero credible explanation as to why prices are rising higher than inflation. Or why we pay almost double than all other industrial nations for care nowhere remotely close to doubly effective.
Shhhhh!
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You're not supposed to know that!
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You're not supposed to know that in other lands things are different...better, even!
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You're not supposed to say that the country you live in isn't the best at everything in the world!
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You aren't supposed to tell your people that somewhere right now, some citizen of some other nation may be buying coffee from a huge store with more food than we've ever seen, and having shelves filled with lots and lots of different brands of coffee...and more than one kind of toothpaste, even!
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Oh sorry!
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I forgot for a second that we're not living in North Korea, where people aren't allowed to know how bad their system is compared to other places in the world.
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We don't live in North Korea, right? We have a free press who can tell us how much it costs here compared to everywhere else, don't we?
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...Don't we?
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But the Obama White House has made no secret of its belief that the trigger could be the compromise on the public option that the President has been looking for.
Everybody pretty much knows by now that the President will compromise with anybody and anything to get this thing passed and into Rahm's "victory column".
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The real questions at this point aren't about what the Obama White House "has made NO secret of", they're about what the Obama White House HAS made a secret of, isn't it?
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If the Obama White House is this willing to compromise in order to get a silly, pointless, Medicare-bankrupting mess of a "health care reform" bill through, then shouldn't we be asking ourselves the question "On what else and with whom else has the White House compromised?"
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Given that we know now of the reality of the "compromise" deal between PhRMA and the Obama White House, who else besides Olympia Snowe does the President have to make happy in order to get his prized parking ticket of a bill passed?-
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Sorry, that should read:
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The real questions at this point aren't about what the Obama White House "has made NO secret of", they're about what the Obama White House HAS made a secret of, aren't they? -
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"Everybody pretty much knows by now that the President will compromise with anybody and anything to get this thing passed and into Rahm's "victory column".
I believe the expression is we already know what you are. All that's left is to negotiate a price.
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Now that the Left knows it is not welcome in the Democrat party the question is, where do we go now. I would suggest running a third party candidate in any area where the democrat votes against the public option. That way you can hurt the party, without contributing to it indirectly, by supporting another spineless sell out.
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Derek:
Now that the Left knows it is not welcome in the Democrat party the question is, where do we go now.Why don't we just kick the center out of our Democratic Party...or at least remove it from leadership?
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There's a lot more of us than there are of them... -
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"There's a lot more of us than there are of them..."
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Yes but they have the power and they are the ones who are catered to. The reason for this is very simple, they assume the Left will vote for them no matter what because they think the Left has no choice but to vote for them. When election time arrives they roll out the "don't waste your vote" argument. The reason independents have so much power is because they change their votes. The Left should learn from that lesson and do the same thing. Maybe then the Left will get some power in the party too.
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"the intensity of yesterday's debate"
"heated atmosphere"
"staunchest advocates"It is almost like they think this is important.
So naturally the script says people need to calm down and support a phony watered down version of a public option.
A trigger that will NEVER be pulled. -
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KT, welcome back from Starfleet Command. Given yesterday's switch by Carper and BILL Nelson (away from Rockefeller's plan to Schumer's) maybe the PO trench warfare isn't so entrenched? Does Schumer have a teeny tiny opening here? And if Snowe doesn't yet commit, is there still time for Biden to work his charm over her like he did with the stimulus vote? Did Nelson say why he switched? If not, would YOU, Kate, or Jay ask him directly, please? If he won't play nice, dress up Michael as a tourist (remove his WH press lanyard, please) and have him shadow BN …even into the men's room if needed to get BN to “leak” the info. Thanks, KT.
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Isn't the real question whether or not the Public Option as its currently being debated will be available to all Americans?
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http://tinyurl.com/yaxbgz8/countdown_with_keith_olbermann/6120/MSNBC/Tuesday_September_29_2009/90025/
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00:08:14 >> With us tonight from the finance committee is senator ron wyden of oregon.
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00:08:50 I'll be offering a proposal that gives all americans choices, like members of congress have through competition.
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00:09:36 For example, under the public option approaches that have been taken in previous bills, more than 85% of the country wouldn't even be able to choose a public option.
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00:09:44 Let's make sure these choices are available to all americans.
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00:09:47 That's what my proposal, the free choice proposal, will do tomorrow.
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00:10:16 >> I'm certainly not going to support legislation that doesn't let consumers hold insurance accountable.
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00:10:28 If you have somebody at a mid-sized company, and they're abusing them, ripping them off.
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00:10:34 Crummy, overpriced service.
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00:10:37 The way these bills are written now, the consumer couldn't get anything else.
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00:11:46 I remember the summer and all of the rallies I would see folks carrying those public option signs and I would have to tell them more than 85% of you won't get to choose the public option and folks were practically falling out of the bleachers.
