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Unlike some people I really am somebody who will tell you - I Told YOU So.

In this case I argued two months ago that the Senate would ultimate choose a course that involved a Triggered Public Option - a prediction that upset and even angered quite a few or my fellow Kossacks.

Some in very stark terms.

Why would you want a trigger?

How many more people do you want to die between now and then? How many more foreclosures? How many more bankruptcies? How much more un-necessary pain?

Well because something the threat of something can be more effect than the reality just a new report that shows the threat of a triggered option might cuts costs even more than the actual public option would.

The question comes down to whether or not private business have the capacity to bring down costs to a reasonable level or not.  Those that have lost all faith in private industry (and that includes a lot of us) feel that they are a complete lost cause, that they never bring down costs and voluntarily impact their own bottom-line and stock value unless they're Forced to do so.

I have argued that we don't have to have faith that they can, history has shown that they can because they did it before - during the original Clinton Health Care debate.

This chart shows the relative rates of inflation for medical costs contrasted with the cost of living and wages.  The huge DIP in the middle of the chart is unmistakeable, and it's also unmistakable that it reached it's peak right in the middle of the most heated portion of the 1993-1994 Hillary.

(The Rate of Cost Increases) DID come down.

And it happened Without a public option, actually without ANY option since what we're so vigorously arguing about now wasn't even proposed back then.

But equally important is the fact not long after Hillarycare crashed and burned - costs began to rise again even far beyond previous levels.

(Top UN Ranked Countries by Human Development Index with Per Capital Health Care Expenses 2004)

1 Iceland 3,294  
2 Norway $4,080  
3 Australia $3,123  
4 Canada $3,173  
5 Ireland $2,618  
6 Sweden $2,828  
7 Switzerland $4,011  
8 Japan $2,293  
9 Netherlands $3,092  
10 France $3,040  
11 Finland $2,203  
12 United States $6,096  

LOOK AT THAT, on a per capita basis we spend literally twice as much as France - and according to the World Health Organization France has the best quality health care in the world - while we are number 37.  THIRTY SEVEN!

The report states:

In the absence of enough political support to pass a strong public option at this time, a "trigger" for a strong public option should be considered for inclusion in health reform legislation whether or not a weak public option is included as a political compromise. Even the threat of such a plan being triggered offers the potential to affect market dynamics between insurers and providers.

Thinkprogress goes on to elaborate on this...

The report says that the Senate and House’s public option provisions (which require the public plan to independently negotiate rates with providers) hold little hope of lowering costs in areas of the country with high provider concentration. In areas where hospitals have "too strong a market presence to be excluded from insurer networks," hospitals could dictate prices, stripping the public plan of its ability to negotiate cheaper rates, the report warns. According to a 2006 study, 86% "of large metropolitan areas were considered to have highly concentrated hospital markets."

Policymakers can overcome the political challenges of enacting a strong public option — one which compels Medicare providers to participate and establishes Medicare-like reimbursement rates — by placing the plan behind a trigger mechanism which "would allow private insurers the opportunity to show that they can provide affordable coverage under the new health reform rules."

The latest CBO analysis of the Senate's version of the PO with the Opt-Out provision indicates that it would actually cost more than most private health plans do now...

As TPM reported:

And just as in the House bill, the public option would cover more medical services, and attract a sicker risk pool, leading it to charge slightly more on average for premiums than private insurers. "CBO's assessment is that a public plan paying negotiated rates would attract a broad network of providers but would typically have premiums that were somewhat higher than the average premiums for the private plans in the exchanges."

Under the current Senate the Public Option would become like a high-risk insurance pool and consquently have high demands on it resulting in higher costs.  The one argument in favor of it with that realization on the table is the fact that would could reasonably expect the inflation rate on the public option to remain relatively stable, while the inflation rate on private insurance could very well continue right through roof particularly in those states and markets which do implement the Opt-out option.

If our goals is to have better quality care, better accessibility to care and lower cost for that care - why exactly can't we take "YES" for an answer, particularly when in the end this might wind up being the only way past the 60-vote Senate threshold (appealing to a "Yes" vote from Snowe in exchange for all but guaranteed "No" from Lieberman)?

The debate begins this Monday and If this is how the Senate End-game ultimately plays out - we just might walk away "crying" but only in up our sleeve when all is said and done.


Originally posted to Vyan on Sat Nov 28, 2009 at 12:55 PM PST.

