[So I wrote this while spending 12 hours sitting in the Boston airport without internet, only to discover that Nate Silver already basically said the same thing. But I’ve already written it – and there’s enough difference that it might still be worth posting]
The latest talk on health care is all about the trigger – an idea that seems to be at least marginally supported by both Ben Nelson and Olympia Snowe (and therefore may be tremendously important). The basic idea: hold out the possibility of a public option as a threat against the insurance companies. If X or Y benchmarks (most likely related to cost, but more ideally related to actual coverage) aren’t met within 3 or 5 years or whatever, the public option is instituted. It sort of works like a reverse safety valve in that respect. Instead of setting a price above which costs can’t run, it sets a floor on the required coverage and if ‘the market’ can find a way to make it happen then everything continues without a public option.
Given their desire to not get run out of business by a more efficient government bargaining option there’s a non-zero chance the companies will actually meet the targets. However, if can’t (or aren’t willing) to bring down costs and increase coverage, then we get the public option that we wanted all along.
As with all things, the devil is in the details, but this at least holds out the possibility of a compromise which avoids the ‘compromise means watering things down just to make it look like no one gets what they want’ attitude which senselessly cut out big chunks from the stimulus package. By which I mean: this is a compromise in the better sense. If the free-marketers are right (and bargaining in good faith about actually wanting to fix the health insurance crisis), then this gives them everything they want. It offers a BIG incentive for the companies to fix the problem but doesn’t force them to actually compete against a government option. If the market is functional – and the public option is a bad idea – then it will self-correct. The threat of the bad thing will inspire the good action.
Similarly, if the ‘market’ approach is in fact completely bankrupt (which…at least when it comes to health care it almost certainly is), then this will demonstrate it to an extent that no one who is even remotely interested in actually helping people can deny.
In an ideal speech situation, the trigger makes a ton of sense. There is a point of legitimate contention—and no definitive proof about which side is right—but the arguments of either side rely on the notion that if their option was given a fair chance it would win out. That’s what a trigger strives for. Give the market options and see how it plays out.
Now, we’re not in (anything that carries even a passing similarity to) an ideal speech situation. But I think the intuitive power of the compromise that the trigger entails offers some opportunities for reminding people that stupidity-of-town-halls-and-manufactured-controversies aside, this is something that a LOT of people care a LOT about.
One thing that’s probably a necessary caveat for discussing the trigger is that I think the public option is really important, but I don’t think it’s public option or the road. The more I read, the more convinced I am that expanding coverage and limiting the ability for insurance companies to utterly screw people over is by far the most important aspect of reform. What exactly we get in terms of the public option in the short term matters symbolically, and helps to pave the way for a possible expansion into a more reasonable overall structure (single payer is probably never going to happen, but something more organized at least).
If you disagree about this and think that the absolute core of health care reform is the public option, then the trigger will of course seem like selling out the heart and soul of the deal. I don’t feel confident enough about these issues to categorically dismiss that idea, but (and it’s a big ‘but’) the attitude that often seems to be on display from those who take the public-option-or-die approach reminds me of the heights (or depths) of Naderism back in 2000.
Obviously, all things being equal the public option is essential – and in a sane system of government where the institutions were designed to facilitate the implementation of promises that people were elected on, it would be worth throwing our toys out of the pram if our representatives gave up on it. But we don’t live in that system. We live in a world where there are all kinds of choke points on legislation. Even in a world without something as preposterous as the de facto acceptance of the filibuster, there’s the simple matter of the difficulties in writing legislation at all. There’s the problem of putting together whatever actually passes each house and then getting votes for the final version. There’s the problem of massively different motivations for reform, and different constituencies, and so on.
To summarize: I’d love to have a guaranteed public option with teeth in the short term. But that’s simply not going to happen. If I have to jettison the certainty of it, but in doing so am able to get a reasonable trigger and a more robust option if it came into force…I think that’s probably a trade worth making.