I've suggested this before in comments. Now I'm going to suggest it in a diary.
Please, please, please flame this - because if Joe Lieberman thinks the left likes this idea, he'll vote against it mindlessly.
Anyway, maybe this can get us to 60 votes. We adopt a triggered public option, but couple that with a trigger on the mandate to buy insurance.
Details below the fold.
So, here goes: IF the Olympia Snowe approved public option trigger fires, THEN the mandate trigger also fires. Which is unlikely.
Otherwise:
IF the health insurance industry in a consolidated metropolitan statistical area (hereafter CMSA) can meet certain criteria, THEN the mandate trigger fires. These criteria include (true wonks should chime in with suggestions here):
- The mandate, once required, can still go away. The criteria are checked annually.
- The Herfindahl-Hirschman Index (HHI), defined here, is a measure of competitiveness. For the link-adverse, it is defined as the sum of the squares of the percentage market shares of the competing companies. A lower HHI represents more competition; an HHI of 10,000 represents a single-company monopoly. The upper limit on the HHI for the CMSA is 1,000. Ten companies each with 10% of the market would be 1,000. If one of them gains to 11%, while another therefore has 9%, you'd have 8*100 + 121 + 81 = 1,002 and the mandate goes away. Right now 96% of CSMA fail this test.
- At least 5 competing companies must have a ratio of payments to providers / premiums of 90%.
- At least 5 competing companies must offer an affordable plan, such that the total cost (expected out of pocket plus premiums) is less than 15% of the median household income in the CSMA.
Time limit
IF the mandate trigger does not go off for 5 consecutive years, THEN the public option is triggered for the CMSA. And the public option, once offered, never goes away.
And ...
Since part of the advantage to the public option is the power of a mass buy, and the public option may be coming in piecemeal - the public option that is offered has to use Medicare as its vehicle. When the public option is triggered for a CSMA, residents therein are allowed to buy into Medicare, with subsidies for poor folks.
Dons asbestos underwear
I welcome your vigorous hatred. For pity's sake, don't let Joe know you see any merit in this idea at all.