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Comment Preferences

  •  Tip Jar (11+ / 0-)

    Commmunism = Government Run Corporations. Fascism = Corporate Run Government. Freedom = Government Protecting People from Corporate Criminals

    by Frank Vyan Walton on Sat Nov 28, 2009 at 12:55:40 PM PST

  •  I'm not trigger fan...HOWEVER (6+ / 0-)
    Recommended by:
    dkistner, Catte Nappe, ETF, Amayi, cyeko, ridemybike

    If they tie it to a public option that is absurdly strong, I think it would be more beneficial than some mealy mouthed public option that turns out to be little more than a pool of sick people that needs to be bailed out by the government every year because it can't self-sustain.


    by Mark Warner is God on Sat Nov 28, 2009 at 01:11:25 PM PST

  •  Small nitpick (1+ / 0-)
    Recommended by:

    The huge DIP in the middle of the chart is unmistakeable, and it's also unmistakable that it reached it's peak right in the middle of the most heated portion of the 1993-1994 Hillary.

    Costs DID come down.

    Costs didn't come down, they just went up more slowly, and for 2 years, increased at a lower rate than inflation.

    Of course, for a trigger to mean anything, it would have to be aggressive enough to actually trigger. The Snowe-job proposals are designed to never trigger.

    It is curious to see the periodical disuse and perishing of means and machinery, which were introduced with loud laudation a few years or centuries before. -RWE

    by Gravedugger on Sat Nov 28, 2009 at 01:13:04 PM PST

  •  What I'd like to see with a trigger... (0+ / 0-)

    In order to bring down costs now, there needs to be a trigger benchmark sent now, even if the PO wouldn't happen until 2013.  Under the call for a Public Option it wouldn't happen until 2013 and the thought is the insurance cos would price gouge until then, premiums would sky rocket and people would be pissed off and voters would think the health care reform was a failure.  

    If it's a trigger with 2010 benchmarks to lower premium costs and if they're missed the PO would become triggered and the trigger was iron clad, I think a trigger might be the better option as well.  

    Folks here say the trigger will never be pulled because it has never been pulled before.  But I question if they were ever meant to be pulled and I wonder if the fact 55 Democratic senators want a public option now if they could write an ironclad trigger with progressive benchmarks and have the trigger automatic if any of the benchmarks are not met.  

    When is the last time the Obama Administration has pleasantly surprised you - Made you think to yourself "Wow, I didn't think they had that in them"?

    by Jonze on Sat Nov 28, 2009 at 01:13:55 PM PST

  •  Triggers do not work... (4+ / 0-)
    Recommended by:
    Catte Nappe, Wary, shaharazade, GeeBee

    because they are designed not to work.  If lawmakers had the political will to ever actually pull the trigger then they would likely have had the  political will to bypass the trigger altogether in the first place.

    •  Yes as Olympia Snowe has admitted (2+ / 0-)
      Recommended by:
      billybush, GeeBee

      It's a carefully designed 'trick' to make people think something important is being done, but it's not.

      OK, she didn't say it in those words she said she put a 'trigger' in the Medicare Part D fiasco and they 'never had to use it" of course, it sounded 'good' back then.

      As Pear explains, "the public plan would be created only if private insurance companies had not made meaningful, affordable coverage available to all Americans within several years."  All of these terms – "meaningful," "affordable" and "several years" – are as vague as can be. The trigger may be set up so, in effect, it never happens, similar to the Medicare Part D trigger that would have created a public prescription drug plan – but never did.  The threshold would be low enough that it could be easily, and superficially, met.

      Yes, the addition of a 'trigger' I think is a way of saying--"Hey look we're NOT going to have a public option, but we'll attempt to make people THINK we will."

      Sorry if I'm not buying it, I'm just not into it. But then I am eligible for Medicare in just 3 and a half years--so I've got that on my mind as well an how Sonwe FAKED out the seniors back then with that 'trigger' that was designed to never work..

      This union may never be perfect, but generation after generation has shown that it can always be perfected. Barack Obama

      by Wary on Sat Nov 28, 2009 at 03:29:04 PM PST

      [ Parent ]

  •  85% in France are (2+ / 0-)
    Recommended by:
    Catte Nappe, Wary

    covered by NON PROFIT insurance that is mandated it costs 5% of your income not 15%-20% as our faux PO was supposed to cost. Most of their hospitals are non profit and they focus on doctors who are GP's, primary care remember them? As for the insurance/extortion industry take a look at how self regulation is doing with the non regulated 'financial industry'. I won't cry, but I will not be insured because if it comes down to a roof over my head, healthy food and seeing a doctor for my day to day needs and lousy exorbitant insurance, I will not buy it why should I? I will also not vote for any one who hoists this extortion on a populace that is really suffering from the for the profit of the too bigs.  

