Patterico's Pontifications

9/3/2009

ObamaCare: Public option + trigger = exit strategy?

Filed under: General — Karl @ 9:56 am



[Posted by Karl]

There is a rumor (most likely floated by White House chief of staff Rahm Emanuel) that Pres. Obama is secretly negotiating with Sen. Olympia Snowe for a healthcare reform that would phase in a government-funded health insurer if private insurance companies fail to meet quality and cost benchmarks over a certain period of the time. Allahpundit scores this as an “Uh-oh,” but the devil is in the details.

Sen. Snowe has pushing the notion of a “public option with trigger” for months, and it has been the Left expressing dismay over the idea. True believers like Robert Reich say Snowe is fronting for Big Pharma and health insurers, with conditions that would be easily met by other pieces of the emerging legislation. Rahm Emanuel has been floating the trigger idea since January, again to the dismay of lefty groups like MoveOn. The left notes that congressional Republicans crafted a similar trigger for the Medicare prescription-drug benefit in 2003 — and it has never been triggered. For the left, the “public option” deferred is the “public option” denied.

However, it is a proposal that serves the administration’s interests. Pres. Obama reportedly would like not only to pass a takeover of health insurance based on an individual mandate, but also to get back some of the post-partisan image he had as a candidate. Some administration officials welcome a showdown with the left wing of the party to achieve these goals. The maneuver would also lure Blue Dog Democrats to the bill — and many Blue Dogs still expect to pass some healthcare reform bill.

This tactic carries its own measure of risks for the administration. The first risk is that the progressives continue to balk and refuse to vote for a final bill with a trigger. This seems unlikely, but most of them are from safe seats and plan to hold those seats long after the Obama presidency, so there could be some rebellion at the margin.

The second (and larger) risk is that a proposal designed to grab the center holds only a handful of votes. That is what happened in the dying days of HillaryCare in 1994. Those proposals never made it to any sort of vote.

The third risk is that whatever momentum is left for ObamaCare rests on the notion that politically, failure is not an option on healthcare reform. The theory that Democrats in swing districts are better off voting for an unpopular takeover of one-sixth of the economy has always seemed counter-intuitve. Now, Sean Trende has done a regression analysis of the 1994 midterm election showing that holding all other things equal, had Democrats gone ahead and passed HillaryCare, their losses likely would have been even greater than they were. Trende notes:

Right now, almost all of the 60 or so Democrats in Republican PVI districts have cast a controversial (in Republican districts) vote on Obama’s stimulus plan. Many of them have voted for cap-and-trade. Unless public opinion changes substantially, many of them will be pressured to cast an extremely controversial vote on the health bill. These Democrats don’t need this vote.

In short, the “public option with trigger” might appeal to Pres. Obama and Sen. Snowe, but there is no reason for Democrats of any stripe to adopt it as their own. That may be why similar healthcare compromises failed last time around.

–Karl

54 Responses to “ObamaCare: Public option + trigger = exit strategy?”

  1. failure is an option elsewhere … why not in the health care grab?

    quasimodo (4af144)

  2. If Democrats want to live in a Socialist state so badly, why don’t they move to Cuba, China, Russia or Zimbabwe??? Why imdw? why dogcrap? Why are you hardcore lefties here and not moved out?

    PCD (02f8c1)

  3. The interesting factor in this go – around is that Big Pharma and the AMA had both signed on to this plan pre – emptively. Still didn’t work.

    Dmac (a93b13)

  4. Dmac – They are no fools. They saw what happened to the banks and the automakers at the hands of these people.

    It concerns me that the “lobster-pot hoochies” are again working to craft a dirty little compromise which will enable the Left to get the camel’s nose under the tent.

    JD (14b6c9)

  5. If Democrats want to live in a Socialist state so badly, why don’t they move to Cuba, China, Russia or Zimbabwe??? Why imdw? why dogcrap? Why are you hardcore lefties here and not moved out?

