I've noticed a lot of fervor on this and other blogs about vociferous opposition to a public option which only goes into effect after a "trigger." I have to say that unlike co-ops and the other ill thought out half measures, I don't have a problem with it - in theory. In practice, however, it could be ruinous.
As has been noted on several blogs, while all other industrialized countries have universal health care, not all of them have single-payer or socialized medicine. Some, like Switzerland, Germany, and the Netherlands, essentially retain a private health care system. However, the private health insurers operate under severe price controls. The choice for controlling health care costs thus is either to heavily regulate private insurance (essentially ensuring profit cannot be made off of denying claims), or the government becoming the health insurer themselves, either prohibiting private insurance (ala Canada) or through market presence forcing private plans to stay cheap to remain competitive.
A trigger on a public option is an effective price control. What we know about Snowe's plan so far is that premiums, on a state by state basis, must fall by a certain percentage, and there needs to be 95% coverage by a certain time.
While we know little in terms of further details, I would be fine in principle with such a trigger if the following were true.
- Significant cut in premiums is required within the time window (20%-50%)
- Trigger was perpetual even after initial targets had been met. This is more important the smaller the initial required cuts are. For example, if there was an ongoing requirement that premiums increase no more than 1% higher than the rate of inflation, U.S. health care prices would be increasing at a slower rate than most of the industrialized world, meaning we'd draw even on prices within a few decades.
- Trigger goes into effect after a very short period. Say three to five years. Remember guys, HR 3200, the most progressive of the bills on the table, doesn't have the public option go into effect until 2013 anyway. So a short-term trigger doesn't delay the introduction of a public option at all. It just holds a gun to the heads of the insurers, giving them one last chance to get their house in order. Indeed, under the house plan, there is no incentive for insurers to lower their prices until a public option goes into effect. A trigger could actually bridge the gap better.
That said, there are huge ways they could fuck this up. The bill could require only a modest 5%-10% cut in premium costs, with no price controls thereafter. These cost savings could probably be achieved through administrative standards, best practices, and other reforms which will be in the bill regardless (meaning no pain to insurers). And, of course, if Republicans get back in charge, they will kill the bill before it goes into effect unless the Dems filibuster it - but the way the House bill is constructed that's a fear anyway.
In the end, the question becomes if Olympia Snowe - unlike all the other remaining Republicans, can be counted on to bargain in any good faith on this whatsoever. I'll be watching closely to see what the details are of this new potential compromise - but I see nothing so far to make me think it's worse than the silly "long fuse" model the house already picked.