Why a 'Trigger' for the Public Option is Nonsense

GOP Sen. Snowe suggests we give private health insurers a shot at reforming themselves first. Yeah, right

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 "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 lightning 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 healthcare. 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 the 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 5,000 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 forever.

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 healthcare 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 healthcare reform. Hopefully, that's what he'll do Wednesday evening.

Otherwise, we get a trigger to nowhere.

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