    The problem with Socialism is you eventually run out of other people’s money …… ya think they got spare money in a socialist paradise like Cuba?

    HeavenSent (01a566)

  6. The pressure to pass something will make some strange bedfellows but the right needs to stop this so we can start over in 2011 with a new Congress.

    Mike K (2cf494)

  7. Dr. Lawrence Hunter On Health Care Reform – KILL BILL. Why We Should Not Get Too Excited About Obama Dropping The Public Option….

      Dr. Lawrence Hunter of the Social Security Institute has a ringside seat of what is really happening in the ObamaCare negotiations and it is not anything like any of us would expect.
    Serious pressure is building and the momentum is on our …

    The Substratum (af9967)

  8. […] Karl at Protein Wisdom thinks there could be a silver lining in this new tactic: Sen. Snowe has pushing the notion of a “public option with trigger” for months, and it has been the Left expressing dismay over the idea. True believers like Robert Reich say Snowe is fronting for Big Pharma and health insurers, with conditions that would be easily met by other pieces of the emerging legislation. Rahm Emanuel has been floating the trigger idea since January, again to the dismay of lefty groups like MoveOn. The left notes that congressional Republicans crafted a similar trigger for the Medicare prescription-drug benefit in 2003 — and it has never been triggered. For the left, the “public option” deferred is the “public option” denied. […]

    Flopping Aces » Blog Archive » The Obama Back-Peddle On Health Care? Not Believing It (e7cd22)

  9. Karl, I hope you are right. But the interests of Congressional Democrats might diverge from the president’s interests in this case. Obama might be willing, even eager, to have a GOP Congress in the next session in return for success at a once-in-a-century power grab. he might even think that’s a good way to set up for his reelection.

    MTF (17058c)

  10. failure is an option elsewhere … why not in the health care grab?

    It’s a core Democratic agenda item, and has been for decades. The party would be in shambles if it failed, with a (supposedly liberal) Democratic president, a +70 advantage in the house and a 19-seat advantage in the Senate.

    Jim “Waterloo” DeMint was right. That Trende guy can keep his regression analysis.

    So, in short, a bill will pass. The only question is, in what form? That’s what has me holding my breath.

    On that score: God, I wish Snowe would get lost. Can’t you people control her? :)

    I sometimes like her, but not this time. The only way to get a decent bill with a public option is to have no Republicans on the bill.

    Anyway, good post, Karl.

    Myron (6a93dd)

  11. 5, HeavenSent, that is not the question, but the result. These boobs ought to move to one of those bankrupt socialist backwater havens if they want that so bad.

    PCD (02f8c1)

  12. IT its not good enough for the goverment… its not good enough for ME??????

    tj (3548ca)

  13. A “decent bill with a pubic option” is an oxymoron, usn’t it?

    JD (9e41b2)

  14. A “decent bill with a pubic option” is an oxymoron oxyMyron, usn’t it?
    Comment by JD — 9/3/2009 @ 12:14 pm

    Fixed it. You’re welcome. 😉

    Stashiu3 (ed6467)

  15. And since he promised not to respond or read anything that misspells his name, it’s a freebie. I was considering addressing anything to him as “My-ron” just to test it, but this works better.

    Stashiu3 (ed6467)

  16. failure is an option militarily, financially, socially; why not in this case?

    quasimodo (4af144)

  17. JD said: A “decent bill with a pubic option” is an oxymoron, usn’t it?

    If we don’t control insurance costs, and get insurance companies to offer affordable insurance to the middle class and low-income earners, we’re wasting our time.

    Absent a public option, cost control would only come about through firm regulation of the insurance industry.

    As soon as new regulations were put in place, lobbyists would get to work undermining them through the congress critters they control, and the rules would fall or be relaxed, one-by-one, until we’re back to where we started, with 62 percent of people being driven into bankruptcy by medical bills.