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00:11:53 They want everybody to have choice.
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00:11:55 I think we have arguments for both sides of the aisle, and i think once all americans have choice and are in a position to hold the insurance companies accountable, that is genuine transformation of the american health system.
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00:12:26 Under this legislation, americans are going to be required to buy health coverage.
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00:12:28 If it's crummy coverage and you don't have choice and you're forced to buy it, you're not going to see people very happy about that.
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00:12:55 >> Senator ron wyden, democrat from oregon in the midst of a fascinating markup hearing in the senate finance committee.
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00:13:01 Thanks for coming on.
00:13:02 We appreciate it.
00:13:03 >> Thanks for having me.As Senator Wyden says, the public option as written into the bills under consideration is nearly worthless to the vast majority of Americans who will be required by law to have private health insurance.
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Also, as Wyden mentions: "If it's crummy coverage and you don't have choice and you're forced to buy it, you're not going to see people very happy about that."
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What difference does passing a Public Option into law make if people aren't allowed to buy it?
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...and what kind of backlash are we going to see against Democrats for going along with it? -
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Good points. I'm sold… (how many Senators have been bought / sold too? but I digress) …but I want to see other Senators / committees + the House keep up pressure for a stronger PO. (Actually, I'm a single payer fan, even going further, wanting a public HC safety net run like police / fire depts. with a parallel private HC system for those who can pay. Just my thoughts only, no research links out there to click.) I also want to marry an heiress, but props to Rockefeller for trying. Check this out…
http://emptywheel.firedoglake.com/2009/09/29/the-senator-henceforth-to-be-known-as-jay-rock/ -
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Decon:
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The Schumer amendment was actually significantly different from the Rockefeller one, so I'm not sure you can accurately say that Carper and Nelson switched their votes. Schumer proposal is very similar to Len Nichols/John Bertko proposal that I wrote about back in March:
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http://swampland.blogs.time.com/2009/03/26/max-baucus-and-the-public-plan/
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You can see some of the arguments for and against it in that post. It would set up the public option to operate very much like a private insurance company, minus the administrative/marketing/etc costs. Back then, believe it or not, I was told privately by a top official for at least one major private insurance company that this something they could live with. But I'm not sure that is the case at this point. -
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...thanks, KT. I try to keep up but likely missed that post …and stuart's guitar playing.
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Karen maybe Snow has seen this poll, as well as others that the voters in her state do not want a trigger they want a government public option
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I don't know about everyone else, but I am getting of this mess. I am beginning to believe that health insurance reform will do little to solve the problem of health care in this country. I am for:
1) opening up Medicare to individuals and very small businesses.
2) require all providers that have accepted federal moneys accept Medicare patients.
3) add dental coverage to Medicare.
4) allow any other business buy a Medicare group plan if their previous plans have an annual rate increase over 3%.
5) require everyone to buy health insurance.Let the private health insurance companies do what they want without additional regulation.
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progressto:
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These are all very, very decent ideas, and I was going to write a snarky response saying something like
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"Open up Medicare? But then people will choose it, and then insurers might lose customers..even go out of business! From whom will Senators be able to get campaign contributions, then?? Surely you know that Medicare can't donate to campaigns! What are you thinking?"
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, but then I thought it might be better to ask you the serious question:
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But how will this plan of yours reduce the amount of money that Medicare pays for hospitals, drugs, laboratory tests and medical procedures down to levels that most rich countries pay (their $3500 per person/per year to our $7400 per person/per year)?
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Won't opening up Medicare just cause it to go broke faster? -
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...I should clarify that not only Medicare, but the entire private and public health care system pays $7400-plus per person/per year in the United States, as opposed to the average of OECD nations which pays less than half that crazy price tag.
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First, as a response to stuartzechman, Medicare insures the elderly and, in some cases the poor and disabled. Naturally, they are the most expensive segment of the population to care for in terms of medical cost, so comparisons with private insurers who insure a broader spectrum of generally healthier people or other countries who care for the entire population, including the young and healthy, are not exactly fair, or valid.
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Second, triggers are a cruel joke. We all know that. They are designed to never be pulled and are merely a smokescreen to make a politician look like they are doing something while they are actually doing nothing, except pandering to their corporate donors.
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The only trigger that was worthwhile was Roy Rogers' horse. Now that was a Trigger!-
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mjshep:
so comparisons with private insurers who insure a broader spectrum of generally healthier people or other countries who care for the entire population, including the young and healthy, are not exactly fair, or valid.
I wasn't comparing the two, although private insurers are actually more costly than Medicare in terms of health care insurance operations.
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I'm not talking about the cost of Medicare as an insurance vehicle at all, actually.
