So I see where we are now lambasting Bill Nelson for taking the goofy position that a trigger for the public option is actually stronger than offering states the opportunity to opt-out. Well, of course he looks like a fool when he tries to make that argument. But not because an opt-out provision is actually stronger.
We’re just as foolish for believing either a trigger provision or an opt-out provision is anything but smoke and mirrors. Sorry Kossacks, but NEITHER the triggers NOR an opt-out will do what supporters are trying to convince everyone of. We’ve already tried both in big, supposedly cost-saving ways, and yet no one ever pulled the trigger or opted out.
To wit:
We have had two major experiments with triggers in Medicare. The first is the Sustainable Growth Rate formula in Medicare that is supposed to trigger physician reimbursement cuts when the growth in Medicare costs becomes unsustainable. It has been overridden by Congress every time it was supposed to cut the docs' pay for a decade.
The other was the 45-percent trigger, passed as part of the Medicare Modernization Act of 2003 (which created the Part D drug benefit). When the combined spending of Medicare and Medicaid topped 45 percent of general fund revenues in two consecutive years, it was mandated that the President and Congress (which, when the bill was written, was assumed would be Bush and the "permanent Republican majority") would submit a detailed legislative proposal to reform Medicare. Unfortunately for the architects of the MMA, the 45-percent trigger was reached in 2007, after the Democrats took control of Congress. Bush's 2008 budget paid nothing more than lip service to the "Medicare funding warning."
The nefariousness of it was Machiavellian: the Medicare prescription drug benefit, approved with no way to pay for it, only added to the growth of Medicare spending, and hastened the arrival at the 45-percent threshold. And with the anticipation of a compliant Republican Congress, you can only imagine that the GOP would have destroyed Medicare as we know it and fulfilled a fantasy they have had since Goldwater. As it was, the trigger never got pulled.
And as for state opt-out provisions, they are only useful if states choose to opt out. Medicaid is entirely an optional program, and at any time, any state could opt out and fund its own healthcare coverage for the poor, without federal matching money. In case you haven't noticed, all 50 states participate in Medicaid. What good is an opt-out, when you go 0-for-50 on opt-outs?
Sorry guys, but "triggers" and "opt-outs" are a lame attempt to offer political cover for sold-out Blue Dogs and DINOs, and fence-sitting Republicans, but I think even the dimmest bulb in Congress can see right through both schemes. If they are not trying to sell it to their constituents, then there is no point in us trying to sell it to them. They correctly see it as a choice between the useless and the pointless.