    I don’t trust the same government that was supposed to regulate Wall Street to do an adequate job regulating Big Insurance. Madoff ripped people off in plain sight of the “regulators.”

    But anyway, I doubt I’m going to convince anyone here on the public option, any more than any of you will convince me it’s some kind of socialist takeover.

    Let’s just agree that we both want Olympia Snowe to stick with her damn party on this one, and vote “no.” What are her motives? I don’t understand.

    Myron (6a93dd)

  18. I love how getting one, or even 2 or 3 republicans makes something “bi partisan” for the media and the left.

    When Bush had many more democrats voting in favor things, it was never credited as bi-partisan – indeed, it was routinely called “partisan” by the media unless more than 30% of democrats were on board.

    I guess this will be just another example of left-wing hypocrasy and media bias.

    Monkeytoe (e66874)

  19. All: I wanted to clarify my statement on bankruptcies. It’s more accurate to say, of personal bankruptcies, 62 percent are linked to medical bills.

    Myron (6a93dd)

  20. That claim is still nonsense, Myron. Because “linked” still implies that medical bills are causing bankruptcies – and they simply are not the major cause of bankruptcies.

    SPQR (5811e9)

  21. I don’t suppose Olympia Snowe has the sand to tell the Obama Administration, “Oh, by the way, my support of the public option with a trigger mechanism is conditional upon your agreement to include real tort reform in the bill.” Like all squishy Republicans she will probably give away her bargaining chip without demanding anything in return.

    JVW (d1215a)

  22. Absent a public option, cost control would only come about through firm regulation of the insurance industry

    Man, these leftists are idiots. The insurance industry PAYS for health care. the costs come from the providers. Regulating insurers and creating a socialistic public option (designed only to take over health-care and give the gov’t more power) will do nothing to decrease the cost of health care.

    Making an insurer a) take on all comers regardless of their current health and b) have everyone pay the same rate regardless of risk – will do nothing but increase costs. Every single one of the left’s ideas will do nothing but increase costs and reduce access to care. It is absolutely incredible how you people either have no brains or are complete liars.

    And the idea that the “public option” would somehow reduce health care costs – absent price controls and rationing – is asinine. Nobody on the left has ever attempted to explain how simply putting the gov’t in charge of health insurance will allegedly reduce health care costs.

    I’m always amazed at how little a) economic understanding and b) common sense the left has.

    Monkeytoe (e66874)

  23. Monkeytoe: I love how getting one, or even 2 or 3 republicans makes something “bi partisan” for the media and the left.

    Don’t add the left in there. We don’t think it’s bipartisan to have a couple of Republican fig leafs. The media is obsessed with bipartisanship. I am not, and I think I speak for many on my side.

    Does anyone truly believe — outside of a few people in the media — that the stimulus was “bipartisan”? Of course it wasn’t. The Democrats passed it. (There again, however, was Olympia Snowe, whose presence, along with two others, trimmed about $100 billion out of that bill.)

    I think bipartisanship is worthy only if the other side has something to offer. And, no offense, but I’ve seen little useful the GOP can bring to this bill, if they’re talking about “death panels” and other such rot.

    What good ideas they do have (portability, for instance) is lost in all the other garbage.

    Myron (6a93dd)

  24. wanted to clarify my statement on bankruptcies. It’s more accurate to say, of personal bankruptcies, 62 percent are linked to medical bills.

    B.S. The statistic is b.s. But, even were it true, but what does “linked to” medical bills mean?

    10% of personal bankruptices are b/c of serious catastrophes that people could not plan for. The other 90% of personal bankruptcies are people not being able to handle their money (buying things they could not afford).

    Monkeytoe (e66874)

  25. JVW said: Like all squishy Republicans she will probably give away her bargaining chip without demanding anything in return.

    I don’t agree. If she strips the public option — which she very well could do — that would be considered something by your side, I assume.

    That’s why I don’t want her anywhere near this.