    Triggers are where legislation goes to die. This is an ugly bill and crying is not the solution. The uninsured cannot afford insurance this is why they don't have it. This bill is nothing but a way to give the insurance companies forced clients who are at their mercy with no price caps and no option but to pay the vig to these extortionists. The power of no should be used. No to this pig of a bill.

    Here's the French System....

    France, like other countries in Europe, has a system of universal health care largely financed by government through a system of national health insurance. In its 2000 assessment of world health care systems, the World Health Organization found that France provided the "best overall health care" in the world.[1] In 2005, France spent 11.2% of GDP on health care, or US$3,926 per capita, a figure much higher than the average spent by countries in Europe and less than in the US. Approximately 77% of health expenditures are covered by government.[2]

    Most general physicians are in private practice but draw their income from the publicly funded insurance funds. These funds, unlike their German counterparts, have never gained management responsibility. Instead the government has taken responsibility for the financial and operational management of health insurance (by setting premium levels related to income and determining the prices of goods and services refunded).[1] It generally refunds patients 70% of most health care costs, and 100% in case of costly or long-term ailments. Supplemental coverage may be bought from private insurers, most of them nonprofit, mutual insurers. Until recently, social security coverage was restricted to those who contributed to social security (generally, workers or retirees), excluding some poor segments of the population; the government of Lionel Jospin put into place "universal health coverage" and extended the coverage to all those legally resident in France. Only about 3.7% of hospital treatment costs are reimbursed through private insurance, but a much higher share of the cost of spectacles and prostheses (21.9%), drugs (18.6%) and dental care (35.9%) (Figures from the year 2000). There are public hospitals, non-profit independent hospitals (which are linked to the public system), as well as private for-profit hospitals.

    Health insurance

    Because the model of finance in the French health care system is based on a social insurance model, contributions to the scheme are based on income. Prior to reform of the system in 1998, contributions were 12.8% of gross earnings levied on the employer and 6.8% levied directly on the employee. The 1998 reforms extended the system so that the more wealthy with capital income (and not just those with income from employment) also had to contribute, since when the 6.8% figure has dropped to 0.75% of earned income. In its place a wider levy based on total income has been introduced, gambling taxes are now redirected towards health care and recipients of social benefits also must contribute.[6] Because the insurance is compulsory, the system can effectively be thought to be financed by taxation rather than traditional insurance (as typified by auto or home insurance, where risk levels determine premiums).

    The founders of the French social security system were largely inspired by the Beveridge report in the United Kingdom, and aimed to create a single system guaranteeing uniform rights for all. However, there was much opposition from certain socio-professional groups who already benefited from the previous insurance coverage that had more favourable terms. These people were allowed to keep their own systems. Today, 95% of the population are covered by 3 main schemes. One for commerce and industry workers and their families, another for agricultural workers and lastly the national insurance fund for self-employed non-agricultural workers.[6]

    All working people are required to pay a portion of their income to a health insurance fund, which mutualised the risk of illness, and which reimbursed medical expenses at varying rates. Children and spouses of insured people were eligible for benefits, as well. Each fund was free to manage its own budget and reimburse medical expenses at the rate it saw fit.

    The government has two responsibilities in this system.

       * The first government responsibility is the fixing of the rate at which medical expenses should be negotiated, and it does this in two ways: The Ministry of Health directly negotiates prices of medicine with the manufacturers, based on the average price of sale observed in neighboring countries. A board of doctors and experts decides if the medicine provides a valuable enough medical benefit to be reimbursed (note that most medicine is reimbursed, including homeopathy). In parallel, the government fixes the reimbursement rate for medical services : this means that a doctor is free to charge the fee that he wishes for a consultation or an examination, but the social security system will only reimburse it at a pre-set rate. These tariffs are set annually through negotiation with doctors' representative organisations.
       * The second government responsibility is oversight of the health-insurance funds, to ensure that they are correctly managing the sums they receive, and to ensure oversight of the public hospital network.


  •  I want the public option (0+ / 0-)

    I would only support the trigger it becomes clear that there is NO OTHER WAY of passing the bill whatsoever. The reality is that if nothing passes the political costs will be much more catastrophic.

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