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I'm talking about the price of health care in the US, not the price of health insurance .
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For example, if Medicare keeps paying the same exorbitant rates for hospitals and prescription drugs that other nations do not, it will go broke, as per the Social Security Trustees Report http://www.cms.hhs.gov/ReportsTrustFunds/downloads/tr2009.PDFMedicare expenditures represented 3.2 percent of GDP in 2008. Costs increase to about 7.3 percent of GDP by 2035 under the intermediate assumptions and to 11.4 percent of GDP by the end of the 75-year period. However, it is important to note that, after 2009, Medicare expenditures are understated because of unrealistic substantial reductions in physician payments scheduled under current law.
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stuartzechman
I will grant you that Medicare costs are high, but let's get the first step done. Obama has already suggested that Medicare adopt best practices and have an existing health board make reforms in best practices. Next, we need to bring Medicare reimbursements down to earth. Ratchet down the reimbursements for specialists and raise them for GP's.It cost $98 for a MRI in Japan versus >$1200 in the US. Why?
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progressto:
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It cost $98 for a MRI in Japan versus >$1200 in the US. Why?
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That's one of the best questions I've seen to date.
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It's corollary would be:
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"Why can't the press corps seem to answer that simple question?" -
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sorry "Its corollary"
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A trigger is one of the least defensible proposals in the whole debate. In is impossible to see it as anything other than a bad-faith effort to derail genuine reform.
Virtually everyone agrees that the current system is in crisis. Obama has called it "unsustainable". The question that we face is what to do about it.
But "trigger" proponents are flipping that dynamic on its head. They are, in essence, conceding that a public option is the solution to insufficient market pressure on private carriers. They are just saying that we are not in crisis yet. This fundamentally contradicts the rhetoric of Obama.
Simply put, you cannot say, as Obama has, that the system is in an unsustainable crisis and also agree to a trigger mechanism. It is so typical of this administration that they would signal support for a position that fundamentally undermines the rationale for reform.
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If there's a trigger on the public option then we should also have a trigger on the mandate. Let the insurance industry prove that there's a real "free rider" problem before we make it law that people have to buy coverage. Fair's fair.
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The trigger is an acceptable compromise, even if it is aggravating that so many Americans don't give a flying crap about anyone else.
I'd be willing to accept a trigger, but only under the following conditions....
1. The insurance companies have one year to decrease costs to consumers by at least 25% and to have it remain at that level.
2. The insurance companies CANNOT refuse care to ANYONE for any reason, unless that person is an illegal alien. This includes an inability to refuse because of pre-existing conditions.
3. The idea of "co-pay" disappears. There is no reason whatsoever that a person should have to pay just to walk in the door of a clinic. They are already paying to see a doctor, so they shouldn't have to pay twice (once out of their pocket with money that may mean the difference between eating for the next few days or not).
4. Doctor's should not be forced to delay treatment to a patient just to get the Insurance company's permission to heal the person.
5. No CEO of any insurance company receives a bonus of any sort unless the company has made money that year, and then it only scales according to the amount of money made, and NOT according to the salary of the CEO in question. AND company wages/benefits will decrease to a reasonable amount. No CEO of an insurance company deserves $75 million in bonus', a free plane, and top end vacations any time they want paid for by the company on top of a $2 million salary.
If they can live up to that, then the public plan does not go into effect.
If they cannot, then the public plan takes effect (and includes everything I specified). Thus the government MAKES the Insurance companies stop screwing us all over.
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[...] posted here: Health Care: Of Triggers and Timing – Swampland – TIME.com Categories: Health Tags: her-story, public, public-option, senate-finance, senator, snowe, [...]
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Commenter #1 got right to it: Where is the CBO score of Snowe's trigger? I have read Snowe's amendment. The trigger--literally by definition--can't be triggered (because affordabilty is defined to be whatever the bill provides). Furthermore the single-state Public Option she envisions can't be done. It would be like the state of Maine deciding Cable TV is too expensive so they're going to launch their own version of each of the popular networks. The only possible CBO score this preposterous trigger could get would be ZERO.
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[...] the original here: Health Care: Of Triggers and Timing – Swampland – TIME.com Comments [...]
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[...] Time’s Karen Tumulty reports that Olympia Snowe may decide to withdraw her much-anticipated amendment to create a “trigger” for a public option, and instead “offer it when the bill reaches the Senate floor.” [...]
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Karen, what have you wrought??? A civil discussion in which people on both sides appear to be well-informed, polite, nonest, and willing to listen to other points of view.
What a miracle, in this debate!
Good article, good thread, Ma'am.
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[...] was defeated by the Finance Committee. And some will have their first tests. Snowe, for instance, plans to offer an amendment on the Senate floor to put the public option on a "trigger," establishing it as a [...]
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