    Myron (6a93dd)

  26. Don’t add the left in there. We don’t think it’s bipartisan to have a couple of Republican fig leafs. The media is obsessed with bipartisanship. I am not, and I think I speak for many on my side

    Yet another lie from Myron. Go to any lefty website and they will claim such things as the economy destroying porkulus was “bi-partisan.”

    They’ll say the same thing w/ Olympia Snowe’s vote to destroy american health care and replace it with rationing and poor quality care at a higher price.

    Monkeytoe (e66874)

  27. But anyway, I doubt I’m going to convince anyone here on the public option, any more than any of you will convince me it’s some kind of socialist takeover.

    The reason why none of the opponents of the public care options are convinced it’s not a raging socialist experiment is directly confirmed by the experiences of Canada and England, both countries whose plans the Obama – Philes continually cite as models of excellence and success. Both are financial and medical care disasters – the dirty shame of this is that real reforms could be made right now, and they wouldn’t bankrupt the country or kill people before their time. That is, you start by making insurance policies transportable, both across state lines and/or jobs. Then you restrict insurance companies from eliminating coverage for those with pre – existing conditions. The majority of the populace knows exactly what’s wrong with the healthcare system in this country, but the Dems refuse to listen to their concerns, nor their solutions. It’s either the whole pig in their my – way – or – the – highway, or nothing. Fools.

    Dmac (a93b13)

  28. Monkeytoe: I can’t imagine why you would think for a minute I would believe your personal (unresearched) opinions on bankruptcies over statistics that have been cited by numerous sources.

    But, well, OK.

    Myron (6a93dd)

  29. BTW – Mike K and Daley Rocks can explain why these concepts are much more feasible to be enacted than a common layperson such as I. If you go to Mike’s site you can view a detailed explanation for real reform that benefits everyone, and not just the Dem political goals.

    Dmac (a93b13)

  30. Myron,

    I don’t care what you believe. Your mind is obviously full of nonsense and “true facts” that your leftist friends tell you.

    I know in your mind nobody is responsible for themselves and we need gov’t to take care of us and the public option will someone make sunshine and unicorns, but that is b/c, as you have amply demonstrated, you are not too bright.

    Monkeytoe (e66874)

  31. That is, you start by making insurance policies transportable, both across state lines and/or jobs. Then you restrict insurance companies from eliminating coverage for those with pre – existing conditions.

    Dmac: Yes, these are two things that I think there is near-universal agreement on. Unfortunately, the GOP is not at the table to make the case for portability, and I don’t hear many Dems talking about it. The pre-existing condition situation will be addressed, if nothing else is.

    If there is no public option and no serious insurance reform, Big Insurance will be glad to cover the “bad bets” of people with pre-existing conditions in exchange for all the new (healthy) people forced to buy their insurance.

    I think the public option and the individual mandate should be linked.

    Myron (6a93dd)

  32. Really, what is the point of this post? Sounds like someone is scared. :)

    The Emperor (1b037c)

  33. Yes, Monkeytoe, you have me pegged. How astute of you, as usual. Except I think unicorns are just a touch creepy, for some reason. Sign me up for sunshine and bunny rabbits.

    Myron (6a93dd)

  34. Sounds like someone is scared.

    Uh, yeah, I’m “scared” Olympia Snowe will cause the end of the public option, as I said plainly, several times. Glad you could ferret that out, detective.

    Myron (6a93dd)

  35. Myron:

    The big problem that you have been avoiding is this: The larger the public option, the more this thing will cost. You are probably smart enough to know that whatever the legislature is telling us this thing will cost, they’ll be wrong, just as they were wrong about projecting costs of Medicare, Medicaid and Prescriptions. The CBO has already weighed in and said that the current bill will add significantly more to the deficit than our congess critters will admit and that those resulting deficits are “unsustainable.”

    We need an entirely new direction in this “quest” because what we have on the table is completely unaffordable.

