Reports are now coming out that Ben Nelson, Rahm Emmanuel and, of course, Olympia Snowe, are all favorably inclined to the "trigger" option. And watching the news shows this weekend, I learned that the group headed by Bob Dole and Tom Daachle has endorsed the trigger as well.
Increasingly, my sense is that the trigger approach is gaining momentum, perhaps enough even to garner 60 votes in the Senate.
With all of this in mind, I believe we should be making an effort to put teeth into a trigger, rather than just trying to defeat the trigger altogether.
Moreover, I believe that there is a real chance that the trigger can be effective.
First, let me note that most of the opposition I hear to the trigger is not really against the theory of the trigger, but upon skepticism that it could work in practice: understandably, many assume that Congress will screw up the details and create loopholes so that a trigger never occurs.
But some pretty-well respected people are not so sure.
Consider this exchange between a reader and Ezra Klein:
New York: Hey Ezra, I've been trying to wrap my head around the public option "trigger" that might be required to get Olympia Snowe on board. It seems to me that in evaluating this proposal, the devil really is in the details of what the trigger event would be. If the trigger event is that the insurance companies have to reach a level of cost savings seven years from now that is extremely unlikely to occur, then isn't the trigger really just a public option that phases in seven years from now? That sounds like something that the Progressive Block should be able to live with. Do you think there are opportunities for a deal around the trigger idea?
Ezra Klein: I basically agree with that. Also, you'd want the trigger to create a national public option, not just an Iowa public option. So the devil is in the details, though I'd suggest that the fact that this is being used by people who don't really support the public option implies that the details won't be that great.
In other words, Klein is not against the trigger in theory, but just concerned about the details.
And today, Nate Silver has weighed in about a "trigger with teeth."
Nate suggests that there should be a "trigger" that is acceptable to progressives. He states that such an acceptable trigger would have several requirements:
The most obvious is that a trigger couldn't be overly tolerant of further growth in health insurance premiums. For instance, suppose that the trigger were triggered if the average cost of health care for a represenative cohort of adults rose by more than inflation + 0.5 percent over the next five years. Health insurance premiums, according to an estimate by the Commonwealth Fund, are expected to increase at an annual rate of about 5.5 percent over the next dozen years, whereas inflation typically runs at between 2 and 3 percent. If premiums were to grow at 3 percent per year instead, that would save the typcial family about $5,000 per year by 2020.
(emphasis mine)
In addition, Nate continues
the insurance companies would need to have real reason to fear the trigger. And that means having a public option that, if it were triggered, would be able to negotiate at Medicare rates, or perhaps Medicare rates plus a small premium of 5 to 10 percent. This is how the public option was originally envisioned -- but the provision appears to have been stripped from the version of the House bill passed by the Energy and Commerce Committee, which arguably represents about the maximal bill that a sufficient number of Blue Dogs would be willing to accept.
(emphasis mine)
Nate also questions whether we should really fear that the trigger could be compromised or canceled by a future, more conservative Congress:
For one thing, once the trigger became law, it would probably have to overcome a Democratic filibuster to be overturned. Even under somewhat worst-case scenarios for the Democrats, they are unlikely to be in a situation in the near future where they wouldn't be able to muster up 40 votes in the Senate. For another, so long as a Democratic president remained in office, even 60 votes might not be enough -- such a proposal would probably require 67, in order to overcome a Presidential veto. And for a third, the Republicans would be on the wrong side of the politics. Americans might be a little bit daft when it comes to the impact of various proposals to reform the health insurance system, but a bill which sought to overturn a de facto cap on the growth of health insurance premiums -- which is what a well-structured trigger plan would be -- would not be very popular.
Now, let me be clear: I too would prefer a public option from day one; indeed, I favor the single payer system altogether. But I think that the momentum for the trigger is real, and that it behooves all of us to work for a "trigger with teeth," rather than put all the eggs into the basket of a "public option now."
Otherwise, we may be faced with a trigger that really has no chance of being effective.