    Please see Massachusetts. Come to me with some kind of reform in whatever form that doesn’t force people to sign up, can be resonably funded within our means and has real, honest to goodness tort reform (a la Texas) and we’ll talk. Until then beating the public option is a non-starter because, again, we can’t afford it.

    BJTexs (a2cb5a)

  36. Not you, Myron. I think you are doing a good job here.

    The Emperor (1b037c)

  37. How will you reduce costs, Myron?

    JD (f4934f)

  38. I sit in 341 hearings week after week. There debtors explain why they are in bankruptcy. Its hardly a random sampling of the nation’s bankruptcies but it becomes clear that medical bills are not causing more than half of all bankruptcies. The claims are best debunked by the study itself with its ridiculous definitions.

    SPQR (5811e9)

  39. The Healthcare Bankruptcy Myth has been debunked many places, including at the link.

    Karl (57ffa9)

  40. Myron will tell you, JD, that you reduce costs by taking away the eeeeevil Insurance company profits and let the government distribute them more effectively and compassionately.

    Neither Myron nor any body else that has been pushing this spectacular pile of monkey crap (sorry monkeytoe) willingly admits to this one fact: Really, really good health care is not cost effective. It is not subject to the usual processes of economies of scale like other “commodities” (yes, I said commodities!)

    Excellent health care costs money. Big assed MRI’s and Nuclear Echograms and Cat Scans and micro robotic surgical arrays cost damn money! The bigger and better they get, the more they cost. That’s not even factoring in the large up front educational costs, continuous educational costs, specialized training and oh, the pills that cost $.05 to manufacture except for the first one which cost $1.2 billion.

    GREAT HEALTH CARE IS EXPENSIVE.

    The very fact that we are having a cost cutting party about health care and not talking about tort reform is enough to put a lie to our current administration’s goal to “cut costs.” I couldn’t find the link but a large accounting firm did an audit of malpractice insurance and judgments over the past 5(?) years and determined that capping punitive damages in malpractice awards at $500,000 would save $80 – $120 Billion a year, direct and indirect costs to providers.

    The other thing is that while liberals are bleating about the use of the phrase “death panels” (thank you, Sarah) they miss or avoid one of the other great truths about health care reform: Most of the “excess” costs in the system rest with the elderly! If you are going to have a real impact on health costs you’ll have to fundamentally change the way the elderly are treated to achieve a significant dollar amount. Well, the elderly vote in droves and they are just catching on to this carved in stone truth. How’s that working out?

    Finally, with or without “elderly care reform” the only other way to significantly control costs is to change the availability of more expensive procedures. That’s what we’ve seen in England and Canada that has a lot of people up in arms. Almost inevitably when I read someone from either of those two countries extolling their system they are both young and healthy! Wait times for not very advanced procedures in both countries varies from inconvenient to downright actionable, were it to happen in this country.

    There’s that pesky tort reform again.

    We haven’t even touched upon the recent demolition that Krauthammer (a man who has a medical degree and worked in the field) did on the fallacious argument of cost savings through Preventative Medicine. Suffice to say that literally hundreds of studies and The New England Journal of Medicine have shown definitively that preventative medicine actually increases costs on many conditions.

    So not only can we not afford it (a deal breaker right there) the most trumpeted reasons given for the magical cost cutting abilities either fail to address the very nature of health care or are grossly misrepresented to further a “moral imperative” where “a right and not a privilege” trump all other common sense, nuts and bolts considerations of HOW WE ARE TO PAY FOR THE DAMN THING!!

    BJTexs (a2cb5a)

  41. Glad you could ferret that out, detective.

    It’s so sad when lefties turn on their own.

    If she strips the public option — which she very well could do — that would be considered something by your side, I assume.

    Myron, if she completely strips it out then yes, that would be a positive development. Many of us fear, however, that she will fall prey to some bogus argument about adding a “trigger” mechanism, which just means that Obama and his allies will have to wait a year or two before deciding that the mechanism has been triggered.

    JVW (d1215a)

  42. BJ – Note how they quit bleating when asked about costs, the unsustainable deficits for as far as the eye can see, according to the CBO.

    JD (6ed147)

  43. Another question they never seem to want to answer is if this is such a crisis, why are they being such sniveling cowards and not implementing this until 2013? This is the exact same thing they did with cap&crush.

    JD (6ed147)

  44. why are they being such sniveling cowards and not implementing this until 2013

    I don’t know. Is there anything going on in 2012 that might come into play?

    JVW (d1215a)

  45. I like the proposal, because it functions as a test to see whether or not people really believe what they claim to.

    If you believe that the medical-industrial complex is incapable of meeting quality and cost benchmarks, and you think that a public option is a good thing, there is no reason to vote against such a proposal.

    aphrael (e0cdc9)

  46. If you believe that the medical-industrial complex is incapable of meeting quality and cost benchmarks, and you think that a public option is a good thing, there is no reason to vote against such a proposal.

    The problem is, aphrael, that unlike a tax cut there is no going back once this is implemented. Even if the public option turns out to be an expensive and disorganized disaster, do you really think it will be repealed once a certain percentage of our fellow citizens are enrolled in it? What would you think of a set of benchmarks that the public option must meet over the next decade, with a provision that the program will be either significantly downgraded or dismantled if they are not met? I am just afraid that the public option has the potential of becoming a financial sinkhole when Congress realizes they can’t possibly trim back the extravagant promises they have made.

    JVW (d1215a)

  47. JVW: I can see reasons why people who are opposed to a public option would oppose a public option with a trigger.

    I don’t see any reason why people who support a public option, and who think that the goals of a public option can’t possibly be met without a public option, would oppose a public option with a trigger.

    aphrael (e0cdc9)

  48. Moron,

    “Individual mandate”

    What part of the constitution provides the federal gov’t with the power to require people to purchase something?

    Again, as to requiring INSURANCE to pay for care for people with pre-existing conditions, please explain your understanding of the definition of “insurance”.

    Should auto insurnce companies be required to provide insurance to people who just had an accident and required to pay for the damage?

    Who is that different than requiring an INSURANCE company to pay the health care for someone who has a significant medical condition already before they purchase the insurance?

    I keep wondering what these people believe the purpose of insurance is?

    Monkeytoe (1baef9)

  49. I don’t see any reason why people who support a public option, and who think that the goals of a public option can’t possibly be met without a public option, would oppose a public option with a trigger.

    A sensible point. What do we make of Sen. Snowe who is apparently against the public option unless it has a trigger mechanism? Is she just putting too much faith in the government actuaries to settle all of this, or is she trying to have it both ways?

    JVW (d1215a)

  50. Why do I have to buy auto insurance if I don’t own a car?

    daleyrocks (718861)

  51. […] will lay down his backdoor plan and they will go along with it. No question about it. But Karl at Protein Wisdom thinks there could be a silver lining in this new tactic: Sen. Snowe has pushing the notion of a […]

    The Baltimore Reporter (5ef58e)

  52. […] that the failure of ObamaCare would be disastrous for the party in the 2010 midetrm elections. The math does not support their argument. Putting that inconvenient truth aside, if only 16% of adults will “blame” Democrats […]

    The Greenroom » Forum Archive » Lessons from the NBC/WSJ poll: The blame frame (e2f069)

  53. […] room makes it more likely that the merged bill will drop the “public option” — or neuter it with a “trigger.” This will alienate roughly 30 Senate Democrats, the House Progressive Caucus (which claims a bill […]

    The Greenroom » Forum Archive » ObamaCare: The Back Room (e2f069)

  54. […] in the back room makes it more likely that the merged bill will drop the “public option” — or neuter it with a “trigger.” This will alienate roughly 30 Senate Democrats, the House Progressive Caucus (which claims a bill […]

    Patterico’s Pontifications » ObamaCare: The Back Room (e4ab32)


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